tag:blogger.com,1999:blog-83211459580762259782024-03-19T02:44:29.524-07:00ANNy Blog......kunci sukses >>>> rajin belajar.....salnihttp://www.blogger.com/profile/00126668517852477742noreply@blogger.comBlogger42125tag:blogger.com,1999:blog-8321145958076225978.post-27343794631911734422012-10-16T09:15:00.000-07:002012-10-16T09:15:25.647-07:00Cara Mempersiapkan Penanggulangan SARS - ANNEX 3<div dir="ltr" style="text-align: left;" trbidi="on">
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<b><span style="font-size: 14.0pt; mso-bidi-font-size: 12.0pt;">PEMROSESAN ALAT, SARUNG TANGAN DAN PERLENGKAPAN<o:p></o:p></span></b></div>
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Risiko terbesar untuk terinfeksi adalah bagi petugas yang:</div>
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<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">v<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]-->Melakukan
atau membantu prosedur </div>
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<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">v<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]-->Memproses
alat dan perlengkapan</div>
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<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">v<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]-->Menangani
urusan kebersihan dan pembuangan sampah</div>
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Dekontaminasi dan mencuci merupakan dua langah pencegahan
infeksi yang sangat efektif untuk mengurangi risiko terkena infeksi bagi
petugas kesehatan, termasuk petugas kebersihan dan rumah tangga bila mereka
menangani alat medis, sarung tangan dan lain-lain. Sterilisasi atau DTT
(desinfeksi tingkat tinggi) dilakukan setelah deontaminasi dan pencucian
selesai dilakukan.</div>
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Dekontaminasi merupakan langkah pertama yang harus dilakukan
untuk memproses alat dan sarung tangan yang kotor, dimana alat-alat yang telah
kontak dengan darah atau cairan tubuh direndam dulu dalam larutan klorin 0.5 %
selama 10menit. Tindakan ini akan mematikan berbagai virus sehingga aman untuk
ditangani oleh petugas yang mencuci. </div>
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<h1>
CARA MEMBUAT LARUTAN KLORIN 0.5 %</h1>
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<!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">v<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]-->Cek konsentrasi produk klorin yang akan dipakai</div>
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</span></span><!--[endif]-->Tentukan jumlah air yang dibutuhkan menurut
tabel dibawah :</div>
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<i>% larutan pekat<o:p></o:p></i></div>
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<i>Jumlah bagian air dibutuhkan
</i>=
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- 1</div>
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<i>% larutan dekontaminasi<o:p></o:p></i></div>
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Campurkan 1 bagian larutan
pekat dengan jumlah bagian air sesuai formula</div>
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Contoh: Membuat larutan
dekontaminasi 0.5% dari larutan pekat 5%</div>
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5 <i>% <o:p></o:p></i></div>
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LANGKAH
1: <i>Jumlah bagian air dibutuhkan </i>= ------ - 1 = 10 – 1 = 9 bagian</div>
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<i> 0.5 % <o:p></o:p></i></div>
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LANGKAH 2: Campur 1 bagian larutan pekat dengan 9
bagian air</div>
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Note: cairan pemutih yang beredar (Bayclean, Sunclean dll)
pada umumnya mempunyai kadar klorin 5.25%. Untuk kepastian harap di cek
kembali. </div>
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salnihttp://www.blogger.com/profile/00126668517852477742noreply@blogger.com1tag:blogger.com,1999:blog-8321145958076225978.post-13957161525581790762012-03-17T01:15:00.000-07:002012-03-17T01:15:46.123-07:00PILAR PENGELOLAAN DM<br />
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<span style="font-family: 'Comic Sans MS';"><b><br /></b></span><span style="font-family: 'Comic Sans MS'; font-size: small;">
A. Edukasi</span><br /><span style="font-family: 'Comic Sans MS'; font-size: small;">
B. Perencanaan Makan </span><br /><span style="font-family: 'Comic Sans MS'; font-size: small;">
C. Latihan Jasmani</span><br /><span style="font-family: 'Comic Sans MS'; font-size: small;">
D. Intervensi Farmakologi</span><br />
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<b style="font-family: 'Comic Sans MS'; font-size: 12pt;">A. Edukasi</b><br />
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Diabetes tipe II umumnya terjadi pada saat pola gaya hidup dan perilaku telah
terbentuk dengan kokoh. Keberhasilan pengelolaan diabetes mandiri membutuhkan
partisipasi aktif pasien, keluarga, dan masyarakat. Tim kesehatan harus
mendampingi pasien dalam menuju perubahan perilaku. Untuk mencapai keberhasilan
perubahan perilaku, dibutuhkan edukasi yang komprehensif, pengembangan
keterampilan dan motivasi.</span><br />
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Edukasi tersebut meliputi pemahaman tentang:<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Penyakit DM.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Makna dan perlunya pengendalian dan pemantauan DM.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Penyulit DM.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Intervensi farmakologis dan non farmakologis.<o:p></o:p></span></div>
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</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hipoglikemia.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Masalah khusus yang dihadapi.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Perawatan kaki pada diabetes.<o:p></o:p></span></div>
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</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Cara pengembangan sistem pendukung dan pengajaran
keterampilan.<o:p></o:p></span></div>
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</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Cara mempergunakan fasilitas perawatan kesehatan.<o:p></o:p></span></div>
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Edukasi secara individual atau
pendekatan berdasarkan penyelesaian masalah merupakan inti perubahan perilaku
yang berhasil. Perubahan Perilaku hampir sama dengan proses edukasi yang
memerlukan penilaian, perencanaan, implementasi, dokumentasi, dan evaluasi.<br />
Masalah kaki yaitu borok di kaki
dengan atau tanpa infeksi terlokalisasi atau menyerang seluruh kaki adalah dan
kematian berbagai jaringan tubuh karena hilangnya suplai darah, infeksi
bakteri, dan kerusakan jaringan sekitarnya merupakan masalah utama pada
penderita diabetes.<br />
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Klasifikasi penyakit kaki pada penderita diabetes melitus :<br />
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</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Tingkat 0 : Risiko tinggi
mengalami penyakit kaki, belum ada borok.<o:p></o:p></span></div>
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</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Tingkat 1 : Borok permukaan
yang tidak terinfeksi.<o:p></o:p></span></div>
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</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Tingkat 2 : Borok lebih dalam,
sering dikaitkan dengan inflamasi jaringan.<o:p></o:p></span></div>
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</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Tingkat 3 : Borok dalam yang
melibatkan tulang dan formasi abscess.<o:p></o:p></span></div>
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</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Tingkat 4 : Kematian jaringan
tubuh terlokalisir, seperti di ibu jari kaki, bagian depan
kaki atau tumit.<o:p></o:p></span></div>
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</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Tingkat 5 : Kematian jaringan
tubuh pada seluruh kaki.<o:p></o:p></span></div>
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Untuk mendiagnosis dan menangani kerusakan saraf kaki dilakukan beberapa tes
antara lain pengukuran:<br />
a. Merasakan sentuhan ringan<br />
b. Kepekaan pada suhu<br />
c. Sensasi pada getaran<br />
d. Efisiensi saraf untuk mengirim pesan ke dan dari otak<br />
<br />
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Resiko tinggi mengalami masalah kaki karena diabetes, yaitu :<br />
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Mengalami kerusakan saraf kaki.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Mempunyai penyakit pembuluh darah di kaki.<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l9 level1 lfo3; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pernah mepunyai borok di kaki.<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l9 level1 lfo3; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Bentuk kaki berubah.<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l9 level1 lfo3; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Adanya callus.<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l9 level1 lfo3; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Buta atau penglihatan buruk , penyakit ginjal terutama
gagal ginjal kronis.<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l9 level1 lfo3; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Para lansia, terutama yang hidup sendirian.<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l9 level1 lfo3; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Orang-orang yang tidak bisa menjangkau kaki mereka
sendiri untuk membersihkannya.<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l9 level1 lfo3; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Kontrol kadar gula darah yang buruk.<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l9 level1 lfo3; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Berkurangnya indra perasa di kaki.<o:p></o:p></span></div>
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<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
Petunjuk umum untuk mencegah borok kaki:<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l2 level1 lfo4; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Periksa kaki anda setiap hari untuk mendeteksi adanya
borok sedini mungkin, apakah ada kulit retak, melepuh,bengkak, luka, atau
perdarahan.<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l2 level1 lfo4; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Periksa sepatu anda baik bagian dalam ataupun luar
sebelum memakainya untuk mendeteksi batu atau benda sejenis lainnya yang
mungkin ada.<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l2 level1 lfo4; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pastikan kaki anda diukur setiap kali membeli alas
kaki yang baru.<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l2 level1 lfo4; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Jauhkan kaki dari udara panas, air panas, dan
lain-lain.<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l2 level1 lfo4; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pakaikan alas kaki pelindung di dalam rumah dan
hindari berjalan tanpa alas kaki.<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l2 level1 lfo4; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pakai sepatu yang bertali dan cukup ruang untuk ibu
jari kaki.<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l2 level1 lfo4; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Berikan pelembab pada daerah kaki yang kering , tetapi
tidak pada sela-sela jari.<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l2 level1 lfo4; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Bersihkan kaki setizp hari, keringkan dengan handuk
termasuk sela-sela jari.<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l2 level1 lfo4; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Segera ke dokter bila kaki luka atau berkurang rasa.<o:p></o:p></span></div>
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<br />
<b>B. Perencanaan makanan</b><br />
<br />
Biasanya pasien DM yang berusia
lanjut terutama yang gemuk dapat dikendalikan hanya dengan pengaturan diet saja
serta gerak badan ringan dan teratur.<br />
<br />
Perencanaan makan merupakan
salah satu pilar pengelolan diabetes, meski sampai saat ini tidak ada satu pun
perencanaan makan yang sesuai untuk semua pasien. Perencanaan makan harus
disesuaikan menurut kebiasaan masing-masing individu. Yang dimaksud dengan
karbohidrat adalah gula, tepung, serat.<br />
Faktor yang berpengaruh pada
respon glikemik makanan adalah cara memasak, proses penyiapan makanan, dan
bentuk makan serta komposisi makanan (karbohidrat, lemak, dan protein). Jumlah
masukan kalori makanan yang berasal dari karbohidrat lebih penting daripada
sumber atau macam karbohidratnya. Gula pasir sebagai bumbu masakan tetap
diijinkan. Pada keadaan glukosa darah terkendali, masih diperbolehkan untuk
mengkonsumsi sukrosa (gula pasir) sampai 5 % kebutuhan kalori.<br />
<br />
Standar yang dianjurkan adalah makanan dengan komposisi:<br />
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Karbohidrat 60 – 70 %<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Protein
10 – 15 %<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Lemak
20 – 25 %<o:p></o:p></span></div>
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<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
Makanan dengan komposisi sampai
70 – 7 5 % masih memberikan hasil yang baik. Jumlah kandungan kolesterol
disarankan < 300 mg/hari, diusahakan lemak berasal dari sumber asam lemak
tidak jenuh MUFA (Mono Unsurated Fatty Acid), dan membatasi PUFA (Poli
Unsaturated Fatty Acid) dan asam lemak jenuh. Jumlah kandungan serat ± 25
g / hari, diutamakan serat larut.<br />
Pemanis buatan dapat dipakai
secukupnya. Pemanis buatan yang aman dan dapat diterima untuk digunakan pasien
diabetes termasuk yang sedang hamil adalah: sakarin, aspartame, acesulfame, potassium,
dan sukralose. Jumlah kalori disesuaikan dengan status gizi,umur , ada tidaknya
stress akut, kegiatan jasmani. Untuk penentuan status gizi, dapat dipakai
Indeks Massa tubuh (IMT) dan rumus Broca.<br />
<br />
Indeks massa tubuh ( IMT ) dapat dihitung dengan rumus:<br />
<br />
IMT = BB ( Kg ) / TB ( M2 )<br />
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<!--[endif]--><o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l13 level1 lfo6; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">IMT Normal Wanita = 18.5 – 23.5<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l13 level1 lfo6; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">IMT Normal Pria =
22.5 – 25<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">BB
kurang
= < 18.5<o:p></o:p></span></div>
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<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
BB lebih<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Dengan
resiko = 23.0- 24.9<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Obes
I
= 2.5.0 - 29.9<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Obes
II
= = 30.0<o:p></o:p></span></div>
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<br /></div>
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<b>PENENTUAN KEBUTUHAN KALORI</b><br />
<br />
Kalori Basal :<br />
Laki-Laki : BB idaman ( kg ) X 30
kalori / kg = …………Kalori<br />
Wanita : BB idaman ( kg ) X 25
kalori / kg = …………Kalori<br />
<br />
Koreksi / Penyesuaian :<br />
Umur > 40 tahun : - 5
% X Kalori
basal = …………Kalori<br />
Aktivitas Ringan : + 10 % X Kalori
basal = ……………Kalori<br />
Sedang : + 20 %<br />
Berat : +30
% <br />
BB Gemuk : - 20
% X Kalori basal
= - / +…………Kalori<br />
Lebih : -10 %<br />
Kurang : 20 %<br />
Stress metabolik :10 – 30
% X Kalori basal = + ……… Kalori<br />
Hamil trimester I&
II
= + 300 Kalori<br />
Hamiltrimester III / laktasi =
+ 500 Kalori<br />
<br />
Total Kebutuhan
= ……… Kalori<br />
<br />
<i>Sumber : PERKENI, Pengelolaan Diabetes Melitus Tipe 2, 2002</i><br />
<br />
<b>Petunjuk Umum untuk Asupan Diet bagi Diabetes:</b><br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hindari biskuit, cake, produk lain sebagai cemilan
pada waktu makan.<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l12 level1 lfo8; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Minum air dalam jumlah banyak, susu skim dan
minuman berkalori rendah lainnya pada waktu makan.<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l12 level1 lfo8; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Makanlah dengan waktu yang teratur.<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l12 level1 lfo8; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hindari makan makanan manis dan gorengan.<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l12 level1 lfo8; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Tingkatkan asupan sayuran dua kali tiap makan.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Jadikan nasi, roti, kentang, atau sereal sebagai menu
utama setiap makan.<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l12 level1 lfo8; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Minum air atau minuman bebas gula setiap anda haus.<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l12 level1 lfo8; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Makanlah daging atau telor dengan porsi lebih kecil.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Makan kacang-kacangan dengan porsi lebih kecil.<o:p></o:p></span></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
<b>C. Latihan Jasmani</b><br />
<br />
Kegiatan jasmani sehari – hari
dan latihan jasmani teratur (3 – 4 kali seminggu selama kurang lebih 30
menit), merupakan salah satu pilar dalam pengelolaan diabetes tipe II. Latihan
jasmani dapat menurunkan berat badan dan memperbaiki sensitifitas terhadap
insulin, sehingga akan memperbaiki kendali glukosa darah. Latihan jasmani yang
dimaksud ialahjalan, bersepeda santai, jogging, berenang.<br />
Latihan jasmani sebaiknya
disesuaikan dengan umur dan status kesegaran jasmani. Kegiatan sehari – hari
seperti berjalan kaki ke pasar, menggunakan tangga, berkebun tetap dilakukan
tetap dilakukan. Batasi atau jangan terlalu lama melakukan kegiatan yang
kurang gerak seperti menonton televisi.<br />
<br />
Prinsip latihan jasmani yang dilakukan :<o:p></o:p></span></div>
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<b><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">1.
Continous :</span></b><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
Latihan jasmani harus
berkesinambungan dan dilakukan terus menerus tanpa berhenti. Contoh:
Jogging 30 menit , maka pasien harus melakukannya selama 30 menit tanpa henti.<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 0cm; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: left; text-indent: 0cm;">
<b><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">2.
Rhytmical :</span></b><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
Latihan olah raga dipilih yang
berirama yaitu otot-otot berkontraksi dan relaksasi secara teratur, contoh
berlari, berenang, jalan kaki.<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 0cm; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: left; text-indent: 0cm;">
<b><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">3.
Interval :</span></b><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
Latihan dilakukan selang-seling
antar gerak cepat dan lambat. Contoh: jalan cepat diselingi jalan lambat,
jogging diselangi jalan<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 0cm; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: left; text-indent: 0cm;">
<b><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">4.
Progresive :</span></b><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l10 level1 lfo9; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Latihan dilakukan secara bertahap sesuai kemampuan,
dari intensitas ringan sampi sedang selama mencapai 30 – 60 menit.<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l10 level1 lfo9; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Sasaran HR = 75 – 85 % dari maksimal
HR.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Maksimal HR = 220 – (umur).<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p> </o:p></span></div>
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<b><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">5. Endurance :</span></b><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
Latihan daya tahan untuk
meningkatkan kemampuan kardiorespirasi, seperti jalan jogging dan sebagainya.<br />
Latihan dengan prinsip seperti
di atas minimal dilakukan 3 hari dalam seminggu, sedang 2 hari yang lain dapat
digunakan untuk melakukan olah raga kesenangannya.<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 0cm; text-align: left; text-indent: 0cm;">
<br /></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 0cm; text-align: left; text-indent: 0cm;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
<b>Modifikasi senam sederhana dapat diberikan kepada penderita DM Lansia,
misalnya:</b><br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l4 level1 lfo10; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Menepuk kedua tangan di atas kepala kemudia di paha.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Secara bergantian menempatkan tangan di dada dan
dibelakang kepala.<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l4 level1 lfo10; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Latihan meregangkan bagian atas dan bagian bawah
tubuh, leher, dan paha.<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l4 level1 lfo10; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Membuat gerakan lingkaran dengan 2 lengan secara
paralel di depan badan.<o:p></o:p></span></div>
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<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
Olah raga yang teratur memainkan peran yang sangat penting dalam menangani
diabetes, manfaat – manfaat utamanya sebagai berikut:<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l5 level1 lfo11; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Olah raga membantu membakar kalori karena dapat
mengurangi berat badan.<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l5 level1 lfo11; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Olah raga teratur dapat meningkatkan jumlah reseptor
pada dinding sel tempat insulin bisa melekatkan diri.<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l5 level1 lfo11; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Olah raga memperbaiki sirkulasi darah dan menguatkan
otot jantung.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Olah raga meningkatkan kadar kolesterol “baik” dan
mengurangi kadar kolesterol “jahat”<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l5 level1 lfo11; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Olah raga teratur bisa membantu melepaskan kecemasan
stress, dan ketegangan, sehingga memberikan rasa sehat dan bugar.<o:p></o:p></span></div>
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PETUNJUK OLAH RAGA UNTUK DIABETES BERGANTUNG INSULIN<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l11 level1 lfo12; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Monitor kadar glukosa darah sebelum dan sesudah
berolah raga<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hindari gula darah rendah dengan memakan karbohidrat
ekstra sebelum olah raga<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hindari olah raga berat selama reaksi puncak insulin<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l11 level1 lfo12; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Lakukan suntikan insulin di tempat – tempat yang
tidak akan digunakan untuk berolah- raga aktif<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l11 level1 lfo12; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Ikuti saran dokter untuk mengurangi dosis insulin
sebelum melakukan olah raga yang melelahkan atau lama<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l11 level1 lfo12; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Glukosa darah bisa turun bahkan beberapa jam setelah
berolah raga karena itu sangat penting untuk memeriksa gula darah secara
periodic <o:p></o:p></span></div>
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PETUNJUK BEROLAH RAGA UNTUK DIABETES TIDAK BERGANTUNG INSULIN<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l8 level1 lfo13; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Gula darah rendah jarang terjadi selama berola raga
dan arena itu tidak perlu untuk memakan karbohidrat ekstra<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l8 level1 lfo13; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Olah raga untuk menurunkan berat badan perlu didukung
dengan pengurangan asupan kalori<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l8 level1 lfo13; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Olah raga sedang perlu dilakukan setiap hari. Olah
raga berat mungkin bisa dilakukan tiga kali seminggu<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l8 level1 lfo13; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Sangat penting untuk melakukan latihan ringan guna
pemanasan dan pendinginan sebelum dan sesudah berolah raga<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l8 level1 lfo13; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pilihlah olah raga yang paling sesuai dengan kesehatan
dan gaya hidup anda secara umum<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l8 level1 lfo13; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Manfaat olah raga akan hilang jika tidak berolah raga
selama tiga hari berturut-turut<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l8 level1 lfo13; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Olah raga bisa meningkatkan nafsu makan dan
berarti juga asupan kalori bertambah. Karena itu sangat penting bagi anda untuk
menghindari makan makanan ekstra setelah berolah raga.<o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l8 level1 lfo13; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Dosis obat telan untuk diabetes mungkin perlu
dikurangi selama olah raga teratur.<o:p></o:p></span></div>
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<b>D. Intervensi Farmakologis</b><br />
<br />
Apabila pengendalian diabetesnya
tidak berhasil dengan pengaturan diet dan gerak badan barulah diberikan obat
hipoglikemik oral. Di Indonesia umumnya OHO yang dipakai ialah Metformin
2 – 3 X 500 mg sehari.Pada pasien yang mempunyai berat badan sedang dipertimbangkan
pemberian sulfonilurea.<br />
<br />
Pedoman pemberian sulfonilurea pada DM usia lanjut :<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></div>
<div align="left" class="MsoNormal" style="line-height: 16.5pt; margin-left: 30.0pt; mso-list: l6 level1 lfo14; tab-stops: list 36.0pt; text-align: left; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Harus waspada akan timbulnya hipoglikemia. Ini
disebabkan karena metabolisme sulfonilurea lebih lambat pada usia lanjut, dan
seringkali pasien kurang nafsu makan, sering adanya gangguan fungsi ginjal dan
hati serta pengaruh interaksi sulfonilurea dengan obat-obatan lain.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Sebaiknya digunakan digunakan sulfonyl urea generasi
II yang mempunyai waktu paruh pendek dan metabolisme lebih cepat.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Jangan mempergunakan klorpropamid karena waktu
paruhnya sangat panjang serta sering ditemukan retensi air dan hiponatremi pada
penggunaan klorpropamid. Begitu pula bila ada komplikasi ginjal, klorpropamid
yang kerjanya 24 – 36 jam tidak boleh diberikan, oleh karena ekskresi obat
sangat berkaian dengan fungsi ginjal. Hipoglikemia akibat klorpamid dapat
berlangsung lama, berbeda dengan hipoglikemi karena tolbutamid.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Sulfonilurea dengan kerja sedang ( seperti
glibenklamid, glikasid), biasanya dosis awal setengah tablet sehari,
kalau perlu dapat dinaikkan 1 – 2 kali sehari.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Dosis oral pada umumnya bila dianggap perlu dapat
dinaikkan tiap 1 – 2 minggu. Untuk mencegah hipoglikemia pada pasien tua lebih
baik tidak memberikan dosis maksimum.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Kegagalan sekunder dapat terjadi setelah penggunan OHO
beberapa lama. Pada kasus sperti ini biasanya dapat dicoba kombinasi OHO dengan
insulin atau langsung diberikan insulin saja.<o:p></o:p></span></div>
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<br /></div>salnihttp://www.blogger.com/profile/00126668517852477742noreply@blogger.com0tag:blogger.com,1999:blog-8321145958076225978.post-29972189086093300442012-03-17T01:05:00.000-07:002012-03-17T01:05:28.604-07:00ASKEP DIABETIK KETOASIDOSIS (DKA)<br />
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<span style="font-family: 'Times New Roman', serif;"><b><br /></b></span></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">A.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">DEFINISI<o:p></o:p></span></b></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Diabetes melitus adalah
sindrom yang disebabkan ketidakseimbangan antara kebutuhan dan suplai insulin.
Sindrom ditandai oleh hiperglikemi dan berkaitan dengan abnormalitas
metabolisme karbohidrat, lemak dan protein. Abnormalitas metabolik ini mengarah
pada perkembangan bentuk spesifik komplikasi ginjal, okular, neurologik dan
kardiovaskuler.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Diabetik
Ketoasidos</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"> adalah komplikasi akut diabetes melitus
yang serius, suatu keadaan darurat yang harus segera diatasi. </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">DAK </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"> memerlukan pengelolaan yang cepat dan tepat,
mengingat angka kematiannya yang tinggi. Pencegahan merupakan upaya penting untuk
menghindari terjadinya </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">DAK.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">D</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">iabetik
</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">ketoasidosis </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">merupakan akibat
dari defisiensi berat insulin dan disertai gangguan metabolisme protein,
karbohidrat dan lemak. Keadaan ini terkadang disebut “akselerasi puasa” dan
merupakan gangguan metabolisme yang paling serius pada diabetes ketergantungan
insulin.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Diabetik
Ketoasidosis</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"> adalah kasus kedaruratan endokrinologi
yang disebabkan oleh defisiensi insulin relatif atau absolut. </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Diabetik Ketoasidosi </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">terjadi
pada penderita IDDM (atau DM tipe II)<o:p></o:p></span></div>
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<br /></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">B.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">ETIOLOGI<o:p></o:p></span></b></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Insulin Dependen Diabetes Melitus (IDDM)
atau diabetes melitus tergantung insulin
disebabkan oleh destruksi sel B pulau langerhans akibat proses autoimun.
Sedangkan non insulin dependen diabetik melitus (NIDDM) atau diabetes melitus
tidak tergantung insulin disebabkan kegagalan relatif sel B dan resistensi
insulin. Resistensu insulin adalah turunnya kemampuan insulin untuk merangsang
pengambilan glukosa oleh jaringan perifer dan untuk menghambat produksi glukosa
oleh hati. Sel B tidak mampu mengimbangi resistensi insulin ini sepenuhnya.
Artinya terjadi defisiensi relatif insulin. Ketidakmampuan ini terlihat dari
berkurangnya sekresi insulin pada perangsangan sekresi insulin, berarti sel B
pankreas mengalami desensitisasi terhadap glukosa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">.<o:p></o:p></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"> Diabetik Ketoasidosi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">
dapat dikelompokkan menjadi dua, yaitu akibat hiperglikemia dan </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">akibat
ketosis, yang sering dicetuskan oleh faktor-faktor :</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Infeksi<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Stress
fisik dan emosional; respons hormonal terhadap stress mendorong peningkatan
proses katabolik . Menolak terapi insulin</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
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<br /></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">C.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">KLASIFIKASI</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"> DM</span></b><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></b></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Klasifikasi
etiologis DM American Diabetes Assosiation (1997) sesuai anjuran perkumpulan
Endokrinologi Indonesia (PERKENI) adalah :<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Diabetes
tipe 1 (destruksi sel B ), umumnya menjurus ke definisi insulin absolut :<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Autoimun<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Idiopatik<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Diabetes
tipe 2 (bervariasi mulai terutama dominan risestensi insulin disertai definisi
insulin relatif sampai terutama defek sekresi insulin disertai resistensi
insulin)<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Diabetes
tipe lain<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Defek
generik fungsi sel B<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Maturity
Onset Diabetes Of The Young (MODY) 1,2,3<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">DNA
mitokondria<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Defek
generik kerja insulin<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Penyakit
eksoskrin pankreas<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Pankreastitis<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Tumor
/ pankreatektomi<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Pankreatopati
fibrokalkulus<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Endokrinopati
: Akromegali, Syndrom Cushing, Feokromositoma dan hipertiroidisme.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">e.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Karena
obat / zat kimia.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Vacor,
pentamidin, asam nikotinat<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Glukokortikoid,
hormon tiroid<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Tiazid,
dilatin, interferon α, dll.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">f.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Infeksi
: Rubela kongenital, sitomegalovirus.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">g.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Penyebab
imunologi yang jarang ; antibodi ; antiinsulin.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">h.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Syndrom
generik lain yang berkaitan dengan DM : Sindrom Down, Sindrom Klinefelter,
Sindrom Turner, dll. <o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Diabetes
Melitus Gestasional (DMG)<o:p></o:p></span></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">D.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">INSIDENSI</span></b><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></b></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Secara umum</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"> insiden IDDM akan meningkat sejak bayi hingga
mendekati pubertas, namun semakin kecil setelah </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">pubertas.
Terdapat dua puncak masa kejadian IDDM yang paling tinggi, yakni usia 4-6 tahun
serta usia 10-14 tahun. Kadang-kadang IDDM juga dapat terjadi pada
tahun-tahun pertama kehidupan, meskipun kejadiannya sangat langka. Diagnosis
yang telat tentunya akan menimbulkan kematian dini. Gejala bayi dengan </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">IDDM
</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">ialah </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">napkin
</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">rash, malaise yang tidak
jelas penyebabnya, penurunan berat badan, senantiasa haus, muntah, dan dehidrasi.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Insulin merupakan komponen vital dalam metabolisme
karbohidrat, lemak, dan protein. Insulin menurunkan kadar glukosa darah
dengan cara memfasilitasi masuknya glukosa ke dalam sel, terutama otot serta
mengkonversi glukosa menjadi glikogen (glikogenesis) sebagai cadangan energi.
Insulin juga menghambat pelepasan glukosa dari glikogen hepar (glikogenolisis)
dan memperlambat pemecahan lemak menjadi trigliserida, asam lemak bebas, dan
keton. Selain itu, insulin juga menghambat pemecahan protein dan lemak untuk
memproduksi glukosa (glukoneogenesis) di hepar dan ginjal. </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Defisiensi insulin yang dibiarkan akan menyebabkan
tertumpuknya glukosa di darah dan terjadinya glukoneogenesis terus-menerus
sehingga menyebabkan kadar gula darah sewaktu (GDS) meningkat drastis. Batas
nilai GDS yang sudah dikategorikan sebagai diabetes mellitus ialah 200 mg/dl
atau 11 mmol/l. Kurang dari itu dikategorikan normal, sedangkan angka yang
lebih dari itu dites dulu dengan Tes Toleransi Glukosa Oral (TTGO) untuk menentukan
benar-benar IDDM atau kategori yang tidak toleran terhadap glukosa oral.</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"><o:p></o:p></span></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">E.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">PROGNOSIS
PENYAKIT<o:p></o:p></span></b></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Pada DM yang tidak terkendali dengan kadar gula
darah yang terlalu tinggi dan kadar hormon insulin yang rendah, tubuh tidak
dapat menggunakan glukosa sebagai sumber energi. Sebagai gantinya tubuh akan
memecah lemak untuk sumber energi.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Pemecahan lemak tersebut akan menghasilkan
benda-benda keton dalam darah (ketosis). Ketosis menyebabkan derajat keasaman
(pH) darah menurun atau disebut sebagai asidosis. Keduanya disebut sebagai
ketoasidosis.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Pasien dengan KAD biasanya memiliki riwayat masukan
kalori (makanan) yang berlebihan atau penghentian obat diabetes/insulin.</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"><o:p></o:p></span></div>
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<br /></div>
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<br /></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">F.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">PATOFISIOLOGI<o:p></o:p></span></b></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Adanya
gangguan dalam regulasi Insulin, khususnya pada IDDM dapat cepat menjadi
Diabetik ketoasidosis manakala terjadi</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"> (1) Diabetik tipe I yang tidak terdiagnosa </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"><o:p></o:p></span></div>
<div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: center;">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">(2)
Ketidakseimbangan jumlah intake makanan dngan insulin </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">(3)
Adolescen dan pubertas </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">(4)
Aktivitas yang tidak terkontrol pada diabetes </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"><o:p></o:p></span></div>
<div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: center;">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">(5)
Stress yang berhubungan dengan penyakit, trauma, atau tekanan Emosional.<o:p></o:p></span></div>
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<tr>
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<br /></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Gangguan
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Penurunan
proses penyimpanan glukosa dalam hati Penurunan kemampuan reseptor sel dalam
uptake glukosa<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kadar
glukosa darah >> Kelaparan tingkat seluler<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Hiperosmolar
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Proses
pemekatan <<<o:p></o:p></span></div>
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<tr>
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<br /></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Glukosuria ekstaselulerShift cairan
intraseluler <o:p></o:p></span></div>
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<tbody>
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<tr>
<td></td>
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<br /></div>
<br clear="ALL" />
<div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: center;">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Pembentukan
benda keton<o:p></o:p></span></div>
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<br /></div>
<br clear="ALL" />
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Poliuria<o:p></o:p></span></div>
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</div>
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<tbody>
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<td height="2" width="326"></td>
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<tr>
<td></td>
<td><img height="43" src="file:///C:/Users/USER/AppData/Local/Temp/msohtmlclip1/01/clip_image005.gif" v:shapes="_x0000_s1034" width="12" /></td>
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<br /></div>
<br clear="ALL" />
<div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: center;">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Dehidrasi<o:p></o:p></span></div>
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<td></td>
<td><img height="43" src="file:///C:/Users/USER/AppData/Local/Temp/msohtmlclip1/01/clip_image005.gif" v:shapes="_x0000_s1035" width="12" /></td>
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<br /></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Keseimbangan
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<tbody>
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<br /></div>
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<br /></div>
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<br /></div>
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<div align="center" class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: center;">
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<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.25pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 36.0pt;">
<br /></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">G.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">INDIKASI DKA</span></b><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></b></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Pasien yang bisa di indikasikan Diabetik Ketoasidosis ,memilik tanda dan
gejala serta di lengkapi dengan pemeriksaan penunjang sebagai berikut:<o:p></o:p></span></div>
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<br /></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Tanda Dan
Gejala :<o:p></o:p></span></b></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kadar
gula darah tinggi (> 240 mg/dl)<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Terdapat
keton di urin<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Banyak
buang air kecil sehingga dapat dehidrasi<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Sesak
nafas (nafas cepat dan dalam)<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">5.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Nafas
berbau aseton<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">6.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Badan
lemas<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">7.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kesadaran
menurun sampai koma<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">8.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">KU
lemah, bisa penurunan kesadaran<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">9.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Polidipsi,
poliuria<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">10.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Anoreksia,
mual, muntah, nyeri perut<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">11.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Bisa
terjadi ileus sekunder akibat hilangnya K+ karena diuresis osmotik<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">12.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kulit
kering<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">13.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Keringat
<<<<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">14.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kussmaul
( cepat, dalam ) karena asidosis metabolic<o:p></o:p></span></div>
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<b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Faktor
risiko yang dapat menyebabkan terjadinya </span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">DAK</span></b><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">
adalah:<o:p></o:p></span></b></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Infeksi,
stres akut atau trauma<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Penghentian
pemakaian insulin atau obat diabetes<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Dosis
insulin yang kurang<o:p></o:p></span></div>
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<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"> </span></b><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Pemeriksaan Penunjang</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"><o:p></o:p></span></b></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Pemeriksaan
Diagnostik meliputi :<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Glukosa
darah : meningkat 200 – 100 mg/dl atau lebih<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Aseton
plasma (keton) : positif secara mencolok<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Asam
lemak bebas : kadar lipid dan kolesterol meningkaat<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Osmolalitas
serum : meningkat tetapi biasanya kurang dari 330 mOsm/l <o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Pemeriksaan Osmolalitas
= 2[Na+K] + [GDR/18] + [UREUM/6]<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">5.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Elektrolit
: Natrium : mungkin normal , meningkat atau menurun<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">6.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kalium
: normal atau peningkatan semu (perpindahan selular), selanjutnya akan menurun<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">7.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Fosfor
: lebih sering menurun<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">8.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Hemoglobin
glikosilat : kadarnya meningkat 2-4 kali lipat dari normal yang mencerminkan
kontrol DM yang kurang selama 4 bulan terakhir<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">9.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Gas
darah arteri : biasanya menunjukkan pH rendah dan penurunan pada HCO3 (asidosis
metabolik) dengan kompensasi alkalosis respiratorik<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">10.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Trombosit
darah : Ht mungkin meningkat atau normal (dehidrasi), leukositosis,
hemokonsentrasi sebagai rrespons terhadap stress atau infeksi<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">11.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Ureum/kreatinin:
Mungkn meningkaatt atau normal(dehidrasi/penurunan fungsi ginjal)<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">12.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Amilase
darah : mungkin meningkat yang mengindikasikan adanya pankreatitis akut sebagai
penyebab DKA<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">13.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Urin
: gula dan aseton positif , berat jenis dan osmolalitas mungkin meningkat<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">14.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kultur
dan sensitifitas : kemungkinan adanya infeksi saluran kemih, pernafasan dan
pada luka<o:p></o:p></span></div>
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<br /></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">H.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">KOMPLIKASI<o:p></o:p></span></b></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Faktor-faktor
yang mempengaruhi angka kematian akibat </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">DKA
</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"> adalah:<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Terlambat
didiagnosis karena biasanya penyandang DM dibawa setelah koma.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Pasien
belum tahu bahwa ia menyandang DM.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Sering
ditemukan bersama-sama dengan komplikasi lain yang berat, seperti: renjatan
(syok), stroke, dll.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kurangnya
fasilitas laboratorium yang menunjang suksesnya penatalaksanaan </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">DAK</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">.<o:p></o:p></span></div>
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<br /></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">I.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">PENATALAKSANAAN<o:p></o:p></span></b></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Prinsip
terapi </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">DAK </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"> adalah dengan mengatasi dehidrasi,
hiperglikemia, dan ketidakseimbangan elektrolit, serta mengatasi penyakit
penyerta yang ada.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Pengawasan
ketat, KU jelek masuk HCU/ICU<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Fase
I/Gawat :<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">REHIDRASI<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">NaCl 0,9% atau RL 2L
loading dalam 2 jam pertama, lalu 80 tpm selama 4 jam, lalu 30-50 tpm selama 18
jam (4-6L/24jam)</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"><o:p></o:p></span></div>
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<br /></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">INSULIN<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">4-8 U/jam sampai GDR
250 mg/dl atau reduksi minimal<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Infus
K (TIDAK BOLEH BOLUS)<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Bila
K+ < 3mEq/L, beri 75mEq/L<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Bila
K+ 3-3.5mEq/L, beri 50 mEq/L<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Bila
K+ 3.5 -4mEq/L, beri 25mEq/L<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Masukkan
dalam NaCl 500cc/24 jam<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Infus
Bicarbonat<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Bila
pH<7,0 atau bicarbonat < 12mEq/L<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Berikan
44-132 mEq dalam 500cc NaCl 0.9%, 30-80 tpm<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Pemberian Bicnat = [ 25
- HCO3 TERUKUR ] x BB x 0.4<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">5.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Antibiotik
dosis tinggi<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Batas
fase I dan fase II sekitar GDR 250 mg/dl atau reduksi<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Fase
II/maintenance:<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Cairan
maintenance<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Nacl
0.9% atau D5 atau maltose 10% bergantian<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Sebelum
maltose, berikan insulin reguler 4U<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kalium<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Perenteral
bila K+ <4mEq<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Peroral
(air tomat/kaldu 1-2 gelas, 12 jam<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Insulin
reguler 4-6U/4-6jam sc<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Makanan
lunak karbohidrat komlek perasü<o:p></o:p></span></div>
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<br /></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">J.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">CARA
MENCEGAH </span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">DKA</span></b><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></b></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Jangan
menghentikan suntikan insulin atau obat diabetes walaupun sedang sakit dan
tidak nafsu makan.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Periksa
kadar gula darah sekali sehari dan catat hasil pemeriksaan tersebut.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Periksa
keton urin bila gula darah > 240 mg/dL atau badan terasa tidak enak.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Saat
sakit, makanlah sesuai pengaturan makan sebelumnya. Bila tidak nafsu makan,
boleh makan bubur atau minuman berkalori lain.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">5.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Minumlah
yang cukup untuk mencegah dehidrasi.</span></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify;">
<br /></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">K.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">DIAGNOSE
KEPERAWATAN DISERTAI DATA SUBJEKTIF DAN OBJEKTIF<o:p></o:p></span></b></div>
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<span style="font-family: 'Times New Roman', serif;"><br /></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Aktivitas
/ Istrahat<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Gejala : <o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Lemah,
letih, sulit bergerak/berjalan<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kram
otot, tonus otot menurun, gangguan istrahat/tidur<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Tanda : <o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Takikardia
dan takipnea pada keadaan istrahat atau aktifitas<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Letargi/disorientasi,
koma<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Penurunan
kekuatan otot<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Sirkulasi<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Gejala : <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 92.7pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l19 level1 lfo23; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Adanya
riwayat hipertensi, IM akut<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Klaudikasi,
kebas dan kesemutan pada ekstremitas<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Ulkus
pada kaki, penyembuhan yang lama<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Takikardia<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Tanda : <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 92.7pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l38 level1 lfo24; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Perubahan
tekanan darah postural, hipertensi<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Nadi
yang menurun/tidak ada<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Disritmia<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Krekels,
Distensi vena jugularis<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kulit
panas, kering, dan kemerahan, bola mata cekung<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Integritas/
Ego<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Gejala : <o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Stress,
tergantung pada orang lain<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Masalah
finansial yang berhubungan dengan kondisi<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Tanda :<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Ansietas,
peka rangsang<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Eliminasi<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Gejala : <o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Perubahan
pola berkemih (poliuria), nokturia<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Rasa
nyeri/terbakar, kesulitan berkemih (infeksi), ISSK baru/berulang<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Nyeri
tekan abdomen, Diare<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Tanda :<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Urine
encer, pucat, kuning, poliuri ( dapat berkembang menjadi oliguria/anuria, jika
terjadi hipovolemia berat)<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Urin
berkabut, bau busuk (infeksi)<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Abdomen
keras, adanya asites<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Bising
usus lemah dan menurun, hiperaktif (diare)<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">5.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Nutrisi/Cairan<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Gejala : <o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Hilang
nafsu makan<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Mual/muntah<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Tidak
mematuhi diet, peningkattan masukan glukosa/karbohidrat<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Penurunan
berat badan lebih dari beberapa hari/minggu<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Haus,
penggunaan diuretik (Thiazid)<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Tanda : <o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kulit
kering/bersisik, turgor jelek<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kekakuan/distensi
abdomen, muntah<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Pembesaran
tiroid (peningkatan kebutuhan metabolik dengan peningkatan gula darah), bau
halisitosis/manis, bau buah (napas aseton)<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">6.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Neurosensori<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Gejala : <o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Pusing/pening,
sakit kepala<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kesemutan,
kebas, kelemahan pada otot, parestesia<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 92.7pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l43 level1 lfo30; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Gangguan
penglihatan<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Tanda : <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 92.7pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l14 level1 lfo31; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Disorientasi,
mengantuk, alergi, stupor/koma (tahap lanjut). Gangguan<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 92.7pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l14 level1 lfo31; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">memori
(baru, masa lalu), kacau mental<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 92.7pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l14 level1 lfo31; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Refleks
tendon dalam menurun (koma)<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 92.7pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l14 level1 lfo31; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Aktifitas
kejang (tahap lanjut dari DKA)<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l57 level1 lfo20; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">7.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Nyeri/kenyamanan<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Gejala : <o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Abdomen
yang tegang/nyeri (sedang/berat)<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Tanda : <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 92.7pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l24 level1 lfo32; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Wajah
meringis dengan palpitasi, tampak sangat berhati-hati<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l57 level1 lfo20; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">8.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Pernapasan<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Gejala : <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 92.7pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l24 level1 lfo32; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Merasa
kekurangan oksigen, batuk dengan/tanpa sputum purulen (tergantung adanya
infeksi/tidak)<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Tanda : <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 92.7pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l24 level1 lfo32; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Lapar
udara, batuk dengan/tanpa sputum purulen<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 92.7pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l24 level1 lfo32; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Frekuensi
pernapasan meningkat<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l57 level1 lfo20; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">9.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Keamanan<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Gejala : <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 92.7pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l46 level1 lfo33; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kulit
kering, gatal, ulkus kulit<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Tanda : <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 92.7pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l46 level1 lfo33; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Demam,
diaforesis<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 92.7pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l46 level1 lfo33; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kulit
rusak, lesi/ulserasi<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 92.7pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l46 level1 lfo33; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Menurunnya
kekuatan umum/rentang erak<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Parestesia/paralisis
otot termasuk otot-otot pernapasan (jika kadar kalium menurun dengan cukup
tajam)<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l57 level1 lfo20; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">10.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Seksualitas<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Gejala : <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 92.7pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo34; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Rabas
vagina (cenderung infeksi)<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Masalah
impoten pada pria, kesulitan orgasme pada wanita<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l57 level1 lfo20; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">11.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Penyuluhan/pembelajaran<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Gejala : <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 92.15pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l21 level1 lfo35; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Faktor
resiko keluarga DM, jantung, stroke, hipertensi. Penyembuhan yang<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Lambat,
penggunaan obat sepertii steroid, diuretik (thiazid), dilantin dan<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Fenobarbital
(dapat meningkatkan kadar glukosa darah).<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Mungkin
atau tidak memerlukan obat diabetik sesuai pesanan<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Rencana
pemulangan : Mungkin memrlukan bantuan dalam pengatuan diet,<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Pengobatan,
perawatan diri, pemantauan terhadap glukosa darah<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
<br /></div>
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<b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Diagnosa Keperawatan<o:p></o:p></span></b></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Defisit
volume cairan berhubungan dengan diuresis osmotik akibat hiperglikemia,
pengeluaran cairan berlebihan : diare, muntah; pembatasan intake akibat mual,
kacau mental<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 2.0cm; mso-add-space: auto; mso-list: l25 level1 lfo36; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Perubahan
nutrisi : kurang dari kebutuhan berhubungan dengan ketidakcukupan insulin,
penurunan masukan oral, status hipermetabolisme<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 2.0cm; mso-add-space: auto; mso-list: l25 level1 lfo36; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Resiko
tinggi terhadap infeksi (sepsis) berhubungan dengan peningkatan kadar glukosa,
penurunan fungsi lekosit, perubahan pada sirkulasi<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 2.0cm; mso-add-space: auto; mso-list: l25 level1 lfo36; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Resiko
tinggi terhadap perubahan sensori-perseptual berhubungan dengan
ketidkseimbangan glukosa/insulin dan/atau elektrolit<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 2.0cm; mso-add-space: auto; mso-list: l25 level1 lfo36; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">5.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kelelalahan
berhubungan dengan penurunan produksi energi metabolik, insufisiensi insulin,
peningkatan keb</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">u</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">tuhan
energi : status hipermetabolik/infeksi<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">6.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Ketidakberdayaan
berhubungan dengan penyakit jangka panjang, ketergantungan pada orang lain<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 2.0cm; mso-add-space: auto; mso-list: l25 level1 lfo36; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">7.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kurang
pengetahuan mengenai penyakit, prognosis, dan pengoobatan berhubungan dengan
kesalahan menginterpretasi informasi, tidak mengenal sumber informasi<o:p></o:p></span></div>
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<br /></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Berdasarkan
pengkajian data keperawatan yang sering terjadi berdasarkan teori, maka
diagnosa keperawatan yang mungkin muncul pada klien diabetes mellitus yaitu :<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kekurangan
volume cairan tubuh berhubungan dengan diuresis osmotik.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Perubahan
status nutrisi kurang dari kebutuhan tubuh berhubungan dengan ketidakcukupan
insulin, penurunan masukan oral.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 2.0cm; mso-add-space: auto; mso-list: l13 level1 lfo37; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Resiko
infeksi berhubungan dengan hyperglikemia.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Resiko
tinggi terhadap perubahan persepsi sensori berhubungan dengan ketidakseimbangan
glukosa/insulin dan atau elektrolit.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 2.0cm; mso-add-space: auto; mso-list: l13 level1 lfo37; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">5.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kelelahan
berhubungan dengan penurunan produksi energi metabolik.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 2.0cm; mso-add-space: auto; mso-list: l13 level1 lfo37; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">6.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Ketidakberdayaan
berhubungan dengan penyakit jangka panjang/progresif yang tidak dapat diobati,
ketergantungan pada orang lain.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 2.0cm; mso-add-space: auto; mso-list: l13 level1 lfo37; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">7.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kurang
pengetahuan tentang penyakit, prognosis dan kebutuhan pengobatan berhubungan
dengan kurangnya pemajanan/mengingat, kesalahan interpretasi informasi.<o:p></o:p></span></div>
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<br /></div>
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<br /></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">L.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">INTERVENSI
KEPERAWATAN<o:p></o:p></span></b></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Defisit
volume cairan berhubungan dengan diuresis osmotik akibat hiperglikemia,
pengeluaran cairan berlebihan : diare, muntah; pembatasan intake akibat mual<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Batasan karakteristik :<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Peningkatan
urin output<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kelemahan,
rasa haus, penurunan BB secara tiba-tiba<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kulit
dan membran mukosa kering, turgor kulit jelek<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Hipotensi,
takikardia, penurunan capillary refill<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kriteria Hasil :<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">TTV
dalam batas normal<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Pulse
perifer dapat teraba<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Turgor
kulit dan capillary refill baik<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l11 level1 lfo40; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Keseimbangan
urin output<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">e)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kadar
elektrolit normal<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Intervensi<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kaji
riwayat durasi/intensitas mual, muntah dan berkemih berlebihan<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Monitor
vital sign dan perubahan tekanan darah orthostatik<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Monitor
perubahan respirasi: kussmaul, bau aceton<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Observasi
kulaitas nafas, penggunaan otot asesori dan cyanosis<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">e)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Observasi
ouput dan kualitas urin.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">f)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Timbang
BB<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">g)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Pertahankan
cairan 2500 ml/hari jika diindikasikan<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">h)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Ciptakan
lingkungan yang nyaman, perhatikan perubahan emosional<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">i)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Catat hal yang
dilaporkan seperti mual, nyeri abdomen, muntah dan distensi lambung<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">j)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Obsevasi adanya
perasaan kelelahan yang meningkat, edema, peningkatan BB, nadi tidak teratur
dan adanya distensi pada vaskuler<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kolaborasi:<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Pemberian
NS dengan atau tanpa dextrosa<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Albumin,
plasma, dextran<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Pertahankan
kateter terpasang<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Pantau
pemeriksaan lab :<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Hematokrit<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">BUN/Kreatinin<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Osmolalitas
darah<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Natrium<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kalium<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">e)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Berikan
Kalium sesuai indikasi<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">f)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Berikan
bikarbonat jika pH <7,0<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">g)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Pasang
NGT dan lakukan penghisapan sesuai dengan indikasi<o:p></o:p></span></div>
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<br /></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Perubahan
nutrisi : kurang dari kebutuhan berhubungan dengan ketidakcukupan insulin,
penurunan masukan oral, status hipermetabolisme<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Batasan karakteristik :<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Klien
melaporkan masukan butrisi tidak adekuat, kurang nafsu makan<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Penurnan
berat badan, kelemahan, tonus otot buruk<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Diare<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kriteria hasil :<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Klien
mencerna jumlah kalori/nutrien yang tepat<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Menunjukkan
tingkat energi biasanya<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Mendemonstrasikan
berat badan stabil atau penambahan sesuai rentang normal<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Intervensi<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l27 level1 lfo46; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Pantau
berat badan setiap hari atau sesuai indikasi<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l27 level1 lfo46; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Tentukan
program diet dan pola makan pasien dan bandingkan dengan makanan yang
dihabiskan<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l27 level1 lfo46; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Auskultasi
bising usus, catat adanya nyeri abdomen/perut kembung, mual, muntahan makanan
yang belum dicerna, pertahankan puasa sesuai indikasi<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l27 level1 lfo46; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Berikan
makanan yang mengandung nutrien kemudian upayakan pemberian yang lebih padat
yang dapat ditoleransi<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l27 level1 lfo46; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">e)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Libatkan
keluarga pasien pada perencanaan sesuai indikasi<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l27 level1 lfo46; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">f)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Observasi
tanda hipoglikemia<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">g)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kolaborasi
:<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Pemeriksaan
GDA dengan finger stick<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Pantau
pemeriksaan aseton, pH dan HCO3<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Berikan
pengobatan insulin secara teratur sesuai indikasi<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 106.35pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l54 level1 lfo47; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Berikan
larutan dekstrosa dan setengah salin normal<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l48 level1 lfo38; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Resiko
tinggi terhadap infeksi (sepsis) berhubungan dengan peningkatan kadar glukosa,
penurunan fungsi lekosit, perubahan pada sirkulasi<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Batasan karakteristik :<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Klien
melaporkan masukan butrisi tidak adekuat, kurang nafsu makan<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l7 level1 lfo49; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Turgor kulit jelek , Demam Tinggi ,leukosit meningkat.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l7 level1 lfo49; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Ulkus pada kaki</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kriteria hasil :<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l49 level1 lfo50; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Mengidentifikasikan intervensi untuk menurunkan resiko
infeks</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l49 level1 lfo50; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Mendemonstrasikan
</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">tehnik ,perubahan gaya hidup untuk mencegah terjadinya
infeksi.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Intervensi<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l5 level1 lfo51; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Observasi tanda-tanda peradangan (
kalor,rubor,dolor,tumor,functio lesa)</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l5 level1 lfo51; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Tingkatkan upaya pencegahan dengan cuci tangan yang baik
pada semua orang yang berhubungan dengan pasien termasuk pasien itu sendiri.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l5 level1 lfo51; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Pertahankan tehnik aseptik pada prosedur invasif.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l5 level1 lfo51; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Lakukan pengobatan sesuai indikasi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l5 level1 lfo51; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">e)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Tingkatkan personal hygiene ,beri informasi dan edukasi
tentang personal hygiene,bagi pasien dan keluarga pasien.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l5 level1 lfo51; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">f)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Beri perawatan kulit dengan teratur seperti massase
daerah yang tertekan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l5 level1 lfo51; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">g)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Posisikan semi fowler dan lakukan perubahan posisi </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l5 level1 lfo51; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">h)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Anjurkan untuk makan dan minum yang adekuat</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l5 level1 lfo51; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">i)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kolaborasi :<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 106.35pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l54 level1 lfo47; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Pemeriksaan
</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">kultur dan sensivitas sesuai dengan indikasi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 106.35pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l54 level1 lfo47; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Beri antibiotik yang sesuai.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l48 level1 lfo38; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Resiko
tinggi terhadap perubahan sensori-perseptual berhubungan dengan
ketidkseimbangan glukosa/insulin dan/atau elektrolit<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Batasan karakteristik :<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l60 level1 lfo52; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Pusing,sakit kepala,kesemutan ,kelemahan oto,parestesis</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l60 level1 lfo52; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Gangguan penglihatan, Kebingungan
,disorientasi.mengantuk,gangguan memori</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l60 level1 lfo52; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Reflkes tendon menurun</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kriteria hasil :<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l50 level1 lfo53; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Mempertahankan tingkat mental biasanya</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l50 level1 lfo53; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Mengenali dan mengkompensasi adanya kerusakan sensori</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Intervensi<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l47 level1 lfo54; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Pantau TTV dan status mental</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l47 level1 lfo54; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Orientasikan kembali sesuai kebutuhannya</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l47 level1 lfo54; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Pelihara aktivitas pasien sekonsisten mungkin ,dorong
kemandirian.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l47 level1 lfo54; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Lindungi dari cidera ketika kesadaran pasien terganggu.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l47 level1 lfo54; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">e)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Evaluasi lapang pandang penglihatan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l47 level1 lfo54; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">f)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Selidiki adaknya keluhan parestesia,nyeri kehilangan
sensori paha/kaki,ulkus kehilangan nadi perifer.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l47 level1 lfo54; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">g)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Berikan tempat tidur yag lembut</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l47 level1 lfo54; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">h)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Bantu pasien dalam ambulansi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l47 level1 lfo54; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">i)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kolaborasi :<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 106.35pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l54 level1 lfo47; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Pengobatan sesuai indikasi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 106.35pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l54 level1 lfo47; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Pantau nilai Laboratorium ( gula darah
,osmolalitas,HB/Ht,Ur,Cr)</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 106.35pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l54 level1 lfo47; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";">o<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Bantu blok saraf setempat</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l48 level1 lfo38; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">5.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kelelahan
berhubungan dengan penurunan produksi energi metabolik, insufisiensi insulin,
peningkatan kebtuhan energi : status hipermetabolik/infeksi</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Batasan karakteristik :<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l3 level1 lfo55; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Lemah,letih,sulite bergerak ,kram otot,</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l3 level1 lfo55; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Frekuensi pernapasan meningkat,takipnea pada keadaan
istirahat atau aktivitas.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l3 level1 lfo55; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Reflkes tendon menurun,kelemahan otot.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kriteria hasil :<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l50 level1 lfo53; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Mengungkapkan peningkatan tingkat energi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l50 level1 lfo53; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Menunjukan perbaikan kemampuan untuk berpartisipasi dalam
aktivitas yang di inginkan.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Intervensi<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo56; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Diskusikan dengan pasien kebutuhan akan aktivitas,jadwal
perencanaan identifikasi aktivitas.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo56; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Beri aktivitas alternative</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo56; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Pantau nadi,respirasi dan tekanan darah sebelum melakukan
aktivitas</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo56; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Diskusikan cara menghemat kalori dalam aktivitas</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo56; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">e)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Tingkatkan partisipasi dalam aktivitas sehari-hari dengan
yang dapat ditoleransi.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l48 level1 lfo38; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">6.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Ketidakberdayaan
berhubungan dengan penyakit jangka panjang/progresif yang tidak dapat diobati,
ketergantungan pada orang lain.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Batasan karakteristik :<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l20 level1 lfo57; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Apatis,menarik diri,marah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l20 level1 lfo57; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Penolakan mengekspresikan perasaannya ; ekspresi tentang
situati yang tidak terkontrol.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l20 level1 lfo57; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Tidak memantau kemajuan ,tidak berpartisipasi dalam
pengambilan keputusan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l20 level1 lfo57; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Penekanan terhadap penyimpangan komplikasi fisik meskipun
pasien bekerja sama dengan aturan.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kriteria hasil :<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l31 level1 lfo58; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Mengakui perasaan putus asa</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l31 level1 lfo58; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Mengidektifikasi cara-cara sehat untuk menghadapi
perasaan.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l31 level1 lfo58; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Membantu merencanakan perawatannya sendiri</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Intervensi<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l4 level1 lfo59; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Anjurkan dan beri kesempatam pasien /keluarga untuk mengekspresikan perasaannya</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l4 level1 lfo59; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Akui normalitas dari perasaan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l4 level1 lfo59; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Tentukan tujuan dan harapan dari pasien dan keluarga</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l4 level1 lfo59; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Anjurkan pasien untuk membuat keputusan berhubungan
dengan ambulansia,aktivitasnya dan lain-lain.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l4 level1 lfo59; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">e)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Beri dukungan pada pasien untuk ikut berperan serta dalam
perawatan sendiri,beri umpan balik positif sesuai dengan usahanya.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l48 level1 lfo38; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">7.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kurang
pengetahuan tentang penyakit, prognosis dan kebutuhan pengobatan berhubungan
dengan kurangnya pemajanan/mengingat, kesalahan interpretasi informasi.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Batasan karakteristik :<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l26 level1 lfo60; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Bertanya /meminta informasi,mengungkapkan masalah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l26 level1 lfo60; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Ketidakakuratan mengikuti instruksi ,terjadinya
komplikasi yang dapat di cegah </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 2.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kriteria hasil :</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"> pasien dapat <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l32 level1 lfo61; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Mengungkapkan pemahaman tentang penyakit</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l32 level1 lfo61; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Mengidektifikasi hubungan tanda/gejala dengan proses
penyakit dan menghubungkan gejala dengan faktor penyebab.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l32 level1 lfo61; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Melakukan prosedur tindakan dengan benar</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l32 level1 lfo61; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Melakukan perubahan gaya hidup dan berpartisipasi dalam
program pengobatan.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: 35.4pt;">
<span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Intervensi</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"> :<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo62; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Ciptakan lingkungan saling percaya,mendengarkan dengan
penuh perhatian.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo62; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Demonstrasikan ketrampilan dalam rutinitas sehari-hari</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo62; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Diskusikan topik-topik utama ,misalnya tentang kadar
glukosa komplikasi nya dan lain-lain.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo62; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Demonstrasikan cara memeriksa gula darah dengan
menggunakan finger stick,pemberian insulin.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo62; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">e)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Diskusikan tentang rencana diet pengunaan makanan tinggi
serat dan cara untuk melakukan makan diluar rumah.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo62; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">f)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Tunjau ulang program pengobatan ( seperti pemberian
insulin ), pengaruh rokok pada penggunaan insulin,anjurkan untuk berhenti
merokok.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo62; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">g)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Buat jadwal latihan/aktivitas teratur dengan pasien,untuk
aktivitas fisiknya di rumah sakit,maupun di rumahnya nanti</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo62; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">h)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Identifikasi gejala hipoglikemi (
lemah.pusing,letargi,lapar peka rangsang,sakit kepala,perubahan mental,serta
jelaskan penyebabnya kapada pasien).</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo62; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">i)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Beri informasi dan
edukasi tentang penyakit diabetes mellitus yang sedan di alaminya (proses
penyakitnya)</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo62; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">j)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Rekomendasikan
untuk tidak mengguanakan obat-obat yang di jual bebas tanpa konsultasi /tidak
boleh menggunakan obat tanpa resep.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
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<br /></div>
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<br /></div>
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<b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">DAFTAR
PUSTAKA</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"><o:p></o:p></span></b></div>
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<br /></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 35.45pt; mso-add-space: auto; mso-list: l39 level1 lfo48; text-align: justify; text-indent: -14.15pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Carpenito,
Lynda Juall (2000), Buku saku Diagnosa Keperawatan, Edisi 8, EGC, Jakarta<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 35.45pt; mso-add-space: auto; mso-list: l39 level1 lfo48; text-align: justify; text-indent: -14.15pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Deglin JH and Vallerand,AH : Davis’s Drug Guide for
Nurses,ed 3>FA Davis ,Philadelphia,1992</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 35.45pt; mso-add-space: auto; mso-list: l39 level1 lfo48; text-align: justify; text-indent: -14.15pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Doengoes,
E. Marilyn (1989), Nursing Care Plans, Second Edition, FA Davis, Philadelphia</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 35.45pt; mso-add-space: auto; mso-list: l39 level1 lfo48; text-align: justify; text-indent: -14.15pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Price,
Sylvia (1990), Patofisiologi dan Konsep Dasar Penyakit , EGC, Jakarta<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 35.45pt; mso-add-space: auto; mso-list: l39 level1 lfo48; text-align: justify; text-indent: -14.15pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">5.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">Profesional guide to diseases,ed 3.Springhouse,PA,1989.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>salnihttp://www.blogger.com/profile/00126668517852477742noreply@blogger.com0Universitas Sam Ratulangi, Jalan Kampus Selatan, Manado, Indonesia1.455717 124.8271631.453733 124.8246955 1.457701 124.8296305tag:blogger.com,1999:blog-8321145958076225978.post-29498973038543895202012-03-17T00:57:00.001-07:002012-03-17T00:57:44.061-07:00Gangguan Sistem Endokrin ( PENYAKIT ADDISON )<br />
<div class="MsoListParagraphCxSpFirst" style="line-height: 115%; mso-list: l8 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS"; mso-fareast-language: IN;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Salah satu penyakit yang di
sebabkan oleh gangguan sistem endokrin adalah Insufisiensi adrenal ( Penyakit
Addison )<o:p></o:p></span></div>
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<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l7 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Penyakit Addison adalah suatu kelainan endokrin atau
hormon yang terjadi pada semua kelompok umur dan menimpa pria – pria dan wanita
– wanita sama rata. Penyakit di karakteristikan oleh kehilangan berat badan,
kelemahan otot, kelelahan, tekanan darah rendah dan adakalanya penggelapan
kulit pada kedua – duanya yaitu bagian – bagian tubuh yang terbuka dan tidak
terbuka. <i>(http:/www.total kesehatan nanda.com/Addison 4html)</i><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l7 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Penyakit Addison adalah terjadi bila fungsi
korteks adrenal tidak adekuat untuk memenuhi kebutuhan pasien akan kebutuhan
hormon – hormon korteks adrenal <i>(keperawatan medical bedah, bruner, dan
suddart edisi 8 hal 1325)</i><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 115%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l7 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Penyakit Addison adalah kekurangan partikal sekresi
hormon korteks adrenal. Keadaan seperti ini terlihat pada hipoado tironisme
yang hanya mengenal zona glomeruluna dan sakresi aldosteron pada sindrom
adrenogenetal dimana gangguan enzim menghambat sekresi steoid <i>(Patofisiologi
Edisi 2 Hal 296)</i><o:p></o:p></span></div>
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<br /></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 115%; mso-list: l8 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS"; mso-fareast-language: IN;">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Tanda Dan gejala Penyakit
Addison<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l3 level1 lfo3; text-indent: -18.0pt;">
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<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l3 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">Hiperpigmentasi</span></span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span class="apple-style-span"><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span></span><!--[endif]--><span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">Hipoglikemi</span></span><span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l3 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">Keringat dingin</span></span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">Penurunan kesadaran</span></span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">Kelelahan</span></span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span class="apple-style-span"><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span></span><!--[endif]--><span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">Bb menurun</span></span><span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></span></div>
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<!--[if !supportLists]--><span class="apple-style-span"><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span></span><!--[endif]--><span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">Kelemahan</span></span><span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></span></div>
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<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: Arial; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br clear="all" style="mso-special-character: line-break; page-break-before: always;" />
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<div class="MsoListParagraphCxSpFirst" style="line-height: 115%; mso-list: l8 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS"; mso-fareast-language: IN;">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Penyimpangan KDM pada
penyakit Addison<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><b><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hiperpigmentasi</span></b><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
Pigmentasi pada penyakit Addison disebabkan karena timbunan melanin pada kulit
dan mukosa. Pigmentasijuga dapat terjadi pada penderita yang menggunakan
kortikosteroid jangka panjang, karena timbul insufisiensiadrenal dengan akibat
meningkatnya hormon adrenokortikotropik. Hormon adrenokortikotropik ini
mempunyai<i>MSH-like effect.</i> Pada penyakit Addison terdapat
peningkatan kadar beta MSH dan hormon adrenokortikotropik.Tidak didapatkan
hubungan antara beratnya penyakit Addison dengan luasnya pigmentasi. Pigmentasi
ini sifatnya difus, terutama pada kulit yang mendapat tekanan (misalnya
pinggang dan bahu), siku, jaringan parut, garis-garis telapak tangan dan
ketiak. Pada daerah perianal, perivulva, skrotum dan areola mamma tampak
lebihgelap. Pigmentasi pada mukosa sering tampak pada mukosa mulut yaitu pada
bibir, gusi, lidah, faring,konjungtiva, vagina dan vulva.Pigmentasi didapatkan
100% pada penderita penyakit Addison. Thorn dan kawan-kawan melaporkan dari 158
kasus Addison seluruhnya didapatkan pigmentasi. Rowntree dan Snell melaporkan
dari 108 kasus didapat 1 kasus tanpa pigmentasi. Penderita dengan kegagalan
adrenokortikal sekunder karena hipopituitarisme tidak didapatkan gejala
hiperpigmentasir.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><b><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Sistem Kardiovaskuler</span></b><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l1 level1 lfo13; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS"; mso-fareast-language: IN;">1)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hipotensi<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; text-indent: 0cm;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hipotensi
merupakan gejala dini dari penyakit Addison, di mana tekanan darah sistolik
biasanya antara 80–100 mmHg, sedang tekanan diastolik 50–60 mmHg. Mekanisme
penyebab terjadinya hipotensi ini diduga karena menurunnya <i>salt</i> hormon
yang mempunyai efek langsung pada tonus arteriol serta akibat gangguan
elektrolit. Reaksi tekanan darah terhadap perubahan sikap adalah abnormal, pada
perubahan posisi dari berbaring menjadi posisi tegak maka tekanan darah akan
menurun <i>(postural</i>hipotensi) yang menimbulkan keluhan pusing, lemah,
penglihatan kabur, berdebar-debar .Hipotensi ini juga terdapat pada penderita
dengan atrofi korteks adrenal dengan medula yang intak, sehingga diduga bahwa
epinefrin bukan penyebab dari hipotensi ini. Tekanan darah akan kembali normal
setelah pemberian garam dan desoksikortikosteron yang meningkatkan tonus
vasomotor.<o:p></o:p></span></div>
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<br /></div>
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<!--[if !supportLists]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS"; mso-fareast-language: IN;">2)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Jantung<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; text-indent: 0cm;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Ukuran jantung
penderita Addison biasanya mengecil pada pemeriksaan radiologi, hal ini mungkin
karena penurunan volume darah sekunder akibat kehilangan air. Bertambah
besarnya ukuran jantung merupakan petunjuk berhasilnya pengobatan. Perubahan
elektrokardiografi biasanya tampak tapi tak mempunyai nilai diagnostik,
seringkali didapatkan voltase yang rendah, PR dan QT interval memanjang, oleh
karena kelainan degeneratif organik pada otot jantung serta akibat gangguan
elektrolit. Gejala lain adalah kelemahan kontraksi otot jantung, nadi kecil dan
sinkop.Akibat hiperkalemia dapat terjadi aritmia yang dapat menyebabkan
kematian mendadak.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.0pt; mso-add-space: auto; text-indent: 0cm;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 57.25pt; mso-add-space: auto; mso-list: l13 level1 lfo12; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><b><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Kelemahan Badan</span></b><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 57.25pt; mso-add-space: auto; text-indent: 0cm;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Kelemahan badan
ini disebabkan karena gangguan keseimbangan air dan elektrolit serta gangguan
metabolisme karbohidrat dan protein sehingga didapat kelemahan sampai paralisis
oto bergaris. Di samping itu, akibat metabolisme protein, terutam pada sel-sel
otot menyebabkan otot-otot bergaris atropi, bicaranya lemah. Gejala kelemahan
otot ini berkurang setelah pemberian cairan, garam serta kortikosteroid.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 57.25pt; mso-add-space: auto; text-indent: 0cm;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 57.25pt; mso-add-space: auto; mso-list: l13 level1 lfo12; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><b><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Penurunan berat badan</span></b><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 57.25pt; mso-add-space: auto; text-indent: 0cm;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Penurunan berat
badan biasanya berkisar antara 10–15 kg dalam waktu 6–12 bulan. Penurunan berat
badan ini karena adanya anoreksia, gangguan gastrointestinal lain, dehidrasi,
serta katabolisme protein yang meningkat pada jaringan ekstrahepatik, terutama
jaringan otot. Dengan pengobatan yang adekuat akan didapatkan kenaikan berat
badan.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 57.25pt; mso-add-space: auto; text-indent: 0cm;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 57.25pt; mso-add-space: auto; mso-list: l13 level1 lfo12; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><b><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Kelainan gastrointestinal </span></b><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 57.25pt; mso-add-space: auto; text-indent: 0cm;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Kelainan
gastrointestinal didapatkan pada 80% dari kasus<b> </b>Addison. Anoreksia
biasanya merupakan gejala yang mula-mula tampak, disertai perasaan mual dan
muntah, nyeri<b> </b>epigastrium, disfagia, konstipasi, kadang-kadang
dapat timbul<b> </b>diare<b>. </b>Cairan lambung biasanya menunjukkan
hipoklorhidria<b> </b>sampai aklorhidria. Ini karena rendahnya konsentrasi
klorida<b> </b>dan natrium dalam darah dan jaringan, sehingga produksi<b> </b>asam
klorida lambung menurun. Hipoklorhidria biasanya kembali normal bila
keseirnbangan elektrolit sudah diperbaiki.<b> </b><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 57.25pt; mso-add-space: auto; text-indent: 0cm;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 57.25pt; mso-add-space: auto; mso-list: l13 level1 lfo12; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><b><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Gangguan elektrolit dan air</span></b><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 57.25pt; mso-add-space: auto; text-indent: 0cm;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Penurunan
hormon aldosteron menyebabkan pengeluaran natrium, klorida dan air serta
retensi kalium. Sebagai akibat dari gangguan elektrolit ini terjadi dehidrasi,
hemokonsentrasi dan asidosis.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 57.25pt; mso-add-space: auto; text-indent: 0cm;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 2.0cm; mso-add-space: auto; mso-list: l0 level1 lfo14; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><b><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Gangguan Metabolisme Karbohidrat</span></b><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 57.25pt; mso-add-space: auto; text-indent: 0cm;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Akibat proses
glukoneogenesis yang menurun, penggunaan glukosa oleh jaringan yang meningkat
serta gangguan absorbsi karbohidrat pada usus halus, akan terjadi hipoglikemi
puasa, di mana kadar gula darah puasa. lebih rendah dari harga normal. Pada tes
toleransi glukosa oral didapat kenaikan kadar gula darah yang kurang adekuat,
yaitu menunjukkan kurve yang datar.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 57.25pt; mso-add-space: auto; text-indent: 0cm;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 2.0cm; mso-add-space: auto; mso-list: l0 level1 lfo14; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><b><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Darah Tepi</span></b><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 57.25pt; mso-add-space: auto; text-indent: 0cm;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Sel-sel darah
merah dan hemoglobin sedikit menurun dengan hemokonsentrasi. Jumlah sel darah
putih sedikit menurun dengan relatif limfositosis, eosinofil sedikit meningkat
Perubahan gambaran darah tepi di atas karena menurunnya hidrokortison. Gambaran
hematologi ini tak mempunyai arti yang khas untuk diagnostik.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 57.25pt; mso-add-space: auto; text-indent: 0cm;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 2.0cm; mso-add-space: auto; mso-list: l0 level1 lfo14; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><b><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Gangguan Neurologi dan psikiatri</span></b><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 63.8pt; mso-add-space: auto; text-indent: 0cm;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Manifestasi kelainan pada saraf
antara lain penglihatan kabur ngantuk, yang mungkin berhubungan dengan
kelemahan yang progresif, kadang-kadang penderita gelisah, mudah tersinggung
serta dapat timbul psikosis. Pada elektro-ensefalogram didapat gelombang alfa
lebih pelan terutama pada daerah frontalis, serta menghilangnya gelombang beta.</span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 0cm; text-indent: 0cm;">
<br /></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 0cm; text-indent: 0cm;">
<span style="font-family: 'Comic Sans MS';"><br /></span></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 115%; mso-list: l8 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%;">Masalah
Keperawatan dan Diagnosa Keperawatan<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l6 level1 lfo4; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%;">Masalah
Keperawatan:<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 72.0pt; mso-add-space: auto; text-indent: 0cm;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%;">Kekurangan volume cairan dan
elektrolit<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 72.0pt; mso-add-space: auto; text-indent: 0cm;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%;">Harga diri rendah<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 72.0pt; mso-add-space: auto; text-indent: 0cm;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%;">Kecemasan<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 72.0pt; mso-add-space: auto; text-indent: 0cm;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%;">Kelelahan<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 72.0pt; mso-add-space: auto; text-indent: 0cm;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%;">Penurunan curah jantung<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; text-indent: 0cm;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l6 level1 lfo4; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">Diagnosa keperawatan
Addison</span></span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 72.0pt; mso-add-space: auto; text-indent: 0cm;">
<span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">a. Kekurangan volume cairan dan elektrolit
berhubungan dengan kehilangan cairan dan elektrolit melalui ginjal.</span></span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 72.0pt; mso-add-space: auto; text-indent: 0cm;">
<span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">b. Harga diri rendah berhubungan dengan
hyperpigmentasi</span></span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 72.0pt; mso-add-space: auto; text-indent: 0cm;">
<span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">c. Ansietas berhubungan dengan kurangnya
pengetahuan dan<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 72.0pt; mso-add-space: auto; text-indent: 0cm;">
<span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">perubahan fungsi fisiologi</span></span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 72.0pt; mso-add-space: auto; text-indent: 0cm;">
<span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">d. Kelelahan berhubungan dengan penurunan produksi
energi metabolisme (kadar glucosa darah)</span></span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 72.0pt; mso-add-space: auto; text-indent: 0cm;">
<span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">e. Risiko tinggi terhadap penurunan curah jantung.</span></span><span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 72.0pt; mso-add-space: auto; text-indent: 0cm;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; mso-list: l8 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS"; mso-fareast-language: IN;">5.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Salah Satu Askep yang
sesuai dengan diagnosa di atas adalah sebagai berikut :</span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; text-indent: 0cm;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 54.0pt; mso-add-space: auto; mso-list: l2 level1 lfo5; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS"; mso-fareast-language: IN;">a.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Diagnosa Keperawatan<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 115%; margin-left: 54.0pt; mso-add-space: auto; text-indent: 0cm;">
<br /></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 54.0pt; text-indent: -18.0pt;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> “Kekurangan
Volume cairan berhubungan dengan kehilangan cairan melalui ginjal / kelenjar
keringat, saluran gastrointestinal”<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 54.0pt; text-indent: -18.0pt;">
<br /></div>
<div class="MsoListParagraph" style="line-height: 115%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l6 level1 lfo4; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Definisi</span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 72.0pt; text-indent: 0cm;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Kekurangan volume cairan : keadaan dimana seseorang
yang tidak makan dan minum peroral mempunyai resiko terjadinya dehidrasi
vaskuler, interstisial atau intraseluler.</span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<div class="MsoListParagraph" style="line-height: 115%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l6 level1 lfo4; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Batasan karekteristik.</span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 90.0pt; text-indent: -18.0pt;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">- </span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Mayor :</span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 114.0pt; text-indent: -18.0pt;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">- </span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Ketidakcukupan masukan
cairan peroral.</span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 114.0pt; text-indent: -18.0pt;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">- </span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Tidak adanya keseimbangan
antara asupan dan saluran.</span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 114.0pt; text-indent: -18.0pt;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">- </span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Membran mukosa / kulit
kering.</span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 114.0pt; text-indent: -18.0pt;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">- </span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Berat badan kurang.</span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 90.0pt; text-indent: -18.0pt;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">- </span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Minor :</span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 114.0pt; text-indent: -18.0pt;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">- </span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Meningkatnya natrium darah.</span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 114.0pt; text-indent: -18.0pt;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">- </span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Menurunnya saluran urine
atau saluran urine berlebihan.</span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 114.0pt; text-indent: -18.0pt;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">- </span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Sering berkemih.</span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 114.0pt; text-indent: -18.0pt;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">- </span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Turgor kulit menurun.</span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 114.0pt; text-indent: -18.0pt;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">- </span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Haus / mual/ anoreksia.</span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<div class="MsoListParagraph" style="line-height: 115%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l6 level1 lfo4; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Faktor faktor yang berhubungan.</span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 90.0pt; text-indent: -18.0pt;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">- </span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Situsional</span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 90.0pt; text-indent: 0cm;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Berhubungan dengan muntah / mual.</span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 90.0pt; text-indent: 0cm;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Berhubungan dengan menurunnya motivasi untuk minum,
sekunder terhadap keletihan dan depresi</span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 90.0pt; text-indent: -18.0pt;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">- </span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Berkurangnya asupan cairan
yang dengan</span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 114.0pt; text-indent: -18.0pt;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">- </span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Mual atau anoreksia,
keletihan</span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 0cm; text-indent: 0cm;">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 115%; margin-left: 54.0pt; mso-add-space: auto; mso-list: l2 level1 lfo5; text-indent: -18.0pt;">
<!--[if !supportLists]--><span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS"; mso-fareast-language: IN;">b.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span></span><!--[endif]--><span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">Intervensi Keperawatan</span></span><span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 54.0pt; mso-add-space: auto; text-indent: 0cm;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l6 level1 lfo4; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Tujuan japen : kebutuhan cairan terpenuhi
setelah dilakukan tindakan keperawatan selama ± 4 jam<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l6 level1 lfo4; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Tujuan japan : klien dapat mempertahankan
keseimbangan cairan dan elektrolit setelah dilakukan tindakan keperawatan
selama ± 7 jam<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l6 level1 lfo4; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Kriteria hasil : <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 115%; margin-left: 72.0pt; mso-add-space: auto; text-indent: 0cm;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">- Pengeluaran urin
adekuat (1 cc/kg BB/jam)<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 36.0pt; text-indent: 34.9pt;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">- TTV dbn N : 80 – 100 x/menit S : 36 – 37<sup>o</sup>C
TD : 120/80 mmHg<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 36.0pt; text-indent: 34.9pt;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">- Tekanan nadi perifer jelas kurang dari 3 detik<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 36.0pt; text-indent: 34.9pt;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">- Turgor kulit elastis<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 36.0pt; text-indent: 34.9pt;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">- Pengisian kapiler naik kurang dari 3 detik<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 36.0pt; text-indent: 34.9pt;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">- Membran mukosa lembab<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 36.0pt; text-indent: 34.9pt;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">- Warna kulit tidak pucat<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 36.0pt; text-indent: 34.9pt;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">- Rasa haus tidak ada<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 36.0pt; text-indent: 34.9pt;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">- BB ideal<o:p></o:p></span></div>
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<br /></div>
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<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l11 level1 lfo6; text-indent: -18.0pt;">
<!--[if !supportLists]--><span class="apple-style-span"><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span></span><!--[endif]--><span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Intervensi
Rasionalisasi<o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 108.0pt; mso-add-space: auto; mso-list: l4 level1 lfo9; text-indent: -18.0pt;">
<!--[if !supportLists]--><span class="apple-style-span"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span></span><!--[endif]--><span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Mandiri :<o:p></o:p></span></span></div>
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<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;"><br />
<span class="apple-style-span">1) intervensi > Dapatkan riwayat dari pasien
atau orang terdekat yang berhubungan dengan lama dan intensitas dari gejala
yang muncul. <o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 54.0pt; mso-add-space: auto; text-indent: 0cm;">
<span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">Rasionalisasi > Membantu memperkirakan volume
total cairan<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 54.0pt; mso-add-space: auto; text-indent: 0cm;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;"><br />
<span class="apple-style-span">2) intervensi > Pantau tanda vital, catat
perubahan tekanan darah pada perubahan posisi, kekuatan dari nadi perifer<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 54.0pt; mso-add-space: auto; text-indent: 0cm;">
<span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">Rasionalisasi > Hipotensi postural merupakan
bagian hipovolemia akibat kekurangan hormon aldosteron dan penurunan curah
jantung sebagai akibat dari penurunan kortisol. Nadi mungkin melemah yang mudah
dapat hilang.</span></span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 54.0pt; mso-add-space: auto; text-indent: 0cm;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 54.0pt; mso-add-space: auto; text-indent: 0cm;">
<span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">3) intervensi > Ukur dan timbang berat badan
setiap hari<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 54.0pt; mso-add-space: auto; text-indent: 0cm;">
<span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">Rasionalisasi > Memberikan perkiraan kebutuhan
akan penggantian volume cairan dan keefektifan pengobatan. Peningkatan berat
badan yang cepat disebabkan oleh adanya retensi cairan dan natrium yang berhubungan
dengan pengobatan steroid.</span></span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 54.0pt; mso-add-space: auto; text-indent: 0cm;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 54.0pt; mso-add-space: auto; text-indent: 0cm;">
<span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">4) intervensi > Kaji pasien mengenai rasa haus,
kelelahan, nadi cepat, pengisian kapiler memanjang turgor kulit jelek, membran
mukosa kering. Catat warna kulit dan temperaturnya. <o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 54.0pt; mso-add-space: auto; text-indent: 0cm;">
<span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">Rasionalisasi > Untuk mengindikasikan berlanjutnya
hipovolemia dan mempengaruhi kebutuhan volume pengganti.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 54.0pt; mso-add-space: auto; text-indent: 0cm;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;"><br />
<span class="apple-style-span">5) intervensi > Periksa adanya perubahan dalam
status mental dan sensori .<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 54.0pt; mso-add-space: auto; text-indent: 0cm;">
<span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">Rasionalisasi >
Dehidrasi berat menunjukkan curah jantung dan perfusi jaringan terutama
jaringan otak.</span></span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;"><o:p></o:p></span></div>
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<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 54.0pt; mso-add-space: auto; text-indent: 0cm;">
<span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">6) intervensi >
Auskultasi bising usus/peristaltik usus. Catat dan laporkan adanya mual,
muntah dan diare<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 54.0pt; mso-add-space: auto; text-indent: 0cm;">
<span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">Rasionalisasi >
Kerusakan fungsi saluran cerna dapat meningkatkan kehilangan cairan dan
elektrolit dan mempengaruhi cara untuk pemberian cairan dan nutrisi.</span></span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 54.0pt; mso-add-space: auto; text-indent: 0cm;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 54.0pt; mso-add-space: auto; text-indent: 0cm;">
<span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">7) intervensi >
</span></span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Berikan perawatan mulut secara teratur<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 54.0pt; mso-add-space: auto; text-indent: 0cm;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Rasionalisasi > membantu menurunkan rasa tidak nyaman akibat
dari dehidrasi dan mempertahankan kerusakan membrane mukosa<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 54.0pt; mso-add-space: auto; text-indent: 0cm;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 54.0pt; mso-add-space: auto; text-indent: 0cm;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">8) </span><span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">intervensi > </span></span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Berikan cairan oral diatas
300 cc/hr sesegera mungkin, sesuai dengan kemampuan. <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 54.0pt; mso-add-space: auto; text-indent: 0cm;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Rasionalisasi > adanya
perbaikan pada saluran cerna dan kembalinya fungsi cairan cerna tersebut
memungkinkan cairan dana elektrolit melalui oral<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 54.0pt; mso-add-space: auto; text-indent: 0cm;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 108.0pt; mso-add-space: auto; mso-list: l4 level1 lfo9; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: IN;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Kolaborasi<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-left: 75.25pt; mso-add-space: auto; mso-list: l5 level1 lfo7; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS"; mso-fareast-language: IN;">1)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">intervensi > Berikan cairan, antara lain :<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: 115%; margin-left: 93.25pt; mso-add-space: auto; mso-list: l10 level1 lfo8; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS"; mso-fareast-language: IN;">a)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Cairan Na Cl 0,9 %<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 2.0cm; text-indent: 0cm;">
<span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">Rasionalisasi > </span></span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">mungkin kebutuhan cairan pengganti 4 – 6 liter, dengan
pemberian cairan Na Cl 0,9 % melalui IV 500 – 1000 ml/jam, dapat mengatasi
kekurangan natrium yang sudah terjad.<o:p></o:p></span></div>
<div class="MsoListParagraph" style="line-height: 115%; margin-left: 93.25pt; mso-add-space: auto; mso-list: l10 level1 lfo8; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS"; mso-fareast-language: IN;">b)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Larutan glukosa<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 2.0cm; text-indent: 0cm;">
<span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">Rasionalisasi > </span></span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">dapat menghilangkan hipovolemia<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 2.0cm; text-indent: 0cm;">
<br /></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 2.0cm; text-indent: 0cm;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">2) intervensi > Berikan obat sesuai dosis<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 2.0cm; text-indent: 15.3pt;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">a) Kartison (ortone) / hidrokartison (cortef) 100
mg intravena setiap 6 jam untuk 24 jam<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 2.0cm; text-indent: 0cm;">
<span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">Rasionalisasi ></span></span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> dapat mengganti kekurangan kartison dalam tubuh dan
meningkatkan reabsorbsi natrium sehingga dapat menurunkan kehilangan cairan dan
mempertahankan curah jantung<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 2.0cm; text-indent: 0cm;">
<br /></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 2.0cm; text-indent: 15.3pt;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">b) Mineral kartikoid, flu dokortisan,
deoksikortis 25 – 30 mg/hr peroral<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 2.0cm; text-indent: 0cm;">
<span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">Rasionalisasi ></span></span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> mulai setelah pemberian dosis hidrokortisol yang
tinggi yang telah mengakbatkan retensi garam berlebihan yang mengakibatkan
gangguan tekanan darah dan gangguan elektrolit<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 2.0cm; text-indent: 0cm;">
<br /></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 2.0cm; text-indent: 0cm;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">3) intervensi > Pasang / pertahankan kateter
urin dan selang NGT sesuai indikasi<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 2.0cm; text-indent: 0cm;">
<span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">Rasionalisasi ></span></span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> dapat menfasilitasi pengukuran haluaran dengan akurat
baik urin maupun lambung, berikan dekompresi lambung dan membatasi muntah<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 2.0cm; text-indent: 0cm;">
<br /></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 2.0cm; text-indent: 0cm;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">4) intervensi > Pantau hasil laborat<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 2.0cm; text-indent: 15.3pt;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">a) Hematokrit ( Ht)<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 2.0cm; text-indent: 0cm;">
<span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">Rasionalisasi ></span></span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> peningkatan
kadar Ht darah merupakan indikasi terjadinya hemokonsentrasi yang akan kembali
normal sesuai dengan terjadinya dehidrasi pada tubuh<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 2.0cm; text-indent: 15.3pt;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">b) Ureum / kreatin<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 2.0cm; text-indent: 0cm;">
<span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">Rasionalisasi ></span></span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> peningkatan kadar ureum dan kreatinin darah merupakan
indikasi terjadinya kerusakan tingkat sel karena dehidrasi / tanda serangan
gagal jantung<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 2.0cm; text-indent: 15.3pt;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">c) Natrium<o:p></o:p></span></div>
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<span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">Rasionalisasi ></span></span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> hiponatremia
merupakan indikasi kehilangan melalui urin yang berlebihan katena gangguan
reabsorbsi pada tubulus ginjal<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 2.0cm; text-indent: 15.3pt;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">d) Kalium<o:p></o:p></span></div>
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<span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">Rasionalisasi ></span></span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> penurunan
kadar aldosteron mengakibatkan penurunan natrium dan air sementara itu kalium
tertahan sehingga dapat menyebabkan hiperkalemia<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 115%; margin-left: 54.0pt; mso-add-space: auto; text-indent: 0cm;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;"><br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;">v<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">Kriteria Evaluasi Yang
Diharapkan:</span></span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<span class="apple-style-span"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;">Pasien menunjukkan adanya perbaikan keseimbangan
cairan, dengan kriteria : pengeluaran urine yang adekuat (batas normal),
tanda-tanda vital stabil, tekanan nadi parifer jelas, turgor kulit baik,
pengisian kapiler baik dan membran mukosa lembab/basah.</span></span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Arial;"><br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--></span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br clear="all" style="mso-special-character: line-break; page-break-before: always;" />
</span>
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<br /></div>
<div align="center" class="MsoListParagraph" style="line-height: 115%; margin-left: 54.0pt; mso-add-space: auto; text-align: center; text-indent: 0cm;">
<span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Referensi<o:p></o:p></span></div>
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<br /></div>
<div class="MsoListParagraphCxSpFirst" style="mso-add-space: auto; mso-list: l12 level1 lfo10; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS"; mso-fareast-language: IN;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Carpenito, Lynda Juall, Buku Saku Diagnosa Keperawatan edisi 6 alih bahasa
YasminAsih, Jakarta : EGC, 1997.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="text-indent: -18pt;">
<!--[if !supportLists]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">2.<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial;">Corrigan EK . Addison`s Disease ; Family Health
Guide; 2006; available at : </span><span class="MsoHyperlink"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial;">http://:www.medic8com/healthguide/articles/addisondis.html</span></span><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-add-space: auto; mso-list: l12 level1 lfo10; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS"; mso-fareast-language: IN;">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Doenges, Marilyn E, Rencana Asuhan Keperawatan Pedoman untuk Perencanaan dan
Pendokumentasian Perawatan Pasien edisi 3 alih bahasa I Made
Kariasa, Ni Made Sumarwati, Jakarta : EGC, 1999.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="text-indent: -18pt;">
<!--[if !supportLists]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">4.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial;">Hospital
; New York School of Medicie ; New York City, 2003; avilable at:</span><a href="http://www.caresfoundation.org/news-letter/sping%2003"><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial;">http://www.caresfoundation.org/news-letter/sping
03</span></a><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial;"><o:p></o:p></span></div>
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<br /></div>
<div class="MsoListParagraph" style="text-indent: -18pt;">
<!--[if !supportLists]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">5.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 12.0pt; mso-bidi-font-family: Arial;">Speiser
PW. Adrenal Krisis in : Pediatric Endocrinology.; Schhiner Children`s<o:p></o:p></span></div>
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<br /></div>salnihttp://www.blogger.com/profile/00126668517852477742noreply@blogger.com0tag:blogger.com,1999:blog-8321145958076225978.post-80356215543430888142012-03-17T00:21:00.000-07:002012-03-17T00:21:14.918-07:00ASKEP TBC PARU<br />
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<b><span lang="EN-US">KONSEP DASAR<o:p></o:p></span></b></div>
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<br /></div>
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<b><span lang="EN-US">A. Definisi <o:p></o:p></span></b></div>
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<span lang="EN-US">Tuberculosis merupakan penyakit infeksi bakteri menahun
yang disebabkan oleh Mycobakterium tuberculosis yang ditandai dengan
pembentukan granuloma pada jaringan yang terinfeksi. Mycobacterium tuberculosis
merupakan kuman aerob yang dapat hidup terutama di paru / berbagai organ tubuh
lainnya yang bertekanan parsial tinggi. Penyakit tuberculosis ini biasanya
menyerang paru tetapi dapat menyebar ke hampir seluruh bagian tubuh termasuk
meninges, ginjal, tulang, nodus limfe. Infeksi awal biasanya terjadi 2-10
minggu setelah pemajanan. Individu kemudian dapat mengalami penyakit aktif
karena gangguan atau ketidakefektifan respon imun.</span></div>
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<br /></div>
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<b><span lang="EN-US">B. Etiologi<o:p></o:p></span></b></div>
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<span lang="EN-US">TB paru disebabkan oleh Mycobakterium tuberculosis yang
merupakan batang aerobic tahan asam yang tumbuh lambat dan sensitive terhadap
panas dan sinar UV. Bakteri yang jarang sebagai penyebab, tetapi pernah terjadi
adalah M. Bovis dan M. Avium.</span></div>
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<br /></div>
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<b><span lang="ES-TRAD">C. Tanda Dan Gejala<o:p></o:p></span></b></div>
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<span lang="ES-TRAD">1. Tanda<o:p></o:p></span></div>
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<span lang="EN-US">a. Penurunan berat badan</span></div>
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<span lang="EN-US">b. Anoreksia</span></div>
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<span lang="EN-US">c. Dispneu</span></div>
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<span lang="EN-US">d. Sputum purulen/hijau, mukoid/kuning.</span></div>
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<span lang="ES-TRAD">2. Gejala<o:p></o:p></span></div>
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<span lang="ES-TRAD">a. Demam<o:p></o:p></span></div>
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<span lang="ES-TRAD">Biasanya menyerupai
demam influenza. Keadaan ini sangat dipengaruhi oleh daya tahan tubuh penderita
dengan berat-ringannya infeksi kuman TBC yang masuk.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify;">
<span lang="ES-TRAD">b. Batuk<o:p></o:p></span></div>
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<span lang="ES-TRAD">Terjadi karena
adanya infeksi pada bronkus. Sifat batuk dimulai dari batuk kering kemudian
setelah timbul peradangan menjadi batuk produktif (menghasilkan sputum). Pada
keadaan lanjut berupa batuk darah karena terdapat pembuluh darah yang pecah.
Kebanyakan batuk darah pada ulkus dinding bronkus.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify;">
<span lang="ES-TRAD">c.Sesak nafas.<o:p></o:p></span></div>
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<span lang="ES-TRAD">Sesak nafas akan
ditemukan pada penyakit yang sudah lanjut dimana infiltrasinya sudah setengah
bagian paru.<o:p></o:p></span></div>
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<span lang="ES-TRAD">d. Nyeri dada<o:p></o:p></span></div>
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<span lang="ES-TRAD">Timbul bila
infiltrasi radang sudah sampai ke pleura (menimbulkan pleuritis)<o:p></o:p></span></div>
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<span lang="ES-TRAD">e.Malaise<o:p></o:p></span></div>
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<span lang="ES-TRAD">Dapat berupa
anoreksia, tidak ada nafsu makan, berat badan turun, sakit kepala, meriang,
nyeri otot, keringat malam.<o:p></o:p></span></div>
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<br /></div>
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<b><span lang="EN-US">D. Patofisiologi <o:p></o:p></span></b></div>
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<span lang="EN-US">Pada tuberculosis, basil tuberculosis menyebabkan suatu
reaksi jaringan yang aneh di dalam paru-paru meliputi : penyerbuan daerah
terinfeksi oleh makrofag, pembentukan dinding di sekitar lesi oleh jaringan
fibrosa untuk membentuk apa yang disebut dengan tuberkel. Banyaknya area
fibrosis menyebabkan meningkatnya usaha otot pernafasan untuk ventilasi paru
dan oleh karena itu menurunkan kapasitas vital, berkurangnya luas total
permukaan membrane respirasi yang menyebabkan penurunan kapasitas difusi paru
secara progresif, dan rasio ventilasi-perfusi yang abnormal di dalam paru-paru
dapat mengurangi oksigenasi darah</span><span style="line-height: 150%; text-indent: 36pt;"> </span></div>
<div class="MsoNormal">
<span lang="EN-US"> </span></div>
<div class="MsoNormal">
<br /></div>
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<b><span lang="ES-TRAD">E. Pemeriksaan Penunjang<o:p></o:p></span></b></div>
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<span lang="ES-TRAD"> </span><span lang="EN-US">Pembacaan hasil tuberkulin dilakukan setelah 48 – 72 jam; dengan
hasil positif bila terdapat indurasi diameter lebih dari 10 mm, meragukan bila
5-9 mm. Uji tuberkulin bisa diulang setelah 1-2 minggu. Pada anak yang telah
mendapt BCG, diameter indurasi 15 mm ke atas baru dinyatakan positif, sedangkan
pada anak kontrak erat dengan penderita TBC aktif, diameter indurasi ≥ 5 mm
harus dinilai positif. Alergi disebabkan oleh keadaan infeksi berat, pemberian
immunosupreson, penyakit keganasan (leukemia), dapat pula oleh gizi buruk,
morbili, varicella dan penyakit infeksi lain.</span></div>
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<span lang="EN-US"> </span><span lang="ES-TRAD">Gambaran radiologis yang
dicurigai TB adalah pembesaran kelenjar nilus, paratrakeal, dan mediastinum,
atelektasis, konsolidasi, efusipieura, kavitas dan gambaran milier.
Bakteriologis, bahan biakan kuman TB diambil dari bilasan lambung, namun
memerlukan waktu cukup lama. Serodiagnosis, beberapa diantaranya dengan cara
ELISA (enzyime linked immunoabserben assay) untuk mendeteksi antibody atau uji
peroxidase – anti – peroxidase (PAP) untuk menentukan Ig G spesifik. </span><span lang="EN-US">Teknik bromolekuler, merupakan pemeriksaan sensitif dengan
mendeteksi DNA spesifik yang dilakukan dengan metode PCR (Polymerase Chain
Reaction). Uji serodiagnosis maupun biomolekular belum dapat membedakan TB
aktif atau tidak. </span></div>
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<span lang="EN-US"> Tes tuberkulin
positif, mempunyai arti :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l2 level1 lfo1; tab-stops: list 18.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">1.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Pernah mendapat infeksi basil
tuberkulosis yang tidak berkembang menjadi penyakit.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l2 level1 lfo1; tab-stops: list 18.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">2.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Menderita tuberkulosis yang
masih aktif</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l2 level1 lfo1; tab-stops: list 18.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">3.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Menderita TBC yang sudah sembuh</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l2 level1 lfo1; tab-stops: list 18.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">4.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Pernah mendapatkan vaksinasi
BCG</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l2 level1 lfo1; tab-stops: list 18.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">5.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Adanya reaksi silang (“cross
reaction”) karena infeksi mikobakterium atipik.</span></div>
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<br /></div>
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<b><span lang="EN-US">F. Epidemiologi Dan
Penularan TBC</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify;">
<span lang="EN-US">Dalam penularan infeksi <i>Mycobacterium tuberculosis</i> hal-hal yang perlu diperhatikan adalah :</span></div>
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<!--[if !supportLists]--><span lang="EN-US">1.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Reservour, sumber dan penularan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span lang="EN-US">Manusia adalah reservoar paling umum, sekret saluran
pernafasan dari orang dengan lesi aktif terbuka memindahkan infeksi langsung
melalui droplet.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l13 level2 lfo2; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">2.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Masa inkubasi</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span lang="EN-US">Yaitu sejak masuknya sampai timbulnya lesi primer
umumnya memerlukan waktu empat sampai enam minggu, interfal antara infeksi
primer dengan reinfeksi bisa beberapa tahun.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l13 level2 lfo2; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">3.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Masa dapat menular</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span lang="ES-TRAD">Selama yang
bersangkutan mengeluarkan bacil Turbekel terutama yang dibatukkan atau
dibersinkan.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l13 level2 lfo2; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">4.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Immunitas</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span lang="EN-US">Anak dibawah tiga tahun paling rentan, karena sejak
lahir sampai satu bulan bayi diberi vaksinasi BCG yang meningkatkan tubuh
terhadap TBC.</span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<b><span lang="EN-US">G. Stadium TBC<o:p></o:p></span></b></div>
<ol start="1" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="line-height: 150%; mso-list: l3 level1 lfo9; tab-stops: list 36.0pt; text-align: justify;"><span lang="EN-US">Kelas 0</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span lang="EN-US">Tidak ada jangkitan tuberkulosis, tidak terinfeksi (tidak
ada riwayat terpapar, reaksi terhadap tes kulit tuberkulin tidak bermakna).</span></div>
<ol start="2" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="line-height: 150%; mso-list: l3 level1 lfo9; tab-stops: list 36.0pt; text-align: justify;"><span lang="EN-US">Kelas 1</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span lang="EN-US">Terpapar tuberkulosis, tidak ada bukti terinfeksi
(riwayat pemaparan, reaksi tes tuberkulosis tidak bermakna)</span></div>
<ol start="3" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="line-height: 150%; mso-list: l3 level1 lfo9; tab-stops: list 36.0pt; text-align: justify;"><span lang="EN-US">Kelas 2</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<st1:place w:st="on"><st1:city w:st="on"><span lang="EN-US">Ada</span></st1:city></st1:place><span lang="EN-US"> infeksi tuberkulosis, tidak timbul penyakit (reaksi tes kulit
tuberkulin bermakna, pemeriksa bakteri negatif, tidak bukti klinik maupun
radiografik).</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span lang="EN-US">Status kemoterapi (pencegahan) :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l12 level1 lfo3; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Tidak ada</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l12 level1 lfo3; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Dalam pengobatan kemoterapi</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l12 level1 lfo3; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Komplit (seri pengobatan dalam
memakai resep dokter)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l12 level1 lfo3; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Tidak komplit</span></div>
<ol start="4" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="line-height: 150%; mso-list: l3 level1 lfo9; tab-stops: list 36.0pt; text-align: justify;"><span lang="EN-US">Kelas 3</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span lang="EN-US">Tuberkuosis saat ini sedang sakit (<i>Mycobacterium tuberkulosis</i> ada dalam biakan, selain itu reaksi
kulit tuberkulin bermakna dan atau bukti radiografik tentang adanya penyakit). </span><span lang="FR">Lokasi penyakit : paru, pleura, limfatik,
tulang dan/atau sendi, kemih kelamin, diseminata (milier), menigeal, peritoneal
dan lain-lain.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span lang="EN-US">Status bakteriologis :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l8 level1 lfo4; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">a.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Positif dengan :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l8 level2 lfo4; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Mikroskop saja</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l8 level2 lfo4; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Biakan saja</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l8 level2 lfo4; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Mikroskop dan biakan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l8 level1 lfo4; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">b.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Negatif dengan :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l5 level1 lfo5; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Tidak dikerjakan</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span lang="EN-US">Status kemoterapi :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span lang="EN-US">Dalam pengobatan kemoterapi sejak kemoterapi diakhiri,
tidak lengkap reaksi tes kulit tuberkulin :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l1 level1 lfo6; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">a.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Bermakna</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l1 level1 lfo6; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">b.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Tidak bermakna</span></div>
<ol start="5" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="line-height: 150%; mso-list: l3 level1 lfo9; tab-stops: list 36.0pt; text-align: justify;"><span lang="EN-US">Kelas 4</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span lang="EN-US">Tuberkulosis saat ini tidak sedang menderita penyakit
(ada riwayat mendapat pengobatan pencegahan tuberkulosis atau adanya temuan
radiografik yang stabil pada orang yang reaksi tes kulit tuberkulinya bermakna,
pemeriksaan bakteriologis, bila dilakukan negatif. Tidak ada bukti klinik
tentang adanya penyakit pada saat ini).</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span lang="EN-US">Status kemoterapi :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l4 level1 lfo7; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">a.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Tidak mendapat kemoterapi</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l4 level1 lfo7; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">b.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Dalam pengobatan kemoterapi</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l4 level1 lfo7; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">c.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Komplit</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l4 level1 lfo7; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">d.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Tidak komplit</span></div>
<ol start="6" style="margin-top: 0cm;" type="1">
<li class="MsoNormal" style="line-height: 150%; mso-list: l3 level1 lfo9; tab-stops: list 36.0pt; text-align: justify;"><span lang="EN-US">Kelas 5</span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span lang="EN-US">Orang dicurigai mendapatkan tuberkulosis (diagnosis
ditunda)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<span lang="EN-US">Kasus kemoterapi :</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l11 level1 lfo8; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">a.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Tidak ada kemoterapi</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l11 level1 lfo8; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">b.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Sedang dalam pengobatan
kemoterapi.</span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<b><span lang="EN-US">H. Penanganan<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l3 level2 lfo9; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">a.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Promotif</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l3 level4 lfo9; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">1.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Penyuluhan kepada masyarakat
apa itu TBC</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l3 level4 lfo9; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="ES-TRAD">2.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US">Pemberitahuan baik melalui spanduk/iklan tentang bahaya TBC, cara
penularan</span><span lang="ES-TRAD">, cara
pencegahan, faktor resiko<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l3 level4 lfo9; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">3.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Mensosialisasiklan BCG di
masyarakat.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l3 level2 lfo9; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">b.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Preventif</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l3 level4 lfo9; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">1.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Vaksinasi BCG</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l3 level4 lfo9; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">2.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Menggunakan isoniazid (INH)</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l3 level4 lfo9; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="ES-TRAD">3.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="ES-TRAD">Membersihkan lingkungan dari
tempat yang kotor dan lembab.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l3 level4 lfo9; tab-stops: list 54.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="PT-BR">4.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="PT-BR">Bila ada gejala-gejala TBC segera ke
Puskesmas/RS, agar dapat diketahui secara dini.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l3 level2 lfo9; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">c.<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US">Kuratif</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 36.0pt;">
<span lang="ES-TRAD">Pengobatan
tuberkulosis terutama pada pemberian obat antimikroba dalam jangka waktu yang
lama. Obat-obat dapat juga digunakan untuk mencegah timbulnya penyakit klinis
pada seseorang yang sudah terjangkit infeksi. Penderita tuberkulosis dengan
gejala klinis harus mendapat minuman dua obat untuk mencegah timbulnya strain
yang resisten terhadap obat. Kombinasi obat-obat pilihan adalah isoniazid
(hidrazid asam isonikkotinat = INH) dengan etambutol (EMB) atau rifamsipin
(RIF). Dosis lazim INH untuk orang dewasa biasanya 5-10 mg/kg atau sekitar 300
mg/hari, EMB, 25 mg/kg selama 60 hari, kemudian 15 mg/kg, RIF 600 mg sekali
sehari. Efek samping etambutol adalah Neuritis retrobulbar disertai penurunan
ketajaman penglihatan. Uji ketajaman penglihatan dianjurkan setiap bulan agar
keadaan tersebut dapat diketahui. </span><span lang="EN-US">Efek samping INH yang
berat jarang terjadi. Komplikasi yang paling berat adalah hepatitis. </span><span lang="PT-BR">Resiko hepatitis sangat rendah pada
penderita dibawah usia 20 tahun dan mencapai puncaknya pada usia 60 tahun
keatas. Disfungsi hati, seperti terbukti dengan peningkatan aktivitas serum
aminotransferase, ditemukan pada 10-20% yang mendapat INH. Waktu minimal terapi
kombinasi 18 bulan sesudah konversi biakan sputum menjadi negatif. Sesudah itu
masuk harus dianjurkan terapi dengan INH saja selama satu tahun.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 36.0pt;">
<span lang="PT-BR">Baru-baru
ini CDC dan American Thoracis Societty (ATS) mengeluarkan pernyataan mengenai
rekomendasi kemoterapi jangka pendek bagi penderita tuberkulosis dengan riwayat
tuberkulosis paru pengobatan 6 atau 9 bulan berkaitan dengan resimen yang
terdiri dari INH dan RIF (tanpa atau dengan obat-obat lainnya), dan hanya
diberikan pada pasien tuberkulosis paru tanpa komplikasi, misalnya : pasien
tanpa penyakit lain seperti diabetes, silikosis atau kanker didiagnosis TBC
setelah batuk darah, padahal mengalami batu dan mengeluarkan keringat malam
sekitar 3 minggu.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 36.0pt;">
<span lang="PT-BR"><br /></span></div>
<div class="MsoNormal">
<span lang="PT-BR"><o:p> </o:p></span><b style="line-height: 150%; text-align: justify;"><span lang="PT-BR">NURSING CARE PLAN</span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; mso-list: l11 level2 lfo8; tab-stops: 27.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="PT-BR">1.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="PT-BR">Pengkajian<o:p></o:p></span></div>
<ol start="1" style="margin-top: 0cm;" type="a">
<li class="MsoNormal" style="line-height: 150%; mso-list: l6 level1 lfo10; tab-stops: list 36.0pt left 147.0pt; text-align: justify;"><span lang="PT-BR">Riwayat keperawatan : riwayat kontak dengan penderita<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l6 level1 lfo10; tab-stops: list 36.0pt left 147.0pt; text-align: justify;"><span lang="PT-BR">Manifestasi klinis seperti demam, anoreksia, penurunan berat badan,
berkeringat malam, keletihan, batuk dan pembentukan sputum, fungsi
pernafasan, nyeri dada, bunyi nafas, kesiapan emosional, persepsi dan
pengertian tuberkulosis dan pengobatannya, evaluasi fisik dan
laboratorium.<o:p></o:p></span></li>
</ol>
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<!--[if !supportLists]--><span lang="PT-BR">2.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="PT-BR">Diagnosa keperawatan<o:p></o:p></span></div>
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<li class="MsoNormal" style="line-height: 150%; mso-list: l9 level1 lfo11; tab-stops: list 36.0pt left 147.0pt; text-align: justify;"><span lang="PT-BR">Gangguan pertukaran gas berhubungan dengan penurunan permukaan
parenkim paru<o:p></o:p></span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 147.0pt; text-align: justify;">
<span lang="PT-BR">Intervensi<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="PT-BR">1.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="PT-BR">Kaji dispnea, takipnea, tak
normal/menurunnya bunyi nafas, peningkatan upaya pernafasan, terbatasnya
ekspansi dinding dada, dan kelemahan<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l0 level1 lfo12; tab-stops: list 54.0pt left 147.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="PT-BR">2.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="PT-BR">Evaluasi perubahan pada tingkat
kesadaran, catat perubahan pada warna kulit, termasuk membran mukosa dan kuku.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l0 level1 lfo12; tab-stops: list 54.0pt left 147.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="PT-BR">3.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="PT-BR">Dorong bernafas bibir selama
ekshalasi, khususnya untuk pasien dengan fibrosis atau kerusakan parenkim.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l0 level1 lfo12; tab-stops: list 54.0pt left 147.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="PT-BR">4.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="PT-BR">Tingkatkan tirah baring/batasi
aktivitas dan bantu aktivitas perawatan diri sesuai keperluan.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l0 level1 lfo12; tab-stops: list 54.0pt left 147.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="PT-BR">5.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="PT-BR">Kolaborasi periksaan AGD dan
pemberian oksigen tambahan yang sesuai.<o:p></o:p></span></div>
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<li class="MsoNormal" style="line-height: 150%; mso-list: l9 level1 lfo11; tab-stops: list 36.0pt left 147.0pt; text-align: justify;"><span lang="PT-BR">Bersihan jalan nafas tidak efektif berhubungan dengan penumpukan
sputum<o:p></o:p></span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 147.0pt; text-align: justify;">
<span lang="PT-BR">Intervensi
:<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="PT-BR">1.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="PT-BR">Kaji fungsi pernafasan, bunyi nafas,
kecepatan, irama dan kedalaman dan penggunaan otot aksesori.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l10 level1 lfo13; tab-stops: list 54.0pt left 147.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="PT-BR">2.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="PT-BR">Catat kemampuan untuk mengeluarkan
mukus/batuk efektif, catat karakter, jumlah sputum, adanya hemoptisis.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l10 level1 lfo13; tab-stops: list 54.0pt left 147.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="PT-BR">3.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="PT-BR">Berikan pasien posisi semi fowler
atau fowler tinggi. Bantu pasien untuk batuk dan latihan nafas dalam.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l10 level1 lfo13; tab-stops: list 54.0pt left 147.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="PT-BR">4.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="PT-BR">Pertahankan masukan cairan sedikitnya
2500 ml/hari kecuali kontraindikasi.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l10 level1 lfo13; tab-stops: list 54.0pt left 147.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="PT-BR">5.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="PT-BR">Kolaborasi pemberian obat-obatan
sesuai indikasi (agen mukolitik, bronkodilator, kortikosteroid).<o:p></o:p></span></div>
<ol start="3" style="margin-top: 0cm;" type="a">
<li class="MsoNormal" style="line-height: 150%; mso-list: l9 level1 lfo11; tab-stops: list 36.0pt left 147.0pt; text-align: justify;"><span lang="PT-BR">Perubahan nutrisi kurang dari kebutuhan tubuh berhubungan dengan
anoreksia<o:p></o:p></span></li>
</ol>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 147.0pt; text-align: justify;">
<span lang="PT-BR">Intervensi
:<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="PT-BR">1.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="PT-BR">Catat status nutrisi pasien pada
penerimaan, catat turgor kulit, berat badan, integritas mukosa oral, riwayat
mual/muntah atau diare.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l7 level1 lfo14; tab-stops: list 54.0pt left 147.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="PT-BR">2.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="PT-BR">Pastikan pola diit biasa pasien,
yang disukai/tidak disukai.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="PT-BR">3.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="PT-BR">Awasi masukan/pengeluaran dan berat
badan secara periodik.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l7 level1 lfo14; tab-stops: list 54.0pt left 147.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="PT-BR">4.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="PT-BR">Dorong dan berikan periode istirahat
sering.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l7 level1 lfo14; tab-stops: list 54.0pt left 147.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="PT-BR">5.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="PT-BR">Berikan perawatan mulut sebelum dan
sesudah tindakan pernafasan.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="PT-BR">6.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="PT-BR">Dorong makan sedikit dan sering
dengan makanan tinggi protein dan karbohidrat.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="PT-BR">7.<span style="font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="PT-BR">Kolaborasi ahli gizi untuk
menentukan komposisi diit.<o:p></o:p></span></div>
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<br /></div>
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<br /></div>
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<b><span lang="PT-BR">DAFTAR PUSTAKA<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 200%; margin-left: 27.0pt; tab-stops: 147.0pt; text-align: justify; text-indent: -9.0pt;">
<span lang="PT-BR">- Barbara, C.L., 1996, Perawatan Medikal Bedah (suatu pendekatan proses
keperawatan), Bandung<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-left: 18.0pt; tab-stops: 147.0pt; text-align: justify;">
<span lang="PT-BR">-
Smeltzer and Bare, 2002, Buku Ajar Keperawatan Medikal Bedah, EGC, Jakarta<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 200%; margin-left: 18.0pt; tab-stops: 147.0pt; text-align: justify;">
<span lang="PT-BR">-
Doengoes, M.E, Rencana Asuhan Keperawatan, edisi 3, EGC, Jakarta.<o:p></o:p></span></div>salnihttp://www.blogger.com/profile/00126668517852477742noreply@blogger.com0tag:blogger.com,1999:blog-8321145958076225978.post-67206998108736741192012-03-16T04:50:00.000-07:002012-03-16T04:50:05.893-07:00ASKEP ANAK DENGAN MALARIA<br />
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<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 14.0pt; line-height: 150%;">BAB I<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 14.0pt; line-height: 150%;">TINJAUAN
TEORITIS<o:p></o:p></span></div>
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<br /></div>
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<br /></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">A.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">DEFINISI<o:p></o:p></span></b></div>
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<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Malaria
adalah penyakit infeksi menular yang disebabkan oleh parasit dari genus
Plasmodium, yang ditularkan melalui gigitan nyamuk anopheles dengan gambaran
penyakit berupa demam yang sering periodik, anemia, pembesaran limpa dan
berbagai kumpulan gejala oleh karena pengaruhnya pada beberapa organ misalnya
otak, hati dan ginjal.<o:p></o:p></span></div>
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<span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Malaria merupakan
penyakit infeksi akut hingga kronik yang disebabkan oleh satu atau lebih
spesies Plasmodium, ditandai dengan panas tinggi bersifat intermiten, anemia,
dan hepatosplenomegali. Plasmodium falciparum menyebabkan<i> malaria tropikana</i>, Plasmodium vivax menyebabkan<i> malaria tertiana</i>,
Plasmodium ovale menyebabkan<i>
malaria ovale</i>, Plasmodium malariae<i> </i>menyebabkan<i> malaria kuartana</i></span><i><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">.
</span></i><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<br /></div>
<div class="MsoListParagraphCxSpFirst" style="margin-left: 54.0pt; mso-add-space: auto; mso-list: l20 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">B.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">KLASIFIKASI<o:p></o:p></span></b></div>
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<br /></div>
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<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Menurut Harijanto (2000) pembagian jenis-jenis
malaria berdasarkan jenis plasmodiumnya antara lain sebagai berikut :<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -21.3pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Malaria
Tropika (Plasmodium Falcifarum)<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Malaria tropika/ falciparum malaria tropika
merupakan bentuk yang paling berat, ditandai dengan panas yang ireguler,
anemia, splenomegali, parasitemia yang banyak dan sering terjadi komplikasi.
Masa inkubasi 9-14 hari. Malaria tropika menyerang semua bentuk eritrosit.
Disebabkan oleh Plasmodium falciparum. Plasmodium ini berupa Ring/ cincin kecil
yang berdiameter 1/3 diameter eritrosit normal dan merupakan satu-satunya
spesies yang memiliki 2 kromatin inti (Double Chromatin).</span><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Plasmodium Falcifarum menyerang sel darah
merah seumur hidup. Infeksi Plasmodium Falcifarum sering kali menyebabkan sel
darah merah yang mengandung parasit menghasilkan banyak tonjolan untuk melekat
pada lapisan endotel dinding kapiler dengan akibat obstruksi trombosis dan iskemik
lokal. Infeksi ini sering kali lebih berat dari infeksi lainnya dengan angka
komplikasi tinggi (Malaria Serebral, gangguan gastrointestinal, Algid Malaria,
dan Black Water Fever).<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; mso-add-space: auto; mso-list: l6 level1 lfo19; text-indent: -21.3pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Malaria
Kwartana (Plasmoduim Malariae)<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Plasmodium Malariae mempunyai tropozoit yang
serupa dengan Plasmoduim vivax, lebih kecil dan sitoplasmanya lebih kompak/
lebih biru. Tropozoit matur mempunyai granula coklat tua sampai hitam dan
kadang-kadang mengumpul sampai membentuk pita. Skizon Plasmodium malariae
mempunyai 8-10 merozoit yang tersusun seperti kelopak bunga/ rossete. Bentuk
gametosit sangat mirip dengan Plasmodium vivax tetapi lebih kecil. Ciri-ciri
demam tiga hari sekali setelah puncak 48 jam. Gejala lain nyeri pada kepala dan
punggung, mual, pembesaran limpa, dan malaise umum. Komplikasi yang jarang
terjadi namun dapat terjadi seperti sindrom nefrotik dan komplikasi terhadap
ginjal lainnya. Pada pemeriksaan akan di temukan edema, asites, proteinuria,
hipoproteinemia, tanpa uremia dan hipertensi.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -21.3pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Malaria
Ovale (Plasmodium Ovale)<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Malaria Tersiana (Plasmodium Ovale) bentuknya
mirip Plasmodium malariae, skizonnya hanya mempunyai 8 merozoit dengan masa
pigmen hitam di tengah. Karakteristik yang dapat di pakai untuk identifikasi
adalah bentuk eritrosit yang terinfeksi Plasmodium Ovale biasanya oval atau
ireguler dan fibriated. Malaria ovale merupakan bentuk yang paling ringan dari
semua malaria disebabkan oleh Plasmodium ovale. Masa inkubasi 11-16 hari, walau
pun periode laten sampai 4 tahun. Serangan paroksismal 3-4 hari dan jarang
terjadi lebih dari 10 kali walau pun tanpa terapi dan terjadi pada malam hari.</span><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Malaria
Tersiana (Plasmodium Vivax)<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Malaria Tersiana (Plasmodium Vivax) biasanya
menginfeksi eritrosit muda yang diameternya lebih besar dari eritrosit normal.
Bentuknya mirip dengan plasmodium Falcifarum, namun seiring dengan maturasi,
tropozoit vivax berubah menjadi amoeboid. Terdiri dari 12-24 merozoit ovale dan
pigmen kuning tengguli. Gametosit berbentuk oval hampir memenuhi seluruh
eritrosit, kromatinin eksentris, pigmen kuning. Gejala malaria jenis ini secara
periodik 48 jam dengan gejala klasik trias malaria dan mengakibatkan demam
berkala 4 hari sekali dengan puncak demam setiap 72 jam.</span><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Dari
semua jenis malaria dan jenis plasmodium yang menyerang system tubuh, malaria
tropika merupakan malaria yang paling berat di tandai dengan panas yang
ireguler, anemia, splenomegali, parasitemis yang banyak, dan sering terjadinya
komplikasi.<o:p></o:p></span></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">C.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">ETIOLOGI<o:p></o:p></span></b></div>
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<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Malaria
pada manusia hanya dapat ditularkan oleh nyamuk betina Anopheles. Lebih dari
400 spesies Anopheles di dunia, hanya sekitar 67 yang terbukti mengandung
sporozoit dan dapat menularkan malaria. <o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Karakteristik
nyamuk Anopeles adalah sebagai berikut :<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">1)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Hidup di daerah tropic dan sub
tropic, ditemukan hidup di dataran rendah<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">2)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Menggigit antara waktu senja
(malam hari) dan subuh hari<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">3)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Biasanya tinggal di dalam rumah,
di luar rumah, dan senang mengigit manusia (menghisap darah)<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">4)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Jarak terbangnya tidak lebih dari
2-3 km<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">5)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Pada saat menggigit bagian
belakangnya mengarah ke atas dengan sudut 48 derajat<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">6)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Siklus hidupnya memerlukan waktu
± 1 minggu, yang biasanya :<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Fase seksual eksogen (sporogoni) dalam tubuh nyamuk.</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Fase aseksual (skizogoni) dalam tubuh hospes
perantara/manusia</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><img alt="*" height="12" src="file:///C:/Users/USER/AppData/Local/Temp/msohtmlclip1/01/clip_image001.gif" width="12" /><span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Daur dalam darah
(skozogoni eritrosit)</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><img alt="*" height="12" src="file:///C:/Users/USER/AppData/Local/Temp/msohtmlclip1/01/clip_image001.gif" width="12" /><span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">daur dalam sel
parenkim hati/stadium jaringan (skizogoni ekso-eritrosit).</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Lebih
senang hidup di daerah rawa</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">7)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Sarang nyamuk Anopheles
bervariasi, ada yang di air tawar, air payau dan ada pula yang bersarang pada
genangan air pada cabang-cabang pohon yang besar (Slamet, 2002, hal 103).<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Menurut
Harijanto (2000) ada empat jenis plasmodium yang dapat menyebabkan</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"> </span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">infeksi</span><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;">, y</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">aitu:<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">a)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Plasmodium vivax, merupakan
infeksi yang paling sering dan menyebabkan malaria tertiana/ vivaks (demam pada
tiap hari ke tiga).<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">b)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Plasmodium falciparum, memberikan
banyak komplikasi dan mempunyai perlangsungan yang cukup ganas, mudah resisten
dengan pengobatan dan menyebabkan malaria tropika/ falsiparum (demam tiap 24-48
jam).<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">c)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Plasmodium malariae, jarang
ditemukan dan menyebabkan malaria quartana/malariae (demam tiap hari empat).<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">d)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Plasmodium ovale, dijumpai pada
daerah Afrika dan Pasifik Barat, diIndonesia dijumpai di Nusa Tenggara dan
Irian, memberikan infeksi yang paling ringan dan dapat sembuh spontan tanpa
pengobatan, menyebabkan malaria ovale.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Masa
inkubasi malaria bervariasi tergantung pada daya tahan tubuh dan spesies
plasmodiumnya. Masa inkubasi Plasmodium vivax 14-17 hari, Plasmodium ovale
11-16 hari, Plasmodium malariae 12-14 hari dan Plasmodium falciparum 10-12 hari
(Mansjoer, 2001).</span><span style="font-family: 'Comic Sans MS'; font-size: 11pt; line-height: 150%;"> </span></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">D.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">PATOFISIOLOGI<o:p></o:p></span></b></div>
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<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Terjadinya
infeksi oleh parasit Plasmodium ke dalam tubuh manusia dapat terjadi melalui
dua cara yaitu :<b><o:p></o:p></b></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">1)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Secara alami melalui gigitan
nyamuk anopheles betina yang mengandung parasit malaria.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">2)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Induksi yaitu jika stadium
aseksual dalam eritrosit masuk ke dalam darah manusia, misalnya melalui
transfuse darah, suntikan, atau pada bayi yang baru lahir melalui plasenta ibu
yang terinfeksi (congenital).<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Patofisiologi
malaria sangat kompleks dan mungkin berhubungan dengan hal-hal sebagai berikut.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">a)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Penghancuran eritrosit yang
terjadi oleh karena :<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Pecahnya
eritrosit yang mengandung parasit<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Fagositosis
eritrosit yang mengandung dan tidak mengandung parasit<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Akibatnya
terjadi anemia dan anoksia jaringan dan hemolisis intravaskuler<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l25 level1 lfo8; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">b)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Pelepasan mediator
Endotoksin-makrofag<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="text-indent: 20.7pt;">
<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Pada
proses skizoni yang melepaskan endotoksin, makrofag melepaskan berbagai
mediator endotoksin.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l25 level1 lfo8; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">c)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Pelepasan TNF ( Tumor necrosing
factor atau factor nekrosis tumor )<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="text-indent: 20.7pt;">
<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Merupakan
suatu monokin yang dilepas oleh adanya parasit malaria. TNF ini bertanggung
jawab terhadap demam, hipoglikemia, ARDS.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l25 level1 lfo8; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">d)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Sekuetrasi eritrosit<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="text-indent: 18.0pt;">
<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Eritrosit
yang terinfeksi dapat membentuk knob di permukaannya. Knob ini mengandung
antigen malaria yang kemudian akan bereaksi dengan antibody. Eritrosit yang
terinfeksi akan menempel pada endotel kapiler alat dalam dan membentuk gumpalan
sehingga terjadi bendungan.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraph" style="margin-left: 54.0pt; mso-add-space: auto; mso-list: l20 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">E.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">MANIFESTASI KLINIS<o:p></o:p></span></b></div>
<div class="MsoNormal" style="text-indent: 18.0pt;">
<br /></div>
<div class="MsoNormal" style="text-indent: 36.0pt;">
<span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Gejala klinik
malaria</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"> pada anak </span><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">sangat bervariasi</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">
dan </span><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">sering tidak khas. Pada anak besar, semua gejala klinik
dapat tampak,</span><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">selain reaksi
radang yang sistemik, juga manifestasi pada organ, mulai dari gejala SSP, ginjal,
paru maupun gangguan faal</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">. <o:p></o:p></span></div>
<div class="MsoListParagraph" style="mso-list: l17 level1 lfo9; text-indent: -21.8pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">1)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Demam<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Demam
periodik yang berkaitan dengan saat pecahnya skizon matang (sporolasi). Pada
Malaria Tertiana (P.Vivax dan P. Ovale), pematangan skizon tiap 48 jam maka
periodisitas demamnya setiap hari ke-3, sedangkan Malaria Kuartana (P.
Malariae) pematangannya tiap 72 jam dan periodisitas demamnya tiap 4 hari. Tiap
serangan di tandai dengan beberapa serangan demam periodik.</span><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 18.0pt; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Gejala
umum (gejala klasik) yaitu terjadinya “Trias Malaria” (malaria proxysm) secara
berurutan: <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="margin-left: 2.0cm; mso-add-space: auto; mso-list: l1 level1 lfo10; text-indent: -21.25pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Periode dingin.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 2.0cm; mso-add-space: auto; text-indent: 15.3pt;">
<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Mulai menggigil, kulit kering dan dingin,
penderita sering membungkus diri dengan selimut atau sarung dan pada saat
menggigil sering seluruh badan bergetar dan gigi-gigi saling terantuk, pucat sampai
sianosis seperti orang kedinginan. Periode ini berlangsung 15 menit sampai 1
jam diikuti dengan meningkatnya temperatur.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 2.0cm; mso-add-space: auto; mso-list: l1 level1 lfo10; text-indent: -21.25pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Periode panas.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 2.0cm; mso-add-space: auto; text-indent: 15.3pt;">
<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Muka merah, kulit panas dan kering, nadi
cepat dan panas tetap tinggi sampai 40oC atau lebih, respirasi meningkat, nyeri
kepala, nyeri retroorbital, muntah-muntah, dapat terjadi syok (tekanan darah
turun), kesadaran delirium sampai terjadi kejang (anak). Periode ini lebih lama
dari fase dingin, dapat sampai 2 jam atau lebih, diikuti dengan keadaan
berkeringat.</span><span style="font-family: 'Comic Sans MS'; font-size: 11pt; line-height: 150%; text-indent: 15.3pt;"> </span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 2.0cm; mso-add-space: auto; mso-list: l1 level1 lfo10; text-indent: -21.25pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Periode berkeringat.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 2.0cm; mso-add-space: auto; text-indent: 15.3pt;">
<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Penderita berkeringat mulai dari temporal,
diikuti seluruh tubuh, sampai basah, temperatur turun, penderita merasa capai
dan sering tertidur. Bila penderita bangun akan merasa sehat dan dapat
melakukan pekerjaan biasa.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l17 level1 lfo9; text-indent: -21.8pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">2)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Splenomegali<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 14.2pt; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Splenomegali
adalah pembesaran limpa yang merupakan gejala khas Malaria Kronik. Limpa
mengalami kongesti, menghitam dan menjadi keras karena timbunan pigmen
eritrosit parasit dan jaringan ikat bertambah (Corwin , 2000, hal. 571).
Pembesaran limpa terjadi pada beberapa infeksi ketika membesar sekitar 3 kali
lipat. Lien dapat teraba di bawah arkus costa kiri, lekukan pada batas
anterior. Pada batasan anteriornya merupakan gambaran pada palpasi yang
membedakan jika lien membesar lebih lanjut. Lien akan terdorong ke bawah ke
kanan, mendekat umbilicus dan fossa iliaca dekstra.<o:p></o:p></span></div>
<div class="MsoListParagraph" style="mso-list: l17 level1 lfo9; text-indent: -21.8pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">3)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Anemia<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 14.2pt; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Derajat
anemia tergantung pada spesies penyebab, yang paling berat adalah anemia karena
Falcifarum. Anemia di sebabkan oleh penghancuran eritrosit yang berlebihan
Eritrosit normal tidak dapat hidup lama (reduced survival time). Gangguan
pembentukan eritrosit karena depresi eritropoesis dalam sumsum tulang
(Mansjoer. dkk, Hal. 411).<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="margin-left: 54.0pt; mso-add-space: auto; mso-list: l20 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">F.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">PENATALAKSANAAN<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.0pt; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 35.45pt; mso-add-space: auto; mso-list: l22 level1 lfo21; mso-text-indent-alt: -14.2pt; text-indent: -35.45pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";"><span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span>I.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><b><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Medikamentosa</span></b><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 49.65pt; mso-add-space: auto; mso-list: l16 level1 lfo22; text-indent: -21.3pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">1)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Untuk semua
spesies Plasmodium, kecuali <i>P.falciparum</i> yang resisten terhadap
klorokuin.</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; mso-add-space: auto; mso-list: l3 level1 lfo23; text-indent: -14.15pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Klorokuin sulfat oral, 25 mg/kgbb terbagi dalam 3 hari
yaitu 10 mg/kg bb pada hari ke-1 dan 2, serta 5 mg/kg bb pada hari ke-3.</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; mso-add-space: auto; mso-list: l3 level1 lfo23; text-indent: -14.15pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Kina dihidroklorid intravena 1mg garam/kg bb/dosis dalam
10 cc/kg bb larutan dekstrosa 5% atau
larutan NaCl 0,9%, diberikan per infus dalam 4 jam, diulangi tiap 8 jam dengan
dosis yang sama sampai terapi oral dapat dimulai. Keseluruhan pemberian obat
adalah 7 hari dengan dosis total 21 kali. </span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; mso-add-space: auto; mso-list: l26 level1 lfo24; text-indent: -14.15pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Lini pertama untuk P. falciparum adalah tablet
artesunat (4 mg/kgBB dosis tunggal/hari/oral,
hari 1, 2, 3) + tablet amodiakuin (10 mg basa/kgBB/hari, hari 1, 2, 3) +
tablet primakuin (dosis 0.75 mg basa/kgBB/oral dosis tunggal pada hari 1). Lini
kedua digunakan tablet kina (30mg/kgBB/hari, dibagi 3 dosis) + tetrasiklin (50
mg/kgBB, 4 dosis)/doksisiklin (2 mg/kgBB/hari, 2 dosis) + primakuin (dosis
tunggal)<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l16 level1 lfo22; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">2)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman";">Plasmodium falciparum</span><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"> yang resisten
terhadap klorokuin<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; mso-add-space: auto; mso-list: l26 level1 lfo24; text-indent: -14.15pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Kuinin sulfat oral 10 mg/kg bb/dosis, 3 kali sehari,
selama 7 hari. <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; mso-add-space: auto;">
<span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Dosis untuk bayi adalah 10 mg/umur dalam bulan dibagi 3
bagian selama 7 hari.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; mso-add-space: auto; mso-list: l26 level1 lfo24; text-indent: -14.15pt;">
<!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Ditambah Tetrasiklin oral 5 mg/kg bb/kali, 4 kali sehari
selama 7 hari (maksimum 4 x 250 mg/hari)<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l16 level1 lfo22; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">3)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Regimen alternatif</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; mso-add-space: auto; mso-list: l26 level1 lfo24; text-indent: -14.15pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Kuinin sulfat oral</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; mso-add-space: auto; mso-list: l26 level1 lfo24; text-indent: -14.15pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Kuinin dihidroklorid intravena ditambah Pirimetamin
sulfadoksin (fansidar) oral </span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.0pt; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.0pt; mso-add-space: auto;">
<span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Tabel 1. Dosis pirimetamin
sulfadoksin (fansidar) menurut umur</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 54.0pt; mso-add-space: auto;">
<br /></div>
<table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; margin-left: 89.75pt; mso-padding-alt: 0cm 0cm 0cm 0cm; mso-yfti-tbllook: 1184;">
<tbody>
<tr style="height: 29.85pt; mso-yfti-firstrow: yes; mso-yfti-irow: 0;">
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: none; border-top: solid windowtext 1.0pt; height: 29.85pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 128.3pt;" valign="top" width="171">
<div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">Umur</span></b><b><span style="font-family: "Comic Sans MS"; mso-ansi-language: IN; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></b></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">(Tahun)</span></b><span lang="EN-US" style="font-family: "Comic Sans MS"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: none; border-top: solid windowtext 1.0pt; height: 29.85pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 163.0pt;" valign="top" width="217">
<div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">Pirimetamin sulfadoksin (Tablet)</span></b><span lang="EN-US" style="font-family: "Comic Sans MS"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="padding: 0cm 5.4pt 0cm 5.4pt; width: 128.3pt;" valign="top" width="171">
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">< 1</span><span lang="EN-US" style="font-family: "Comic Sans MS"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
</td>
<td style="padding: 0cm 5.4pt 0cm 5.4pt; width: 163.0pt;" valign="top" width="217">
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">1/4</span><span lang="EN-US" style="font-family: "Comic Sans MS"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="padding: 0cm 5.4pt 0cm 5.4pt; width: 128.3pt;" valign="top" width="171">
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">1-3</span><span lang="EN-US" style="font-family: "Comic Sans MS"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
</td>
<td style="padding: 0cm 5.4pt 0cm 5.4pt; width: 163.0pt;" valign="top" width="217">
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">1/2</span><span lang="EN-US" style="font-family: "Comic Sans MS"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="padding: 0cm 5.4pt 0cm 5.4pt; width: 128.3pt;" valign="top" width="171">
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">4-8</span><span lang="EN-US" style="font-family: "Comic Sans MS"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
</td>
<td style="padding: 0cm 5.4pt 0cm 5.4pt; width: 163.0pt;" valign="top" width="217">
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">1</span><span lang="EN-US" style="font-family: "Comic Sans MS"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="padding: 0cm 5.4pt 0cm 5.4pt; width: 128.3pt;" valign="top" width="171">
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">9-14</span><span lang="EN-US" style="font-family: "Comic Sans MS"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
</td>
<td style="padding: 0cm 5.4pt 0cm 5.4pt; width: 163.0pt;" valign="top" width="217">
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">2</span><span lang="EN-US" style="font-family: "Comic Sans MS"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-bottom: solid windowtext 1.0pt; border: none; padding: 0cm 5.4pt 0cm 5.4pt; width: 128.3pt;" valign="top" width="171">
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">> 14</span><span lang="EN-US" style="font-family: "Comic Sans MS"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border: none; padding: 0cm 5.4pt 0cm 5.4pt; width: 163.0pt;" valign="top" width="217">
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: Arial; mso-fareast-font-family: "Times New Roman";">3</span><span lang="EN-US" style="font-family: "Comic Sans MS"; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
</td>
</tr>
</tbody></table>
<div class="MsoListParagraph" style="mso-list: l16 level1 lfo22; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">4)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Pencegahan relaps<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">
Primakuin fosfat oral<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="margin-left: 63.8pt; mso-add-space: auto; mso-list: l12 level1 lfo25; text-indent: -14.15pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Malaria <i>falciparum </i>: 0,5-0,75 mg/kgbb, dosis
tunggal, pada hari pertama pengobatan</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; mso-add-space: auto; mso-list: l12 level1 lfo25; text-indent: -14.15pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Malaria <i>vivax, malariae, </i>dan <i>ovale </i>: 0,25
mg/kg bb, dosis tunggal selama 5-14 hari.</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.0pt; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l22 level1 lfo21; mso-text-indent-alt: -14.7pt; text-indent: -36.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";"><span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span>II.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><b><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Suportif</span></b><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 35.45pt; mso-add-space: auto; mso-list: l21 level1 lfo14; text-indent: -21.25pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">1)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Pemberian cairan, nutrisi, transfusi darah</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; mso-add-space: auto; mso-list: l18 level1 lfo26; text-indent: -14.15pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Penuhi kebutuhan volume cairan intravaskular dan jaringan
dengan pemberian oral atau parenteral.</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; mso-add-space: auto; mso-list: l18 level1 lfo26; text-indent: -14.15pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Pelihara keadaan nutrisi.</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; mso-add-space: auto; mso-list: l18 level1 lfo26; text-indent: -14.15pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Transfusi darah <i>pack red cell</i> 10 ml/kg bb atau <i>whole
blood </i>20 ml/kg bb apabila anemia dengan Hb < 7,1g/dl.</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; mso-add-space: auto; mso-list: l18 level1 lfo26; text-indent: -14.15pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Bila terjadi perdarahan, diberikan komponen darah yang
sesuai.</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; mso-add-space: auto; mso-list: l18 level1 lfo26; text-indent: -14.15pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Pengobatan gangguan asam basa dan elektrolit.</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; mso-add-space: auto; mso-list: l18 level1 lfo26; text-indent: -14.15pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Pertahankan fungsi sirkulasi dengan baik, bila perlu
pasang CVP. Dialisis peritoneal
dilakukan pada gagal ginjal.</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Pertahankan oksigenasi jaringan, bila perlu berikan
oksigen. Apabila terjadi gagal nafas perlu pemasangan ventilator mekanik (bila
mungkin).</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">§<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Pertahankan kadar gula darah normal.</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">2)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Antipiretik</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Diberikan apabila demam > 39 C, kecuali pada riwayat
kejang demam dapat diberikan lebih awal.</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">G.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">PEMERIKSAAN DIAGNOSTIK<o:p></o:p></span></b></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">1)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Pemeriksaan Mikroskopis Malaria<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Diagnosis
malaria sebagai mana penyakit pada umumnya didasarkan pada manifestasi klinis
(termasuk anamnesis), uji imunoserologis dan ditemukannya parasit (plasmodium)
di dalam penderita. Uji imunoserologis yang dirancang dengan bermacam-macam
target dianjurkan sebagai pelengkap pemeriksaan mikroskopis dalam menunjang
diagnosis malaria atau ditujukan untuk survey epidemiologi di mana pemeriksaan
mikrokopis tidak dapat dilakukan. Diagnosis definitif demam malaria ditegakan
dengan ditemukanya parasit plasmodium dalam darah penderita. Pemeriksaan
mikrokropis satu kali yang memberi hasil negatif tidak menyingkirkan diagnosis
deman malaria. Untuk itu diperlukan pemeriksaan serial dengan interval antara
pemeriksaan satu hari.</span><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Pemeriksaan
mikroskropis membutuhkan syarat-syarat tertentu agar mempunyai nilai diagnostik
yang tinggi (sensitivitas dan spesifisitas mencapai 100%).<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">1)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Waktu pengambilan sampel harus
tepat yaitu pada akhir periode</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"> </span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">demam
memasuki periode berkeringat. Pada periode ini jumlah trophozoite dalam
sirkulasi dalam mencapai maksimal dan cukup matur sehingga memudahkan
identifikasi spesies parasit.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">2)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Volume yang diambil sebagai
sampel cukup, yaitu darah kapiler (finger prick) dengan volume 3,0-4,0 mikro
liter untuk sediaan tebal dan 1,0-1,5 mikro liter untuk sedian tipis.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">3)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Kualitas perparat harus baik
untuk menjamin identifikasi spesies plasmodium yang tepat.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">4)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Identifikasi spesies plasmodium<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">5)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Identifikasi morfologi sangat
penting untuk menentukan spesies plasmodium dan selanjutnya digunakan sebagai
dasar pemilihan obat.<o:p></o:p></span></div>
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</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">QBC (Semi Quantitative Buffy
Coat)<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Prinsip
dasar: tes floresensi yaitu adanya protein pada plasmodium yang dapat mengikat
acridine orange akan mengidentifikasi eritrosit terinfeksi plasmodium. QBC
merupakan teknik pemeriksaan dengan menggunakan tabung kapiler dengan diameter
tertentu yang dilapisi acridine orange tetapi cara ini tidak dapat membedakan
spesies plasmodium dan kurang tepat sebagai instrumen hitung parasit.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">3)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Pemeriksaan Imunoserologis<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Pemeriksaan
imunoserologis didesain baik untuk mendeteksi antibodi spesifik terhadap
paraasit plasmodium maupun antigen spesifik plasmodium atau eritrosit yang
terinfeksi plasmodium teknik ini terus dikembangkan terutama menggunakan teknik
radioimmunoassay dan enzim immunoassay.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">4)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Pemeriksan Biomolekuler<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Pemeriksaan
biomolekuler digunakan untuk mendeteksi DNA spesifik parasit/ plasmodium dalam
darah penderita malaria.tes ini menggunakan DNA lengkap yaitu dengan melisiskan
eritrosit penderita malaria untuk mendapatkan ekstrak DNA.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 14.0pt; line-height: 150%;">BAB II<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 14.0pt; line-height: 150%;">ASUHAN
KEPERAWATAN<o:p></o:p></span></div>
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<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">A.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">PENGKAJIAN<o:p></o:p></span></b></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">1)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Data Demografi<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Nama
Anak<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Umur<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Jenis
Kelamin<o:p></o:p></span></div>
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</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Dasar data pengkajian<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Aktivitas/
istirahat<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Gejala : Keletihan, kelemahan, malaise umum<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Tanda : Takikardi, Kelemahan otot dan
penurunan kekuatan.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 92.7pt; mso-add-space: auto; mso-list: l15 level1 lfo18; tab-stops: 222.6pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Sirkulasi<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.0pt; mso-add-space: auto; tab-stops: 222.6pt;">
<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Tanda : Tekanan darah normal atau sedikit
menurun. Denyut perifer kuat dan cepat (fase demam) Kulit hangat, diuresis
(diaphoresis ) karena vasodilatasi. Pucat dan lembab (vaso kontriksi),
hipovolemia,penurunan aliran darah.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 92.7pt; mso-add-space: auto; mso-list: l15 level1 lfo18; tab-stops: 222.6pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Eliminasi<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.0pt; mso-add-space: auto; tab-stops: 222.6pt;">
<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Gejela : Diare atau konstipasi; penurunan
haluaran urine<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.0pt; mso-add-space: auto; tab-stops: 222.6pt;">
<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Tanda : Distensi abdomen<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 92.7pt; mso-add-space: auto; mso-list: l15 level1 lfo18; tab-stops: 222.6pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Makanan
dan cairan<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.0pt; mso-add-space: auto; tab-stops: 222.6pt;">
<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Gejala : Anoreksia mual dan muntah<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.0pt; mso-add-space: auto; tab-stops: 222.6pt;">
<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Tanda : Penurunan berat badan, penurunan
lemak subkutan, dan Penurunan masa
<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.0pt; mso-add-space: auto; tab-stops: 222.6pt;">
<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">
otot. Penurunan haluaran urine, kosentrasi urine.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 92.7pt; mso-add-space: auto; mso-list: l15 level1 lfo18; tab-stops: 222.6pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Neuro
sensori<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.0pt; mso-add-space: auto; tab-stops: 222.6pt;">
<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Gejala : Sakit kepala, pusing dan pingsan.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.0pt; mso-add-space: auto; tab-stops: 222.6pt;">
<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Tanda : Gelisah, ketakutan, kacau mental,
disorientas deliriu atau koma.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 92.7pt; mso-add-space: auto; mso-list: l15 level1 lfo18; tab-stops: 222.6pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Pernapasan.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.0pt; mso-add-space: auto; tab-stops: 222.6pt;">
<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Tanda : Takipnea dengan penurunan kedalaman
pernapasan .<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.0pt; mso-add-space: auto; tab-stops: 222.6pt;">
<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Gejala : Napas pendek pada istirahat dan
aktivitas.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.0pt; mso-add-space: auto; tab-stops: 222.6pt;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.0pt; mso-add-space: auto; tab-stops: 222.6pt;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l24 level1 lfo12; text-indent: -18.0pt;">
<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";">B.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">DIAGNOSA KEPERAWATAN<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpMiddle">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l13 level1 lfo13; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Perubahan nutrisi kurang dari
kebutuhan tubuh berhubungan dengan asupan makanan yang tidak adekuat:
anorexia, mual/muntah<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l13 level1 lfo13; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Resiko tinggi terhadap infeksi
berhubungan dengan penurunan sistem kekebalan tubuh<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l13 level1 lfo13; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Hipertermia berhubungan dengan
peningkatan metabolisme, dehidrasi, efek langsung sirkulasi kuman pada
hipotalamus.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l13 level1 lfo13; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Perubahan perfusi jaringan
berhubungan dengan penurunan komponen seluler yang diperlukan untuk pengiriman
oksigen dan nutrien dalam tubuh.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l13 level1 lfo13; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";">Kecemasan
berhubungan dengan perubahan status kesehatan.</span></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l13 level1 lfo13; text-indent: -18.0pt;">
<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"><br /></span></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 72pt; text-align: left; text-indent: -18pt;">
<span style="font-family: 'Comic Sans MS'; font-size: 15px; line-height: 22px; text-indent: -18pt;"><b><u>INTERVENSI</u></b></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;"><o:p></o:p></span></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoTableMediumGrid3Accent1" style="border-bottom-style: none; border-collapse: collapse; border-color: initial; border-image: initial; border-left-style: none; border-right-style: none; border-top-style: none; border-width: initial; width: 697px;">
<tbody>
<tr>
<td style="background: #4F81BD; border-bottom: solid white 3.0pt; border: solid white 1.0pt; mso-background-themecolor: accent1; mso-border-bottom-themecolor: background1; mso-border-themecolor: background1; padding: 0cm 5.4pt 0cm 5.4pt; width: 26.7pt;" valign="top" width="36">
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-yfti-cnfc: 5;">
<b><span style="color: white; font-size: 9pt;">NO<o:p></o:p></span></b></div>
</td>
<td style="background: #4F81BD; border-bottom: solid white 3.0pt; border-left: none; border-right: solid white 1.0pt; border-top: solid white 1.0pt; mso-background-themecolor: accent1; mso-border-bottom-themecolor: background1; mso-border-left-alt: solid white 1.0pt; mso-border-left-themecolor: background1; mso-border-right-themecolor: background1; mso-border-top-themecolor: background1; padding: 0cm 5.4pt 0cm 5.4pt; width: 92.1pt;" valign="top" width="123">
<div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-yfti-cnfc: 1; text-align: center;">
<b><span style="color: white; font-size: 9pt;">DIAGNOSA<o:p></o:p></span></b></div>
</td>
<td style="background: #4F81BD; border-bottom: solid white 3.0pt; border-left: none; border-right: solid white 1.0pt; border-top: solid white 1.0pt; mso-background-themecolor: accent1; mso-border-bottom-themecolor: background1; mso-border-left-alt: solid white 1.0pt; mso-border-left-themecolor: background1; mso-border-right-themecolor: background1; mso-border-top-themecolor: background1; padding: 0cm 5.4pt 0cm 5.4pt; width: 99.25pt;" valign="top" width="132">
<div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-yfti-cnfc: 1; text-align: center;">
<b><span style="color: white; font-size: 9pt;">TUJUAN<o:p></o:p></span></b></div>
</td>
<td style="background: #4F81BD; border-bottom: solid white 3.0pt; border-left: none; border-right: solid white 1.0pt; border-top: solid white 1.0pt; mso-background-themecolor: accent1; mso-border-bottom-themecolor: background1; mso-border-left-alt: solid white 1.0pt; mso-border-left-themecolor: background1; mso-border-right-themecolor: background1; mso-border-top-themecolor: background1; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.9pt;" valign="top" width="208">
<div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-yfti-cnfc: 1; text-align: center;">
<b><span style="color: white; font-size: 9pt;">INTERVENSI<o:p></o:p></span></b></div>
</td>
<td style="background: #4F81BD; border-bottom: solid white 3.0pt; border-left: none; border-right: solid white 1.0pt; border-top: solid white 1.0pt; mso-background-themecolor: accent1; mso-border-bottom-themecolor: background1; mso-border-left-alt: solid white 1.0pt; mso-border-left-themecolor: background1; mso-border-right-themecolor: background1; mso-border-top-themecolor: background1; padding: 0cm 5.4pt 0cm 5.4pt; width: 148.85pt;" valign="top" width="198">
<div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-yfti-cnfc: 1; text-align: center;">
<b><span style="color: white; font-size: 9pt;">RASIONAL<o:p></o:p></span></b></div>
</td>
</tr>
<tr>
<td style="background: #4F81BD; border-bottom: none; border-left: solid white 1.0pt; border-right: solid white 3.0pt; border-top: none; mso-background-themecolor: accent1; mso-border-left-themecolor: background1; mso-border-right-themecolor: background1; mso-border-top-alt: solid white 1.0pt; mso-border-top-themecolor: background1; padding: 0cm 5.4pt 0cm 5.4pt; width: 26.7pt;" valign="top" width="36">
<div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-yfti-cnfc: 68; text-align: center;">
<b><span style="color: white; font-size: 9pt;">1<o:p></o:p></span></b></div>
</td>
<td style="background: #A7BFDE; border-bottom: solid white 1.0pt; border-left: none; border-right: solid white 1.0pt; border-top: none; mso-background-themecolor: accent1; mso-background-themetint: 127; mso-border-bottom-themecolor: background1; mso-border-left-alt: solid white 1.0pt; mso-border-left-themecolor: background1; mso-border-right-themecolor: background1; mso-border-top-alt: solid white 1.0pt; mso-border-top-themecolor: background1; padding: 0cm 5.4pt 0cm 5.4pt; width: 92.1pt;" valign="top" width="123">
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-yfti-cnfc: 64;">
<span style="font-size: 9pt;"><span style="color: #444444;">Perubahan nutrisi kurang dari
kebutuhan tubuh berhubungan dengan asupan makanan yang tidak adekuat:
anoreksia, mual/muntah<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-yfti-cnfc: 64;">
<br /></div>
</td>
<td style="background: #A7BFDE; border-bottom: solid white 1.0pt; border-left: none; border-right: solid white 1.0pt; border-top: none; mso-background-themecolor: accent1; mso-background-themetint: 127; mso-border-bottom-themecolor: background1; mso-border-left-alt: solid white 1.0pt; mso-border-left-themecolor: background1; mso-border-right-themecolor: background1; mso-border-top-alt: solid white 1.0pt; mso-border-top-themecolor: background1; padding: 0cm 5.4pt 0cm 5.4pt; width: 99.25pt;" valign="top" width="132">
<div align="left" class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-left: 7.25pt; mso-add-space: auto; mso-list: l1 level1 lfo2; mso-yfti-cnfc: 64; text-align: left; text-indent: -14.2pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Kebutuhan nutrisi anak dapat terpenuh</span><span style="font-size: 9pt;">i</span><span lang="EN-US" style="font-size: 9pt;"><o:p></o:p></span></span></div>
<div align="left" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.25pt; mso-add-space: auto; mso-yfti-cnfc: 64; text-align: left;">
<br /></div>
<div align="left" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.25pt; mso-add-space: auto; mso-list: l1 level1 lfo2; mso-yfti-cnfc: 64; text-align: left; text-indent: -14.2pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Tidak terjadi penurunan berat badan secara drastis<o:p></o:p></span></span></div>
</td>
<td style="background: #A7BFDE; border-bottom: solid white 1.0pt; border-left: none; border-right: solid white 1.0pt; border-top: none; mso-background-themecolor: accent1; mso-background-themetint: 127; mso-border-bottom-themecolor: background1; mso-border-left-alt: solid white 1.0pt; mso-border-left-themecolor: background1; mso-border-right-themecolor: background1; mso-border-top-alt: solid white 1.0pt; mso-border-top-themecolor: background1; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.9pt;" valign="top" width="208">
<div class="MsoListParagraphCxSpLast" style="line-height: normal; margin-left: 7.6pt; mso-add-space: auto; mso-list: l1 level1 lfo2; mso-yfti-cnfc: 64; text-indent: -14.2pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Kaji
riwayat nutrisi, termasuk makanan yang disukai. Observasi dan catat masukan
makanan anak.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-yfti-cnfc: 64;">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-left: 7.6pt; mso-add-space: auto; mso-list: l1 level1 lfo2; mso-yfti-cnfc: 64; text-indent: -14.2pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Berikan
makan sedikit tetapi sering dan
makanan tambahan kecil yang tepat.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; mso-yfti-cnfc: 64;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.6pt; mso-add-space: auto; mso-list: l1 level1 lfo2; mso-yfti-cnfc: 64; text-indent: -14.2pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Pertahankan
jadwal penimbangan berat badan secara teratur.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.6pt; mso-add-space: auto; mso-list: l1 level1 lfo2; mso-yfti-cnfc: 64; text-indent: -14.2pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Observasi
dan catat kejadian mual/ muntah, dan gejala lain yang berhubungan.<o:p></o:p></span></span></div>
</td>
<td style="background: #A7BFDE; border-bottom: solid white 1.0pt; border-left: none; border-right: solid white 1.0pt; border-top: none; mso-background-themecolor: accent1; mso-background-themetint: 127; mso-border-bottom-themecolor: background1; mso-border-left-alt: solid white 1.0pt; mso-border-left-themecolor: background1; mso-border-right-themecolor: background1; mso-border-top-alt: solid white 1.0pt; mso-border-top-themecolor: background1; padding: 0cm 5.4pt 0cm 5.4pt; width: 148.85pt;" valign="top" width="198">
<div class="MsoListParagraphCxSpLast" style="line-height: normal; margin-left: 7.0pt; mso-add-space: auto; mso-list: l5 level1 lfo1; mso-yfti-cnfc: 64; text-indent: -13.5pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Mengawasi
masukan kalori atau kualitas kekeurangan konsumsi makanan.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-yfti-cnfc: 64;">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-left: 7.0pt; mso-add-space: auto; mso-list: l5 level1 lfo1; mso-yfti-cnfc: 64; text-indent: -13.5pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Dilatasi
gaster dapat terjadi bila pemberian makan terlalu cepat setelah periode
anoreksia<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; mso-yfti-cnfc: 64;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.0pt; mso-add-space: auto; mso-list: l5 level1 lfo1; mso-yfti-cnfc: 64; text-indent: -13.5pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Mengawasi
penurunan berat badan atau efektifitas intervensi nutris</span><span style="font-size: 9pt;">i</span><span lang="EN-US" style="font-size: 9pt;"><o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle">
<br /></div>
<div class="MsoListParagraphCxSpLast" style="line-height: normal; margin-left: 7.0pt; mso-add-space: auto; mso-list: l5 level1 lfo1; mso-yfti-cnfc: 64; text-indent: -13.5pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Gejala GI
dapat menunjukan efek anemia (hipoksia) pada organ<o:p></o:p></span></span></div>
</td>
</tr>
<tr>
<td style="background: #4F81BD; border-bottom: none; border-left: solid white 1.0pt; border-right: solid white 3.0pt; border-top: solid white 1.0pt; mso-background-themecolor: accent1; mso-border-left-alt: solid white 1.0pt; mso-border-left-themecolor: background1; mso-border-left-themecolor: background1; mso-border-right-alt: solid white 3.0pt; mso-border-right-themecolor: background1; mso-border-right-themecolor: background1; mso-border-top-alt: solid white .75pt; mso-border-top-themecolor: background1; mso-border-top-themecolor: background1; padding: 0cm 5.4pt 0cm 5.4pt; width: 26.7pt;" valign="top" width="36">
<div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-yfti-cnfc: 4; text-align: center;">
<b><span style="font-size: 9pt;"><span style="color: #444444;">2<o:p></o:p></span></span></b></div>
</td>
<td style="background: #D3DFEE; border-bottom: solid white 1.0pt; border-left: none; border-right: solid white 1.0pt; border-top: none; mso-background-themecolor: accent1; mso-background-themetint: 63; mso-border-alt: solid white .75pt; mso-border-bottom-themecolor: background1; mso-border-left-alt: solid white .75pt; mso-border-left-themecolor: background1; mso-border-right-themecolor: background1; mso-border-themecolor: background1; mso-border-top-alt: solid white .75pt; mso-border-top-themecolor: background1; padding: 0cm 5.4pt 0cm 5.4pt; width: 92.1pt;" valign="top" width="123">
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-size: 9pt;"><span style="color: #444444;">Resiko tinggi terhadap infeksi berhubungan dengan
penurunan sistem kekebalan tubuh: prosedur tindakan invasif<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<br /></div>
</td>
<td style="background: #D3DFEE; border-bottom: solid white 1.0pt; border-left: none; border-right: solid white 1.0pt; border-top: none; mso-background-themecolor: accent1; mso-background-themetint: 63; mso-border-alt: solid white .75pt; mso-border-bottom-themecolor: background1; mso-border-left-alt: solid white .75pt; mso-border-left-themecolor: background1; mso-border-right-themecolor: background1; mso-border-themecolor: background1; mso-border-top-alt: solid white .75pt; mso-border-top-themecolor: background1; padding: 0cm 5.4pt 0cm 5.4pt; width: 99.25pt;" valign="top" width="132">
<div align="left" class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-left: 7.2pt; mso-add-space: auto; mso-list: l4 level1 lfo5; text-align: left; text-indent: -14.15pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Tidak menunjukkan tanda-tanda
infeksi<o:p></o:p></span></span></div>
<div align="left" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.2pt; mso-add-space: auto; mso-list: l4 level1 lfo5; text-align: left; text-indent: -14.15pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Anak bebas dari infeksi</span><b><span lang="EN-US" style="font-size: 9pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background: #D3DFEE; border-bottom: solid white 1.0pt; border-left: none; border-right: solid white 1.0pt; border-top: none; mso-background-themecolor: accent1; mso-background-themetint: 63; mso-border-alt: solid white .75pt; mso-border-bottom-themecolor: background1; mso-border-left-alt: solid white .75pt; mso-border-left-themecolor: background1; mso-border-right-themecolor: background1; mso-border-themecolor: background1; mso-border-top-alt: solid white .75pt; mso-border-top-themecolor: background1; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.9pt;" valign="top" width="208">
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto; mso-list: l8 level1 lfo4; text-indent: -14.2pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Pantau terhadap kecenderungan peningkatan suhu tubuh.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpLast" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto; mso-list: l8 level1 lfo4; text-indent: -14.2pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Amati adanya menggigil dan diaforosis.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto; mso-list: l8 level1 lfo4; text-indent: -14.2pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Memantau tanda - tanda penyimpangan kondisi/ kegagalan
untuk memperbaiki selama masa terapi.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto; mso-list: l8 level1 lfo4; text-indent: -14.2pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Berikan obat anti infeksi sesuai petunjuk.<o:p></o:p></span></span></div>
</td>
<td style="background: #D3DFEE; border-bottom: solid white 1.0pt; border-left: none; border-right: solid white 1.0pt; border-top: none; mso-background-themecolor: accent1; mso-background-themetint: 63; mso-border-alt: solid white .75pt; mso-border-bottom-themecolor: background1; mso-border-left-alt: solid white .75pt; mso-border-left-themecolor: background1; mso-border-right-alt: solid white 1.0pt; mso-border-right-themecolor: background1; mso-border-right-themecolor: background1; mso-border-themecolor: background1; mso-border-top-alt: solid white .75pt; mso-border-top-themecolor: background1; padding: 0cm 5.4pt 0cm 5.4pt; width: 148.85pt;" valign="top" width="198">
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.0pt; mso-add-space: auto; mso-list: l9 level1 lfo3; text-indent: -14.2pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Demam disebabkan oleh efek endoktoksin pada hipotalamus
dan hipotermia adalah tanda tanda penting yang merefleksikan perkembangan
status syok/ penurunan perfusi jaringan.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.0pt; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.0pt; mso-add-space: auto; mso-list: l9 level1 lfo3; text-indent: -14.2pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Menggigil sering kali mendahului memuncaknya suhu pada
infeksi umum.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.0pt; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.0pt; mso-add-space: auto; mso-list: l9 level1 lfo3; text-indent: -14.2pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Dapat menunjukkan ketidak tepatan terapi antibiotik atau
pertumbuhan dari organisme.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal;">
<br /></div>
<div class="MsoListParagraphCxSpLast" style="line-height: normal; margin-left: 7.0pt; mso-add-space: auto; mso-list: l9 level1 lfo3; text-indent: -14.2pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Dapat memberikan
imunitas sementara untuk infeksi umum<o:p></o:p></span></span></div>
</td>
</tr>
<tr>
<td style="background: #4F81BD; border-bottom: none; border-left: solid white 1.0pt; border-right: solid white 3.0pt; border-top: solid white 1.0pt; mso-background-themecolor: accent1; mso-border-left-themecolor: background1; mso-border-right-themecolor: background1; mso-border-top-themecolor: background1; padding: 0cm 5.4pt 0cm 5.4pt; width: 26.7pt;" valign="top" width="36">
<div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-yfti-cnfc: 68; text-align: center;">
<b><span style="font-size: 9pt;"><span style="color: #444444;">3<o:p></o:p></span></span></b></div>
</td>
<td style="background: #A7BFDE; border-bottom: solid white 1.0pt; border-left: none; border-right: solid white 1.0pt; border-top: none; mso-background-themecolor: accent1; mso-background-themetint: 127; mso-border-bottom-themecolor: background1; mso-border-left-alt: solid white 1.0pt; mso-border-left-themecolor: background1; mso-border-right-themecolor: background1; mso-border-top-alt: solid white 1.0pt; mso-border-top-themecolor: background1; padding: 0cm 5.4pt 0cm 5.4pt; width: 92.1pt;" valign="top" width="123">
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-yfti-cnfc: 64;">
<span style="color: #444444;"><span style="font-size: 9pt;">Hipertermia berhubungan dengan
peningkatan metabolisme, dehidrasi, efek langsung sirkulasi kuman pada
hipotalamus.</span><b><span style="font-size: 9pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background: #A7BFDE; border-bottom: solid white 1.0pt; border-left: none; border-right: solid white 1.0pt; border-top: none; mso-background-themecolor: accent1; mso-background-themetint: 127; mso-border-bottom-themecolor: background1; mso-border-left-alt: solid white 1.0pt; mso-border-left-themecolor: background1; mso-border-right-themecolor: background1; mso-border-top-alt: solid white 1.0pt; mso-border-top-themecolor: background1; padding: 0cm 5.4pt 0cm 5.4pt; width: 99.25pt;" valign="top" width="132">
<div align="left" class="MsoListParagraph" style="line-height: normal; margin-left: 7.25pt; mso-add-space: auto; mso-list: l3 level1 lfo7; mso-yfti-cnfc: 64; text-align: left; text-indent: -14.2pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Suhu
tubuh anak normal<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-yfti-cnfc: 64;">
<br /></div>
</td>
<td style="background: #A7BFDE; border-bottom: solid white 1.0pt; border-left: none; border-right: solid white 1.0pt; border-top: none; mso-background-themecolor: accent1; mso-background-themetint: 127; mso-border-bottom-themecolor: background1; mso-border-left-alt: solid white 1.0pt; mso-border-left-themecolor: background1; mso-border-right-themecolor: background1; mso-border-top-alt: solid white 1.0pt; mso-border-top-themecolor: background1; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.9pt;" valign="top" width="208">
<div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto; mso-list: l7 level1 lfo6; mso-yfti-cnfc: 64; text-indent: -14.2pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Pantau
suhu pasien (derajat dan pola), perhatikan menggigil</span><span style="font-size: 9pt;">.</span><span lang="EN-US" style="font-size: 9pt;"><o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto; mso-yfti-cnfc: 64;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto; mso-yfti-cnfc: 64;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto; mso-list: l7 level1 lfo6; mso-yfti-cnfc: 64; text-indent: -14.2pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Pantau
suhu lingkungan.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto; mso-yfti-cnfc: 64;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto; mso-yfti-cnfc: 64;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto; mso-yfti-cnfc: 64;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto; mso-list: l7 level1 lfo6; mso-yfti-cnfc: 64; text-indent: -14.2pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Berikan
kompres mandi hangat, hindari penggunaan alkohol.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto; mso-yfti-cnfc: 64;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto; mso-yfti-cnfc: 64;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto; mso-yfti-cnfc: 64;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto; mso-list: l7 level1 lfo6; mso-yfti-cnfc: 64; text-indent: -14.2pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Berikan
antipiretik.<o:p></o:p></span></span></div>
</td>
<td style="background: #A7BFDE; border-bottom: solid white 1.0pt; border-left: none; border-right: solid white 1.0pt; border-top: none; mso-background-themecolor: accent1; mso-background-themetint: 127; mso-border-bottom-themecolor: background1; mso-border-left-alt: solid white 1.0pt; mso-border-left-themecolor: background1; mso-border-right-themecolor: background1; mso-border-top-alt: solid white 1.0pt; mso-border-top-themecolor: background1; padding: 0cm 5.4pt 0cm 5.4pt; width: 148.85pt;" valign="top" width="198">
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.0pt; mso-add-space: auto; mso-list: l5 level1 lfo1; mso-yfti-cnfc: 64; text-indent: -13.5pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Hipertermi
menunjukan proses penyakit infeksius akut. Pola demam menunjukkan diagnosis.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.0pt; mso-add-space: auto; mso-yfti-cnfc: 64; text-indent: 36.0pt;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.0pt; mso-add-space: auto; mso-list: l5 level1 lfo1; mso-yfti-cnfc: 64; text-indent: -13.5pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Suhu
ruangan/ jumlah selimut harus diubah untuk mempertahankan suhu mendekati
normal.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; mso-yfti-cnfc: 64;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.0pt; mso-add-space: auto; mso-list: l5 level1 lfo1; mso-yfti-cnfc: 64; text-indent: -13.5pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Dapat
membantu mengurangi demam, penggunaan es/alkohol mungkin menyebabkan
kedinginan. Selain itu alkohol dapat mengeringkan kulit.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; mso-yfti-cnfc: 64;">
<br /></div>
<div class="MsoListParagraphCxSpLast" style="line-height: normal; margin-left: 7.0pt; mso-add-space: auto; mso-list: l5 level1 lfo1; mso-yfti-cnfc: 64; text-indent: -13.5pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Digunakan
untuk mengurangi demam dengan aksi sentralnya pada hipotalamus.<o:p></o:p></span></span></div>
</td>
</tr>
<tr>
<td style="background: #4F81BD; border-bottom: none; border-left: solid white 1.0pt; border-right: solid white 3.0pt; border-top: solid white 1.0pt; mso-background-themecolor: accent1; mso-border-left-alt: solid white 1.0pt; mso-border-left-themecolor: background1; mso-border-left-themecolor: background1; mso-border-right-alt: solid white 3.0pt; mso-border-right-themecolor: background1; mso-border-right-themecolor: background1; mso-border-top-alt: solid white .75pt; mso-border-top-themecolor: background1; mso-border-top-themecolor: background1; padding: 0cm 5.4pt 0cm 5.4pt; width: 26.7pt;" valign="top" width="36">
<div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-yfti-cnfc: 4; text-align: center;">
<b><span style="font-size: 9pt;"><span style="color: #444444;">4<o:p></o:p></span></span></b></div>
</td>
<td style="background: #D3DFEE; border-bottom: solid white 1.0pt; border-left: none; border-right: solid white 1.0pt; border-top: none; mso-background-themecolor: accent1; mso-background-themetint: 63; mso-border-alt: solid white .75pt; mso-border-bottom-themecolor: background1; mso-border-left-alt: solid white .75pt; mso-border-left-themecolor: background1; mso-border-right-themecolor: background1; mso-border-themecolor: background1; mso-border-top-alt: solid white .75pt; mso-border-top-themecolor: background1; padding: 0cm 5.4pt 0cm 5.4pt; width: 92.1pt;" valign="top" width="123">
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="color: #444444;"><span style="font-size: 9pt;">Perubahan perfusi jaringan berhubungan dengan penurunan
komponen seluler yang di perlukan untuk pengiriman oksigen dan nutrien dalam
tubuh</span><b><span style="font-size: 9pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background: #D3DFEE; border-bottom: solid white 1.0pt; border-left: none; border-right: solid white 1.0pt; border-top: none; mso-background-themecolor: accent1; mso-background-themetint: 63; mso-border-alt: solid white .75pt; mso-border-bottom-themecolor: background1; mso-border-left-alt: solid white .75pt; mso-border-left-themecolor: background1; mso-border-right-themecolor: background1; mso-border-themecolor: background1; mso-border-top-alt: solid white .75pt; mso-border-top-themecolor: background1; padding: 0cm 5.4pt 0cm 5.4pt; width: 99.25pt;" valign="top" width="132">
<div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-left: 7.2pt; mso-add-space: auto; mso-list: l2 level1 lfo9; text-indent: -14.15pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Anak menunjukkan Perfusi jaringan adekuat dengan TTV yang
stabil</span><b><span lang="EN-US" style="font-size: 9pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background: #D3DFEE; border-bottom: solid white 1.0pt; border-left: none; border-right: solid white 1.0pt; border-top: none; mso-background-themecolor: accent1; mso-background-themetint: 63; mso-border-alt: solid white .75pt; mso-border-bottom-themecolor: background1; mso-border-left-alt: solid white .75pt; mso-border-left-themecolor: background1; mso-border-right-themecolor: background1; mso-border-themecolor: background1; mso-border-top-alt: solid white .75pt; mso-border-top-themecolor: background1; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.9pt;" valign="top" width="208">
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto; mso-list: l6 level1 lfo8; text-indent: -14.2pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Pertahankan tirah baring bantu dengan aktivitas perawatan.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto; mso-list: l6 level1 lfo8; text-indent: -14.2pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Pantau terhadap kecenderungan tekanan darah, mencatat
perkembangan hipotensi dan perubahan pada tekanan nadi.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto; mso-list: l6 level1 lfo8; text-indent: -14.2pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Perhatikan kualitas, kekuatan dari denyut perifer.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: normal;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto; mso-list: l6 level1 lfo8; text-indent: -14.2pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Kaji frukuensi pernafasan kedalaman dan kualitas.
Perhatikan dispnea berat.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpLast" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto; mso-list: l6 level1 lfo8; text-indent: -14.2pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Berikan cairan secara parenteral.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<br /></div>
</td>
<td style="background: #D3DFEE; border-bottom: solid white 1.0pt; border-left: none; border-right: solid white 1.0pt; border-top: none; mso-background-themecolor: accent1; mso-background-themetint: 63; mso-border-alt: solid white .75pt; mso-border-bottom-themecolor: background1; mso-border-left-alt: solid white .75pt; mso-border-left-themecolor: background1; mso-border-right-alt: solid white 1.0pt; mso-border-right-themecolor: background1; mso-border-right-themecolor: background1; mso-border-themecolor: background1; mso-border-top-alt: solid white .75pt; mso-border-top-themecolor: background1; padding: 0cm 5.4pt 0cm 5.4pt; width: 148.85pt;" valign="top" width="198">
<div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-left: 7.0pt; mso-add-space: auto; mso-list: l5 level1 lfo1; text-indent: -14.2pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Menurunkan beban kerja miokard dan konsumsi oksigen,
memaksimalkan efektifitas dari perfusi jaringan.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.0pt; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.0pt; mso-add-space: auto; mso-list: l5 level1 lfo1; text-indent: -14.2pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Hipotensi akan berkembang bersamaan dengan kuman yang
menyerang darah.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.0pt; mso-add-space: auto; mso-list: l5 level1 lfo1; text-indent: -14.2pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Pada awal nadi cepat kuat karena peningkatan curah
jantung, nadi dapat lemah atau lambat karena hipotensi yang terus menerus,
penurunan curah jantung dan vaso kontriksi perifer.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal;">
<br /></div>
<div class="MsoListParagraphCxSpLast" style="line-height: normal; margin-left: 7.0pt; mso-add-space: auto; mso-list: l5 level1 lfo1; text-indent: -14.2pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Peningkatan pernafasan terjadi sebagai respon terhadap
efek-efek langsung dari kuman pada pusat pernafasan. Pernafasan menjadi
dangkal bila terjadi insufisiensi pernafasan, menimbulkan resiko kegagalan
pernafasan akut.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<br /></div>
<div class="MsoListParagraph" style="line-height: normal; margin-left: 7.0pt; mso-add-space: auto; mso-list: l5 level1 lfo1; text-indent: -14.2pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Untuk mempertahankan perfusi jaringan, sejumlah besar
cairan mungkin dibutuhkan untuk mendukung volume sirkulasi.<o:p></o:p></span></span></div>
</td>
</tr>
<tr style="height: 38.85pt; mso-yfti-irow: 4; mso-yfti-lastrow: yes;">
<td style="background: #4F81BD; border-right: solid white 3.0pt; border: solid white 1.0pt; height: 38.85pt; mso-background-themecolor: accent1; mso-border-right-themecolor: background1; mso-border-themecolor: background1; padding: 0cm 5.4pt 0cm 5.4pt; width: 26.7pt;" valign="top" width="36">
<div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-yfti-cnfc: 68; text-align: center;">
<b><span style="font-size: 9pt;"><span style="color: #444444;">5<o:p></o:p></span></span></b></div>
</td>
<td style="background: #A7BFDE; border-bottom: solid white 1.0pt; border-left: none; border-right: solid white 1.0pt; border-top: none; height: 38.85pt; mso-background-themecolor: accent1; mso-background-themetint: 127; mso-border-bottom-themecolor: background1; mso-border-left-alt: solid white 1.0pt; mso-border-left-themecolor: background1; mso-border-right-themecolor: background1; mso-border-top-alt: solid white 1.0pt; mso-border-top-themecolor: background1; padding: 0cm 5.4pt 0cm 5.4pt; width: 92.1pt;" valign="top" width="123">
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-yfti-cnfc: 64;">
<span style="color: #444444;"><span style="font-size: 9pt;">Kecemasan berhubungan dengan
perubahan status kesehatan.</span><b><span style="font-size: 9pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background: #A7BFDE; border-bottom: solid white 1.0pt; border-left: none; border-right: solid white 1.0pt; border-top: none; height: 38.85pt; mso-background-themecolor: accent1; mso-background-themetint: 127; mso-border-bottom-themecolor: background1; mso-border-left-alt: solid white 1.0pt; mso-border-left-themecolor: background1; mso-border-right-themecolor: background1; mso-border-top-alt: solid white 1.0pt; mso-border-top-themecolor: background1; padding: 0cm 5.4pt 0cm 5.4pt; width: 99.25pt;" valign="top" width="132">
<div align="left" class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-left: 7.2pt; mso-add-space: auto; mso-list: l0 level1 lfo10; mso-yfti-cnfc: 64; text-align: left; text-indent: -14.1pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 11.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Keluarga dapat mendiskusikan kecemasannya<o:p></o:p></span></span></div>
<div align="left" class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.2pt; mso-add-space: auto; mso-list: l0 level1 lfo10; mso-yfti-cnfc: 64; text-align: left; text-indent: -14.1pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 11.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Penggunaan koping keluarga yang efektif</span><b><span lang="EN-US" style="font-size: 9pt;"><o:p></o:p></span></b></span></div>
</td>
<td style="background: #A7BFDE; border-bottom: solid white 1.0pt; border-left: none; border-right: solid white 1.0pt; border-top: none; height: 38.85pt; mso-background-themecolor: accent1; mso-background-themetint: 127; mso-border-bottom-themecolor: background1; mso-border-left-alt: solid white 1.0pt; mso-border-left-themecolor: background1; mso-border-right-themecolor: background1; mso-border-top-alt: solid white 1.0pt; mso-border-top-themecolor: background1; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.9pt;" valign="top" width="208">
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto; mso-list: l6 level1 lfo8; mso-yfti-cnfc: 64; text-indent: -14.2pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Berikan
informasi pada keluarga tentang tindakan yang akan dilakukan terhadap
kesembuhan anak.<o:p></o:p></span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto; mso-yfti-cnfc: 64;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-left: 7.55pt; mso-add-space: auto; mso-list: l6 level1 lfo8; mso-yfti-cnfc: 64; text-indent: -14.2pt;">
<!--[if !supportLists]--><span style="color: #444444;"><span lang="EN-US" style="font-family: Symbol; font-size: 9.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-size: 9pt;">Bantu
keluarga untuk berespon positif pada pada keadaan anak.<o:p></o:p></span></span></div>
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</span></span><!--[endif]--></span><span lang="EN-US" style="font-size: 9pt;"><span style="color: #444444;">Meningkatkan
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font-family:"Comic Sans MS"'>Peningkatan IgM<o:p></o:p></span></p>
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<span
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selular darah menurun<o:p></o:p></span></p>
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<span style='font-size:9.0pt;line-height:115%;
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<span
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<br /></div>salnihttp://www.blogger.com/profile/00126668517852477742noreply@blogger.com0Universitas Sam Ratulangi, Jalan Kampus Selatan, Manado, Indonesia1.455717 124.8271631.453733 124.8246955 1.457701 124.8296305tag:blogger.com,1999:blog-8321145958076225978.post-28349855009761065502012-03-16T04:23:00.000-07:002012-03-16T04:23:53.642-07:00ASKEP PADA ANAK DENGAN RETINOBLASTOMA<br />
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">BAB I<o:p></o:p></span></span></div>
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<br /></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">TINJAUAN
TEORITIS<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><b><span lang="EN-US" style="font-size: 12pt;">A.<span style="font-size: 7pt; font-weight: normal;"> </span></span></b><b><span lang="EN-US" style="font-size: 12pt;">Anatomi dan Fisiologi Retina<o:p></o:p></span></b></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Anatomi Retina<o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Retina
adalah selembar tipis jaringan saraf yang semitransparan dan multilapis yang
melapisi bagian dalam 2/3 posterior dinding bola mata. Retina membentang
kedepan hamper sama jauhnya dengan corpus sillier, dan berakhir di tepi ora
serrata.<o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Retina mempunyai
tebal 0,1 mm pada kutub posterior. Di tengah-tengah retina posterior.<o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Fisiologi Retina<o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Retina
adalah jaringan paling kompleks di mata. Untuk melihat, mata harus berfungsi
sebagai suatu alat optis, sebagai suatu reseptor kompleks, dan sebagai suatu
trasdunces yang efektif. Sel-sel batang dan kerucut dilapisan fotoreseptor
mampu mengubah rangsangan cahaya memjadi suatu impuls saraf yang dihantarkan
oleh lapisan, serta saraf retina melalui saraf optikus dan akhirnya ke korteks
penglihatan.<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><b><span lang="EN-US" style="font-size: 12pt;">B.<span style="font-size: 7pt; font-weight: normal;"> </span></span></b><b><span lang="EN-US" style="font-size: 12pt;">Pengertian<o:p></o:p></span></b></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">ü<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 12pt;">Retinoblastoma merupakan tumor ganas
intraokular yang ditemukan pada anak-anak, terutama pada usia dibawah lima tahun.
Tumor berasal dari jaringan retino embrional (Mansjoer, 2005).<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">ü<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 12pt;">Retino</span><span style="font-size: 12pt;">b</span><span lang="EN-US" style="font-size: 12pt;">lastoma
adalah <i> Tumor ganas dalam bola mata pada anak dan bayi sampai 5
tahun </i>(</span><span style="font-size: 12pt;"> Sidarta Ilyas<i>,
</i>2002 )<i>.</i></span><span lang="EN-US" style="font-size: 12pt;"><o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">ü<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 12pt;">Retinoblastoma
adalah suatu neoplasma yang berasal dari neuroretina (sel kerucut sel batang)
atau sel glia yang bersifat ganas. <o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">ü<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 12pt;">Retinoblastoma adalah tumor retina
yang terdiri atas sel neuroblastik yang tidak berdiferensiasi dan merupakan
tumor ganas retina pada anak.<o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;"> <o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: 13pt; line-height: 150%;"><span style="font-family: Georgia, 'Times New Roman', serif;">Jadi dari beberapa pengertian
diatas disimpulakan bahwa retinoblastoma adalah penyakit kanker mata
(retina) pada anak usia kurang dari 5 tahun</span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Merupakan
tumor ganas intraokuler yang ditemukan pada anak-anak, terutama pada usia
dibawah lima tahun. Tumor berasal dari jaringan retina embrional. Dapat terjadi
unilateral (70%) dan bilateral (30%). Sebagian besar kasus bilateral bersifat
herediter yang diwariskan melalui kromosom.<o:p></o:p></span></span></div>
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<br /></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Massa
tumor diretina dapat tumbuh kedalam vitreus (endofitik) dan tumbuh menembus
keluar (eksofitik). Pada beberapa kasus terjadi penyembuhan secara spontan.
Sering terjadi perubahan degeneratif, diikuti nekrosis dan kalsifikasi. Pasien
yang selamat memiliki kemungkinan 50% menurunkan anak dengan retinoblastoma.
Pewarisan ke saudara sebesar 4-7%.<o:p></o:p></span></span></div>
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<b><span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">C.
Etiologi<o:p></o:p></span></span></b></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;"><br />
Retinoblastoma
disebabkan oleh mutasi gen RB1, yang terletak pada lengan panjang kromosom 13
pada locus 14 (13q14) dan kode protein pRB, yang berfungsi sebagai supresor
pembentukan tumor. pRB adalah nukleoprotein yang terikat pada DNA (Deoxiribo
Nucleid Acid) dan mengontrol siklus sel pada transisi dari fase G1 sampai fase
S. Jadi mengakibatkan perubahan keganasan dari sel retina primitif sebelum
diferensiasi berakhir. Retinoblastoma normal yang terdapat pada semua orang
adalah suatu gen supresor atau anti-onkogen. Individu dengan penyakit yang
herediter memiliki satu alel yang terganggu di setiap sel tubuhnya, apabila alel
pasangannya di sel retina yang sedang tumbuh mengalami mutasi spontan,
terbentuklah tumor. Pada bentuk penyakit yang nonherediter, kedua alel gen
Retinoblastoma normal di sel retina yang sedang tumbuh diinaktifkan oleh mutasi
spontan.<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><b><span lang="EN-US" style="font-size: 12pt; line-height: 115%;">D. Patofisiologi</span></b><span lang="EN-US"> </span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Teori tentang histogenesis dari
Retinoblastoma yang paling banyak dipakai umumnya berasal dari sel prekursor
multipotensial (mutasi pada lengan panjang kromosom pita 13, yaitu 13q14 yang
dapat berkembang pada beberapa sel retina dalam atau luar. Pada intraokular,
tumor tersebut dapat memperlihatkan berbagai pola pertumbuhan yang akan
dipaparkan di bawah ini.<o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Pola Penyebaran Tumor<o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Pola pertumbuhan<o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Retinoblastoma Intraokular dapat
menampakkan sejumlah pola pertumbuhan, pada pola pertumbuhan endofitik, ini
tampak sebagai gambaran massa putih sampai coklat muda yang menembus membran
limitan interna. Retinoblastoma Endofitik kadang berhubungan dengan vitreus
seeding. Sel-sel dari Retinoblastoma yang masih dapat hidup terlepas dalam
vitreous dan ruang sub retina dan biasanya dapat menimbulkan perluasan tumor
melalui mata. Vitreous seeding sebagian kecil meluas memberikan gambaran klinis
mirip endopthalmitis,vitreous seeding mungkin juga memasuki bilik mata depan,
yang dapat berkumpul di iris membentuk nodule atau menempati bagian inferior
membentuk Pseudohypopyon <o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">Tumor Eksofitik biasanya kuning
keputihan dan terjadi pada ruang subretinal, yang mengenai pembuluh darah
retina dan sering kali terjadi peningkatan diameter pembuluh darah dengan warna
lebih pekat.</span><span lang="EN-US"> </span><span lang="EN-US" style="font-size: 12pt;">Retinoblastoma
eksofitik, berasal dari lapisan luar retina dan meluas ke koroid menyebabkan
solid RD, dapat meluas hingga ke sklera. Retinoblastoma eksofitik ini dapat
pula menyebabkan retinal detachment</span><span lang="EN-US" style="font-size: 14pt;">.</span><span lang="EN-US" style="font-size: 12pt;"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Invasi saraf optikus;<o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Dengan penyebaran tumor sepanjang
ruang sub arachnoid ke otak. Sel Retinoblastoma paling sering keluar dari mata
dengan menginvasi saraf optikus dan meluas kedalam ruang sub arachnoid. <o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Diffuse infiltration retina<o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Pola yang ketiga adalah
Retinoblastoma yang tumbuh menginfiltrasi luas yang biasanya unilateral,
nonherediter, dan ditemukan pada anak yang berumur lebih dari 5 tahun. Pada
tumor dijumpai adanya injeksi conjunctiva, anterior chamber seeding,
pseudohypopyon, gumpalan besar sel vitreous dan tumor yang menginfiltrasi
retina, karena masa tumor yang dijumpai tidak jelas, diagnosis sering
dikacaukan dengan keadaan inflamasi seperti pada uveitis intermediate yang
tidak diketahui etiologinya. Glaukoma sekunder dan Rubeosis Iridis terjadi pada
sekitar 50% kasus.<o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Penyebaran metastasis ke kelenjar
limfe regional, paru, otak dan tulang.<o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Sel tumor mungkin juga melewati
kanal atau melalui slera untuk masuk ke orbita. Perluasan ekstraokular dapat
mengakibatkan proptosis sebagaimana tumor tumbuh dalam orbita. Pada bilik mata
depan, sel tumor menginvasi trabecular messwork, memberi jalan masuk ke
limphatik conjunctiva. Kemudian timbul kelenjar limfe preauricular dan cervical
yang dapat teraba.<o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Di Amerika Serikat, pada saat
diagnosis pasien, jarang dijumpai dengan metastasis sistemik dan perluasan
intrakranial. Tempat metastasis Retinoblastoma yang paling sering pada anak
mengenai tulang kepala, tulang distal, otak, vertebra, kelenjar limphe dan
viscera abdomen. <o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Tumor mata ini, terbagi atas IV stadium, masing-masing:<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">v<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 12pt;">Stadium I: menunjukkan tumor masih
terbatas pada retina (stadium tenang)<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">v<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 12pt;">Stadium II: tumor terbatas pada bola
mata.<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">v<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 12pt;">Stadium III: terdapat perluasan
ekstra okuler regional, baik yang melampaui ujung nervus optikus yang dipotong
saat enuklasi.<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">v<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 12pt;">Stadium IV: ditemukan metastase jauh
ke dalam otak.<o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Pada beberapa kasus terjadi
penyembuhan secara spontan, sering terjadi
perubahan degeneratif, diikuti nekrosis dan klasifikasi. Pasien yang selamat
memiliki kemungkinan 50 % menurunkan anak dengan retinoblastoma.<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><b><span lang="EN-US" style="font-size: 12pt;">E. Tanda dan Gejala</span></b><b><span lang="EN-US" style="font-size: 12pt;"><o:p></o:p></span></b></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;"><span style="font-size: 7pt;"> </span>1.<span style="font-size: 7pt;">
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<v:imagedata o:title="" src="file:///C:\Users\USER\AppData\Local\Temp\msohtmlclip1\01\clip_image002.png"><span style="font-family: Georgia, 'Times New Roman', serif;">
<o:lock aspectratio="f" v:ext="edit">
<w:wrap type="through">
</w:wrap></o:lock></span></v:imagedata></v:shape><span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Leukokoria
merupakan keluhan dan gejala yang paling sering ditemukan.<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l9 level1 lfo3; mso-text-indent-alt: -18.0pt; text-align: justify; text-indent: -36.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;"><span style="font-size: 7pt;"> </span>2.<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Tanda dini retinoblastoma adalah mata
juling, mata merah atau terdapatnya warna iris yang tidak normal.<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l9 level1 lfo3; mso-text-indent-alt: -18.0pt; text-align: justify; text-indent: -36.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;"><span style="font-size: 7pt;"> </span>3.<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Tumor dengan ukuran sedang akan
memberikan gejala hipopion, di dalam bilik mata depan, uveitis, endoftalmitis,
ataupun suatu panoftalmitis.<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l9 level1 lfo3; mso-text-indent-alt: -18.0pt; text-align: justify; text-indent: -36.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;"><span style="font-size: 7pt;"> </span>4.<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Bola mata menjadi besar, bila tumor
sudah menyebar luas di dalam bola mata.<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l9 level1 lfo3; mso-text-indent-alt: -18.0pt; text-align: justify; text-indent: -36.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;"><span style="font-size: 7pt;"> </span>5.<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Bila terjadi nekrosis tumor, akan
terjadi gejala pandangan berat.<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l9 level1 lfo3; mso-text-indent-alt: -18.0pt; text-align: justify; text-indent: -36.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;"><span style="font-size: 7pt;"> </span>6.<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Tajam penglihatan sangat menurun.<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l9 level1 lfo3; mso-text-indent-alt: -18.0pt; text-align: justify; text-indent: -36.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;"><span style="font-size: 7pt;"> </span>7.<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Nyeri<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l9 level1 lfo3; mso-text-indent-alt: -18.0pt; text-align: justify; text-indent: -36.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;"><span style="font-size: 7pt;"> </span>8.<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Pada tumor yang besar, maka mengisi
seluruh rongga badan kaca sehingga badan kaca terlihat benjolan berwarna putih
kekuning-kuningan dengan pembuluh darah di atasnya.<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; text-align: justify;">
<br /></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<br /></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<b><span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">F.
Manifestasi Klinis<o:p></o:p></span></span></b></div>
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<v:shape id="Picture_x0020_3" o:spid="_x0000_s1070" style="height: 157.6pt; left: 0; margin-left: 1.8pt; margin-top: 4.55pt; mso-position-horizontal-relative: text; mso-position-horizontal: absolute; mso-position-vertical-relative: text; mso-position-vertical: absolute; mso-wrap-distance-bottom: 0; mso-wrap-distance-left: 9pt; mso-wrap-distance-right: 9pt; mso-wrap-distance-top: 0; mso-wrap-style: square; position: absolute; text-align: left; visibility: visible; width: 184.9pt; z-index: 3;" type="#_x0000_t75">
<v:imagedata o:title="retinoblastoma3" src="file:///C:\Users\USER\AppData\Local\Temp\msohtmlclip1\01\clip_image003.jpg"><span style="font-family: Georgia, 'Times New Roman', serif;">
<w:wrap type="square">
</w:wrap></span></v:imagedata></v:shape><v:shapetype coordsize="21600,21600" filled="f" id="_x0000_t32" o:oned="t" o:spt="32" path="m,l21600,21600e"><span style="font-family: Georgia, 'Times New Roman', serif;">
<v:path arrowok="t" fillok="f" o:connecttype="none">
<o:lock shapetype="t" v:ext="edit">
</o:lock></v:path></span></v:shapetype><v:shape id="_x0000_s1027" o:connectortype="straight" strokecolor="#0f243e [1615]" strokeweight="3pt" style="height: 36.7pt; left: 0; margin-left: -126.05pt; margin-top: 23.35pt; position: absolute; text-align: left; width: 43.6pt; z-index: 4;" type="#_x0000_t32">
<v:stroke endarrow="block"><span style="font-family: Georgia, 'Times New Roman', serif;">
<v:shadow color="#622423 [1605]" offset2="-1pt" offset="1pt" opacity=".5" type="perspective">
</v:shadow></span></v:stroke></v:shape><span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Gejala
retinoblastoma dapat menyerupai penyakit lain dimata. Bila letak tumor
dimakula, dapat terlihat gejala awal strabismus. Massa tumor yang semakin
membesar akan memperlihatkan gejala leukokoria, tanda-tanda peradangan di
vitreus (Vitreous seeding) yang menyerupai endoftalmitis. <o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Bila
sel-sel tumor terlepas dan masuk ke segmen anterior mata , akan menyebabkan
glaucoma atau tanda-tanda peradangan berupa hipopion atau hifema. Pertumbuhan
tumor ini dapat menyebabkan metastasis dengan invasi tumor melalui nervus
optikus ke otak, melalui sclera ke jaringan orbita dan sinus paranasal, dan
metastasis jauh ke sumsum tulang melalui pembuluh darah. Pada fundus terlihat
bercak kuning mengkilat, dapat menonjol kebadan kaca. Di permukaan terdapat
neovaskularisasi dan perdarahan. Warna iris tidak normal. Penyebaran secara
limfogen, ke kelenjar limfe preaurikular dan submandibula dan, hematogen, ke
sumsum tulang dan visera, terutama hati.<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<br /></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<br /></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<br /></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<br /></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<br /></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<br /></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<br /></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<b><span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">G.
Klasifikasi<o:p></o:p></span></span></b></div>
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<br /></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">1. Golongan I<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l13 level1 lfo4; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">ü<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 12pt;">Tumor
soliter/multiple kurang dari 4 diameter papil.<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l13 level1 lfo4; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">ü<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 12pt;">Terdapat
pada atau dibelakang ekuator<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l13 level1 lfo4; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">ü<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 12pt;">Prognosis
sangat baik<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">2. Golongan II<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l2 level1 lfo5; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">ü<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 12pt;">Satu
atau beberapa tumor berukuran 4-10 diameter papil<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l2 level1 lfo5; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">ü<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 12pt;">Prognosis
baik<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">3. Golongan III<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l7 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">ü<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 12pt;">Tumor
ada didepan ekuator atau tumor soliter berukuran >10 diameter papil<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l7 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">ü<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 12pt;">Prognosis
meragukan<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">4. Golongan IV<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l3 level1 lfo7; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">ü<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 12pt;">Tumor
multiple sampai ora serata<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l3 level1 lfo7; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">ü<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 12pt;">Prognisis
tidak baik<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">5. Golongan V<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l15 level1 lfo8; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">ü<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 12pt;">Setengah
retina terkena benih di badan kaca<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l15 level1 lfo8; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">ü<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 12pt;">Prognosis
buruk<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; text-align: justify;">
<br /></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<br /></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<b><span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">H.
Diagnosis Banding<o:p></o:p></span></span></b></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Fibroplasia
retrolental, displasia retina , endoftalmitis nematoda, katarak, dan ablasi
retina.<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: 18.0pt; mso-list: l4 level1 lfo13; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><b><span lang="EN-US" style="font-size: 12pt;">A.<span style="font-size: 7pt; font-weight: normal;"> </span></span></b><b><span lang="EN-US" style="font-size: 12pt;">Prognosis<o:p></o:p></span></b></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 18.0pt;">
<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Tumor
mempunyai prognosis baik bila ditemukan
dini dan intraokuler. Prognosis sangat buruk
bila sudah tersebar ekstra ocular pada
saat pemeriksaan pertama. Tumor dapat masuk ke dalam otak melalui
saraf optik yang terkena infiltrasi sel tumor.<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 18.0pt; text-align: justify;">
<br /></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<b><span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">J.
Pemeriksaan Penunjang<o:p></o:p></span></span></b></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Ultrasonografi
dan tomografi komputer dilakukan terutama untuk pasien dengan metastasis ke
luar, misalnya dengan gejala proptosis bola mata.<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;"><br />
<b>K. Penatalaksanaan<o:p></o:p></b></span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Tujuan
pengobatan dari retinoblastoma telah berubah secara dramatis sejak
beberapatahun belakangan sehubungan dengan evolusi dari kemajuan teknik
operasi. Tujuan dari terapi adalah diutamakan untuk menyelamatkan hidup pasien
dan juga mata pasien.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<b><u><span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Tumor intraocular<o:p></o:p></span></span></u></b></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo17; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span class="a"><span lang="EN-US" style="font-size: 12pt;">A.<span style="font-size: 7pt;"> </span></span></span><span class="a"><span lang="EN-US" style="font-size: 12pt;">Dini
: be</span></span><span class="l6"><span lang="EN-US" style="font-size: 12pt;">sar tumor < 4 disc diameter dan tebal
< 2,5 mm tergantung lokasi tumor </span></span><span class="a"><span lang="EN-US" style="font-size: 12pt;">dapat
dilakukan tindakan fotoagulasi dan atau krioterapi<span style="color: #231f20;">.</span></span></span><span class="a"><span lang="EN-US" style="font-size: 12pt;"><o:p></o:p></span></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo17; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span class="a"><span lang="EN-US" style="font-size: 12pt;">B.<span style="font-size: 7pt;"> </span></span></span><span lang="EN-US" style="font-size: 12pt;">Untuk
tumor lanjut intraokular yang belum terjadi vitreous seeding, bola mata
dipertahankan tanpa dilakukan enukleasi dengan cara kemoreduksi pemberian kemoterapi
kombinasi Carboplatin etoposide</span><span class="a"><span lang="EN-US" style="color: #231f20; font-size: 12pt;">
dan vitreuos sebanyak 2 siklus untuk mengecilkan massa tumor dilanjutkan
fokal terapi dengan fotokoagulasi atau terapikrio.</span></span><span class="a"><span lang="EN-US" style="font-size: 12pt;"><o:p></o:p></span></span></span></div>
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<br /></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">Lanjut
: stadium 4 dan 5 intraokular dan tajam penglihatan nol dilakukan tindakan bedah
pengangkatan bola mata (enukleasi). Pengobatan selanjutnya tergantung dari
pemeriksaan patologi anatomi. Bila hasil pemeriksaan patologi anatomi pada RB
unilateral menunjukkan tumor telah menembus sklera atau infiltrasi difus
kekoroid atau korpus; pengobatan dilanjutkan dengan kemoterapi. Khusus
untuk kasus dengan infiltrasi N.optikus post laminar pengobatan
dilanjutkan dengan radioterapi dan kemoterapi. Harus diingat bahwa pemberian
radioterapi pada anak < 2 tahun tidak dianjurkan.Untuk tumor</span><span class="a"><span lang="EN-US" style="color: #231f20; font-size: 14pt;"> </span></span><span class="a"><span lang="EN-US" style="color: #231f20; font-size: 12pt;">bilateral tindakan pengobatan sesuai dengan masing-masing
stadium tumor. Bila hasil PA menunjukkan perluasan ekstratraokular pengobatan
dilanjutkan dengan kemoterapi dengan atau tanpa radioterapi.<o:p></o:p></span></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<b><u><span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Tumor ekstraokular <o:p></o:p></span></span></u></b></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Klinis
dengan protopsis :<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">A.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 12pt;">Bila
secara radiologi pada RB unilateral tidak ditemukan destruksi tulang
orbita,perluasan intrakranial dalam (-), metastasis jauh ( BMP / LP ) ( -) ;
dilakukan tindakan bedah mengangkat seluruh isi rongga mata (eksenterasi orbita),
dilanjutkan dengan radioterapi ( usia > 2 tahun ) dan kemoterapi.</span><span lang="EN-US" style="font-size: 12pt;"><o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">B.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="font-size: 12pt;">Bila
secara radiologis pada RB unilateral ditemukan destruksi dinding orbita<span style="letter-spacing: 1.5pt;">, atau </span>metastase intrakranial dengan atau
tanpa metastase jauh, tidak perlu dilakukan tindakan bedah dan diberikan :
radioterapi ( usia > 2 tahun ) dan kemoterapic. Tumor disertai pembesaran
kelenjar regional, penderita diberikan pengobatan: radiasi ( >2 tahun ) pada
orbita dan kelenjar limfe yang membesar dilanjutkan dengan kemoterapid. Tumor
dengan metastasis jauh pada stadium lanjut ini gambaran kliniknya dapat sangat
bervariasi pada masing-masing penderita, oleh karenanya pengobatan berdasarkan
penilaian secara tersendiri kasus demi kasus ialah kemoterapi dan radioterapi
dapat dipertimbangkan kemudian.</span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">BAB II<o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">TINJAUAN ASUHAN
KEPERAWATAN<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><strong><span lang="EN-US" style="font-size: 12pt;">A.<span style="font-size: 7pt; font-weight: normal;">
</span></span></strong><strong><span lang="EN-US" style="font-size: 12pt;">Pengkajian<o:p></o:p></span></strong></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">1)<span style="font-size: 7pt;">
</span></span><strong><span lang="EN-US" style="font-size: 12pt;">Pengkajian
yang penting untuk retinoblastoma</span></strong><span lang="EN-US" style="font-size: 12pt;"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Sejak
kapan sakit mata dirasakan. Penting untuk mengetahui perkembangan penyakitnya,
dan sejauhmana perhatian klien dan keluarganya terhadap masalah yang dialami.
Retinoblastoma mempunyai prognosis baik bila ditemukan dini.<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">2)<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Riwayat trauma sebelum atau sesudah ada
keluhan<o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Trauma
dapat memberikan kerusakan pada seluruh lapis kelopak ataupun bola mata.
Trauma sebelumnya dapat juga memberikan
kelainan pada mata tersebut sebelum meminta pertolongan.<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">3)<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Apakah ada keluarga yang menderita
penyakit yang sama sebelumnya. Retinoblastoma bersifat herediter
yang diwariskan melalui kromosom, protein yang
selamat memiliki kemungkinan 50 %
menurunkan anak dengan retinoblastoma.<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">4)<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Apakah pasien merasakan adanya perubahan
dalam matanya. Retinoblastoma dapat menyebabkan bola mata menjadi besar.<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">5)<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Apakah ada keluhan lain yang menyertai<o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Keluhan
sakit kepala merupakan keluhan paling
sering diberikan oleh penderita. Adanya keluhan pada organ
lain juga bisa diakibatkan oleh tumor yang bermetastase.<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">6)<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Penyakit mata sebelumnya<o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Kadang-kadang
dengan mengetahui riwayat penyakit mata
sebelumnya akan dapat menerangkan tambahan
gejala-gejala penyakit yang dikeluhkan penderita.<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">7)<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Penyakit lain yang sedang diderita<o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Bila
sedang menderita penyakit lain dengan keadaan yang buruk, dapat pula
memperburuk keadaan klien<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">8)<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Usia penderita<o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Dikenal
beberapa jenis penyakit
yang terjadi pada
usia tertentu. Retinoblastoma umumnya ditemukan
pada anak-anak, terutama pada usia di bawah
5 tahun.<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">9)<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Riwayat Psikologi<o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Reaksi
pasien dana keluarganya terhadap gangguan penglihatan yang dialami pasien:
cemas, takut, gelisah, sering menangis, sering bertanya.<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">10)<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Mekanisme koping<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">11)<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Pemeriksaan Fisik Umum<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">Diperlukan
untuk mengetahui kemungkinan adanya keadaan umum yang dapat merupakan penyebab
penyakit mata yang sedang diderita.</span><span style="font-size: 12pt;"> </span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">12)<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Pemeriksaan Khusus Mata<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">a.<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Pemeriksaan tajam penglihatan<o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Pada
retinoblastoma, tumor dapat menyebar luas di dalam bola mata sehingga
dapat merusak semua organ di mata
yang menyebabkan tajam penglihatan sangat menurun.<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">b.<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Pemeriksaan gerakan bola mata<o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Pembesaran
tumor dalam rongga mata akan menekan saraf dan bahkan dapat merusak saraf
tersebut dan apabila mengenai saraf III, IV, dan VI maka akan menyebabkan mata
juling.<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">c.<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Pemeriksaan susunan mata luar dan
lakrimal<o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Pemeriksaan
dimulai dari kelopak mata, sistem lakrimal, konjungtiva, kornea,
bilik mata depan, iris,
lensa dan pupil. Pada
retinoblastoma didapatkan:<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">-<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Leukokoria, Yaitu reflek pupil yang
berwarna putih.<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">-<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Hipopion, Yaitu terdapatnya nanah di
bilik mata depan.<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">-<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Hifema, Yaitu terdapatnya darah di bilik
mata depan<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 14pt;">-<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Uveitis, </span><span lang="EN-US" style="font-size: 12pt;">Yaitu terdapatnya darah di bilik mata depan</span><span lang="EN-US" style="font-size: 14pt;"><o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">d.<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Pemeriksaan Pupil<o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Leukokoria
(refleks pupil yang berwarna putih) merupakan keluhan dan
gejala yang
paling
sering
ditemukan pada
penderita dengan retinoblastoma.<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">e.<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Pemeriksaan funduskopi<o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Menggunakan
oftalmoskopi untuk pemeriksaan media, papil
saraf optik, dan retina. Refleksi tak ada (atau gelap) akibat perdarahan
yang banyak dalam badan kaca.<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">f.<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Pemeriksaan tekanan bola mata<o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">Pertumbuhan
tumor ke dalam bola mata menyebabkan tekanan bola mata meningkat.<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><strong><span lang="EN-US" style="font-size: 12pt;">B.<span style="font-size: 7pt; font-weight: normal;">
</span></span></strong><strong><span lang="EN-US" style="font-size: 12pt;">Pengelompokan Data<o:p></o:p></span></strong></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">1. Data Subjektif<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">·<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Mengeluh nyeri pada mata<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">·<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Sulit melihat dengan jelas<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">·<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Mengeluh sakit kepala<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">·<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Merasa takut<o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">2. Data Objektif<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">·<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Mata juling (strabismus)<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">·<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Mata merah<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">·<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Bola mata besar<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">·<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Aktivitas kurang<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l10 level1 lfo11; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">·<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Tekanan bola mata meningkat<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l10 level1 lfo11; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">·<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Gelisah<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l10 level1 lfo11; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">·<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Refleks pupil berwarna putih
(leukokoria)<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l10 level1 lfo11; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">·<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Tajam penglihatan menurun<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l10 level1 lfo11; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">·<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Sering menangis<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l10 level1 lfo11; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">·<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Keluarga sering bertanya<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l10 level1 lfo11; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">·<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Ekspresi meringis<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l10 level1 lfo11; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">·<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Tak akurat mengikuti instruksi<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l10 level1 lfo11; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">·<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Keluarga nampak murung<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l10 level1 lfo11; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">·<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Keluarga nampak gelisah<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l10 level1 lfo11; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;">·<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Pertanyaan/pernyataan keluarga salah
konsepsi<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l14 level1 lfo12; text-align: justify; text-indent: -18.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><b><span lang="EN-US" style="font-size: 12pt;">C.<span style="font-size: 7pt; font-weight: normal;"> </span></span></b><b><span lang="EN-US" style="font-size: 12pt;">Diagnose <o:p></o:p></span></b></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; text-align: justify;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l8 level1 lfo15; mso-text-indent-alt: -18.0pt; text-align: justify; text-indent: -36.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;"><span style="font-size: 7pt;"> </span>1.<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Nyeri b/d proses penyakit, inflamasi<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l8 level1 lfo15; mso-text-indent-alt: -18.0pt; text-align: justify; text-indent: -36.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;"><span style="font-size: 7pt;"> </span>2.<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Gangguan persepsi sensori : visual b/d
gangguan penerimaan sensori<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l8 level1 lfo15; mso-text-indent-alt: -18.0pt; text-align: justify; text-indent: -36.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;"><span style="font-size: 7pt;"> </span>3.<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Resiko cedera b/d keterbatasan lapang
pandang<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l8 level1 lfo15; mso-text-indent-alt: -18.0pt; text-align: justify; text-indent: -36.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;"><span style="font-size: 7pt;"> </span>4.<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Perubahan status nutrisi kurang dari
kebutuhan tubuh b/d status hipermetabolik<o:p></o:p></span></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l8 level1 lfo15; mso-text-indent-alt: -18.0pt; text-align: justify; text-indent: -36.0pt;">
<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;"><span style="font-size: 7pt;"> </span>5.<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Ansietas b/d perubahan status kesehatan<o:p></o:p></span></span></div>
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<span style="font-family: Georgia, 'Times New Roman', serif;"><span lang="EN-US" style="font-size: 12pt;"><span style="font-size: 7pt;"> </span>6.<span style="font-size: 7pt;">
</span></span><span lang="EN-US" style="font-size: 12pt;">Gangguan harga diri b/d kecacatan bedah<o:p></o:p></span></span></div>
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<br /></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; text-align: justify;">
<span lang="EN-US" style="font-size: 12pt;"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36pt;">
<br />
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l3 level1 lfo1; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">A.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal;"> </span></span></b><!--[endif]--><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Intervens</span></b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">i <o:p></o:p></span></div>
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<br /></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-bottom-style: none; border-collapse: collapse; border-color: initial; border-image: initial; border-left-style: none; border-right-style: none; border-top-style: none; border-width: initial; width: 593px;">
<tbody>
<tr>
<td style="border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 90.45pt;" valign="top" width="121">
<div align="center" class="MsoNoSpacing" style="line-height: 200%; text-align: center;">
<b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%;">Diagnosa<o:p></o:p></span></b></div>
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<td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 99.25pt;" valign="top" width="132">
<div align="center" class="MsoNoSpacing" style="line-height: 200%; text-align: center;">
<b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%;">Tujuan<o:p></o:p></span></b></div>
</td>
<td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 120.5pt;" valign="top" width="161">
<div align="center" class="MsoNoSpacing" style="line-height: 200%; text-align: center;">
<b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%;">Intervensi<o:p></o:p></span></b></div>
</td>
<td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 134.65pt;" valign="top" width="180">
<div align="center" class="MsoNoSpacing" style="line-height: 200%; text-align: center;">
<b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 200%;">Rasional<o:p></o:p></span></b></div>
</td>
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<tr>
<td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 90.45pt;" valign="top" width="121">
<div class="MsoNoSpacing" style="margin-left: 18.0pt; mso-list: l2 level1 lfo2; mso-text-indent-alt: -9.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">1.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Nyeri
b/d proses penyakit, inflamasi<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<br /></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 99.25pt;" valign="top" width="132">
<div class="MsoNoSpacing" style="margin-left: 17.1pt; mso-list: l0 level1 lfo3; text-align: justify; text-indent: -17.1pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Melaporkan kehilangan nyeri<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 120.5pt;" valign="top" width="161">
<div class="MsoNoSpacing" style="margin-left: 14.7pt; mso-list: l0 level1 lfo3; text-indent: -13.5pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Tentukan
riwayat nyeri mis : lokasi nyeri, frekuensi, durasi dan intensitas (skala
0-10)<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 14.7pt; mso-list: l0 level1 lfo3; text-indent: -13.5pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Evaluasi
/ sadari terapi tertentsu mis : pembedahan, radiasi, kemoterapi.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 14.7pt; mso-list: l0 level1 lfo3; text-indent: -13.5pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Berikan
tindakan kenyamanan dasar dan aktivitas hiburan<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 14.7pt; mso-list: l0 level1 lfo3; text-indent: -13.5pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Dorong
penggunaan keterampilan manajemen nyeri (mis : tekhnik relaksasi,
visualisasi) tertawa, music, sentuhan terapeutik<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 14.7pt; mso-list: l0 level1 lfo3; text-indent: -13.5pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Kolaborasi
: berikan analgesic sesuai indikasi<o:p></o:p></span></div>
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<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 134.65pt;" valign="top" width="180">
<div class="MsoNoSpacing" style="margin-left: 21.6pt; mso-list: l0 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Informasi memberikan data dasar untuk
mengevaluasi kebutuhan keefektivan intervensi<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 21.6pt; mso-list: l0 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Ketidaknyamanan rentang luas adalah
umum (mis : nyeri insisi)<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 21.6pt;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: 21.6pt; mso-list: l0 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Meningkatkan relaksasi dan membantu
menfokuskan kembali perhatian<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 21.6pt; mso-list: l0 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Memungkinkan pasien untuk
berpartisipasi secara aktif dan meningkatkan rasa control<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 21.6pt; mso-list: l0 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Nyeri adalah komplikasi sering dari
kanker, meskipun respon individual bebeda<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 90.45pt;" valign="top" width="121">
<div class="MsoNoSpacing" style="margin-left: 18.0pt; mso-list: l2 level1 lfo2; mso-text-indent-alt: -13.5pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">2.<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Gangguan persepsi sensori : visual b/d
gangguan penerimaan sensori<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 99.25pt;" valign="top" width="132">
<div class="MsoNoSpacing" style="margin-left: 15.75pt; mso-list: l0 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-ansi-language: IN; mso-bidi-font-size: 11.0pt;">Mengenal
gangguan sensori dan berkompensasi terhadap perubahan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 15.75pt; mso-list: l0 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-ansi-language: IN; mso-bidi-font-size: 11.0pt;">Mengidentifikasi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">/ memperbaiki </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-ansi-language: IN; mso-bidi-font-size: 11.0pt;">potensial bahaya dalam lingkungan.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;"><o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 120.5pt;" valign="top" width="161">
<div class="MsoNoSpacing" style="margin-left: 17.1pt; mso-list: l0 level1 lfo3; text-indent: -17.1pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Pastikan derajat/tipe kehilangan
penglihatan<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 17.1pt;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: 17.1pt; mso-list: l0 level1 lfo3; text-indent: -17.1pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Dorong mengekspresikan perasaan
tentang kehilangan/kemumgkinan kehilangan penglihatan<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-bottom: 0.0001pt; text-indent: 36pt;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: 17.1pt; mso-list: l0 level1 lfo3; text-indent: -17.1pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Tunjukan pemberian tetes mata, contoh
menghitung tetesan, mengikuti jadwal, tidak salah dosis<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 17.1pt; mso-list: l0 level1 lfo3; text-indent: -17.1pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Lakukan tindakan untuk membantu pasien
menangni keterbatasan penglihatan , contoh kurangi kekacauan, perbaiki sinar
suram dan masalah penglihatan malam<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 17.1pt; mso-list: l0 level1 lfo3; text-align: justify; text-indent: -17.1pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Kolaborasi : </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Siapkan
intervensi bedah sesuai indikasi: enuklasi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 17.1pt; text-align: justify;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: 17.1pt; text-align: justify;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: 17.1pt; text-align: justify;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: 17.1pt; text-align: justify;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: 17.1pt; mso-list: l0 level1 lfo3; text-indent: -17.1pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Pelaksanaan
krioterapi, fotokoagulasi laser, atau kombinasi sitostatik</span><span lang="EN-US">.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;"><o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 134.65pt;" valign="top" width="180">
<div class="MsoNoSpacing" style="margin-left: 21.6pt; mso-list: l0 level1 lfo3; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Mempengaruhi harapan masa depan pasien
dan pilihan intervensi.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 21.6pt; mso-list: l0 level1 lfo3; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Sementara intervensi dini mencegah
kebutaan, pasien menghadapi kemungkinan atau mengalami kehilangan penglihatan<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 21.6pt; mso-list: l0 level1 lfo3; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Mengontrol TIO, mencegah kehilangan
penglihatan lanjut<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 21.6pt; text-align: justify;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: 21.6pt; mso-list: l0 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Menurunkan bahaya keamanan sehubungan
dengan perubahan lapang pandang/kehilangan penglihatan dan akomodasi pupil
terhadap sinar lingkungan<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: 21.6pt; mso-list: l0 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Pengangkatan
bola mata, dilakukan apabila tumor sudah mencapai seluruh vitreous dan visus
nol, dilakukan untuk mencegah tumor bermetastasis lebih jauh</span><span lang="EN-US">.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 21.6pt; mso-list: l0 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Dilakukan
apabila tumor masih intraokuler, untuk mencegah pertumbuhan tumor akan
mempertahankan visus.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;"><o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 90.45pt;" valign="top" width="121">
<div class="MsoNoSpacing" style="margin-left: 9.0pt; mso-list: l2 level1 lfo2; mso-text-indent-alt: -4.5pt; text-indent: -9.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">3.<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Resiko cedera b/d keterbatasan lapang
pandang<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 99.25pt;" valign="top" width="132">
<div class="MsoListParagraphCxSpFirst" style="margin-bottom: 0.0001pt; margin-left: 20.25pt; margin-right: 0cm; margin-top: 0cm; text-indent: -20.25pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; mso-ansi-language: IN; mso-bidi-font-family: Symbol; mso-bidi-font-size: 13.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 13.0pt; mso-fareast-font-family: "Times New Roman";">Menyatakan pemahaman factor yang terlibat dalam
kemungkinan cedera.</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-ansi-language: IN; mso-bidi-font-size: 13.0pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="margin-bottom: 0.0001pt; margin-left: 20.25pt; margin-right: 0cm; margin-top: 0cm; text-indent: -20.25pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; mso-ansi-language: IN; mso-bidi-font-family: Symbol; mso-bidi-font-size: 13.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 13.0pt; mso-fareast-font-family: "Times New Roman";">Mengubah lingkungan sesuai indikasi untuk meningkatkan
keamanan</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-ansi-language: IN; mso-bidi-font-size: 13.0pt; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 120.5pt;" valign="top" width="161">
<div class="MsoNoSpacing" style="margin-left: 17.1pt; mso-list: l0 level1 lfo3; text-indent: -17.1pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Batasi aktivitas seperti menggerakkan
kepala tiba-tiba, menggaruk mata, membungkuk.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 17.1pt; mso-list: l0 level1 lfo3; text-indent: -17.1pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Anjurkan
keluarga memberikan mainan yang aman (tidak pecah), dan pertahankan pagar
tempat tidur.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 17.1pt; mso-list: l0 level1 lfo3; text-indent: -17.1pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Arahkan
semua alat mainan yang dibutuhkan klien pada tempat</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 17.1pt;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: 17.1pt;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: 17.1pt; mso-list: l0 level1 lfo3; text-indent: -17.1pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Pemberian
analgesik, misalnya: acetaminophen (tyenol), empirin dengan kodein.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;"><o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 134.65pt;" valign="top" width="180">
<div class="MsoNoSpacing" style="margin-left: 21.6pt; mso-list: l0 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Menurunkan stress pada area operasi
atau menurunkan tekanan intraokuler<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 21.6pt; mso-list: l0 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Menurunkan
resiko memecahkan mainan dan jatuh dari tempat tidur</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 3.6pt;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: 21.6pt;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: 21.6pt; mso-list: l0 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Memfokuskan
lapang pandang dan mencegah cedera pada saat </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">berusaha untuk
menjangkau mainan.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 21.6pt; mso-list: l0 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 11.0pt;">Digunakan
untuk mengatasi ketidaknyamanan, meningkatkan istirahat/mencegah gelisah</span><span lang="EN-US">.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 21.6pt;">
<br /></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 90.45pt;" valign="top" width="121">
<div class="MsoNoSpacing" style="margin-left: 9.0pt; mso-list: l2 level1 lfo2; mso-text-indent-alt: -4.5pt; text-indent: -9.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">4.<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Perubahan status nutrisi kurang dari
kebutuhan tubuh b/d status hipermetabolik<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 99.25pt;" valign="top" width="132">
<div class="MsoListParagraphCxSpFirst" style="margin-bottom: 0.0001pt; margin-left: 20.25pt; margin-right: 0cm; margin-top: 0cm; text-indent: -20.25pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 13.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 13.0pt; mso-fareast-font-family: "Times New Roman";">Mendemostrasikan berat badan stabil<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="margin-bottom: 0.0001pt; margin-left: 20.25pt; margin-right: 0cm; margin-top: 0cm; text-indent: -20.25pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 13.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-bidi-font-size: 13.0pt; mso-fareast-font-family: "Times New Roman";">Bebas tanda malnutrisi<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 120.5pt;" valign="top" width="161">
<div class="MsoNoSpacing" style="margin-left: 17.1pt; mso-list: l0 level1 lfo3; text-indent: -17.1pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Pantau masukan makanan setiap hari<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 17.1pt; mso-list: l0 level1 lfo3; text-indent: -17.1pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Ukur tinggi, berat badan dan ketebalan
lipatan kulit trisep<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 17.1pt;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: 17.1pt;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: 17.1pt; mso-list: l0 level1 lfo3; text-indent: -17.1pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Dorong pasien untuk makan diet tinggi
kalori kaya nutrient, dengan masukan cairan adekuat<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 17.1pt; mso-list: l0 level1 lfo3; text-indent: -17.1pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Identifikasi pasien yang mengalami
mual/muntah yang diantisipasi<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 17.1pt;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: 17.1pt; mso-list: l0 level1 lfo3; text-indent: -17.1pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Dorang komunikasi terbuka mengenai
masalah anoreksia<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 134.65pt;" valign="top" width="180">
<div class="MsoNoSpacing" style="margin-left: 21.6pt; mso-list: l0 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Mengidentifikasi kekuatan/defisiensi
nutrisi<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 21.6pt; mso-list: l0 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Membantu dalam identifikasi malnutrisi
protein-kalori, khususnya bila berat badan dan pengukuran antropometrik<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 21.6pt; mso-list: l0 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Kebutuhan jaringan metabolic
ditingkatkan begitu juga cairan.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 21.6pt;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: 21.6pt; mso-list: l0 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Mual muntah psikogenik terjadi sebelum
kemoterapi mulai secara umum tidak berespon terhadap obat antiemetic.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 21.6pt; mso-list: l0 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Sering sebagai sumber distress emosi,
khususnya untuk orang terdekat yang menginginkan untuk memberi makan pasien
dengan sering. Bila pasien menolak, orang terdekat dapat merasakan
ditolak/frustasi<o:p></o:p></span></div>
</td>
</tr>
<tr style="height: 76.0pt; mso-yfti-irow: 5;">
<td style="border-top: none; border: solid black 1.0pt; height: 76.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 90.45pt;" valign="top" width="121">
<div class="MsoNoSpacing" style="margin-left: 9.0pt; mso-list: l2 level1 lfo2; mso-text-indent-alt: -4.5pt; text-indent: -9.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">5.<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Ansietas b/d perubahan status
kesehatan<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 76.0pt; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 99.25pt;" valign="top" width="132">
<div class="MsoNoSpacing" style="margin-left: 15.75pt; mso-list: l1 level1 lfo4; text-indent: -15.75pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Ansietas
menurun sampai pada tingkat yang dapat diatasi<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 15.75pt; mso-list: l1 level1 lfo4; text-indent: -15.75pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Menggunakan
sumber secara efektif<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 76.0pt; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 120.5pt;" valign="top" width="161">
<div class="MsoNoSpacing" style="margin-left: 17.1pt; mso-list: l1 level1 lfo4; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Kaji tingkat ansietas, derajat
pengalaman nyeri dan pengetahuan kondisi saat ini.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 17.1pt;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: 17.1pt; mso-list: l1 level1 lfo4; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Dorong pasien untuk mengakui masalah
dan mengekspresikan perasaan.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 17.1pt; mso-list: l1 level1 lfo4; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Berikan informasi yang akurat dan
jujur.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 76.0pt; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 134.65pt;" valign="top" width="180">
<div class="MsoNoSpacing" style="margin-left: 21.6pt; mso-list: l1 level1 lfo4; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Mempengaruhi persepsi pasien terhadap
ancaman diri, dapat mempengaruhi upaya medic untuk mengontrol TIO<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 21.6pt; mso-list: l1 level1 lfo4; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Memberikan kesempatan pasien untuk
menerima situasi nyata.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 21.6pt;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: 21.6pt; mso-list: l1 level1 lfo4; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Menurunkan ansietas sehubungan dengan
ketidaktahuan/harapan yang akan datang<o:p></o:p></span></div>
</td>
</tr>
<tr style="height: 76.0pt; mso-yfti-irow: 6; mso-yfti-lastrow: yes;">
<td style="border-top: none; border: solid black 1.0pt; height: 76.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 90.45pt;" valign="top" width="121">
<div class="MsoNoSpacing" style="margin-left: 9.0pt; mso-list: l2 level1 lfo2; mso-text-indent-alt: -4.5pt; text-indent: -9.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">6.<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Gangguan harga diri b/d kecacatan
bedah<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 76.0pt; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 99.25pt;" valign="top" width="132">
<div class="MsoNoSpacing" style="margin-left: 15.75pt; mso-list: l1 level1 lfo4; text-indent: -15.75pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Mengungkapakan
pemahaman mekanisme koping untuk menghadapi masalah secara efektif<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 76.0pt; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 120.5pt;" valign="top" width="161">
<div class="MsoNoSpacing" style="margin-left: 17.1pt; mso-list: l1 level1 lfo4; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;"> Dikskusikan dengan pasien/orang
terdekat/orang tua bagaimana diagnosis dan pengobatan yang mempengaruhi
kehidupan pribadi pasien/rumah dan akivitas bermain<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 17.1pt; mso-list: l1 level1 lfo4; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Evaluasi struktur yang ada dan
digunakan oleh pasien/orang terdekat<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 17.1pt; mso-list: l1 level1 lfo4; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Berikan dukungan emosi untuk
pasien/orang terdekat selama tes diagnostic dan fase pengobatan<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 17.1pt;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: 17.1pt;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: 17.1pt;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: 17.1pt; mso-list: l1 level1 lfo4; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Gunakan sentuhan selam interaksi. Bila
dapat diterima pada pasien dan mempertahankan kontak mata<o:p></o:p></span></div>
</td>
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</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Membantu memastikan masalah untuk
memulai proses pemecahan masalah<o:p></o:p></span></div>
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<br /></div>
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<br /></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Membantu merencanakan perawatan saat
di Rumah Sakit serta setelah pulang<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Meskipun beberapa pasien beradaptasi
diri dengan efek kanker atau efek samping terapi;banyak memerlukan dukungan
tambahan selama periode ini<o:p></o:p></span></div>
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</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt;">Pastikan individualitas dan penerimaan
penting dalam menurunkan perasaan pasien tentang ketidakamanan dan keraguan
diri<o:p></o:p></span></div>
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</tbody></table>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;">DAFTAR
PUSTAKA</span><span style="font-family: 'Times New Roman', serif;"><o:p></o:p></span></span></div>
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<span lang="EN-US" style="font-size: 12pt;"><span style="font-family: Georgia, 'Times New Roman', serif;"><br /></span></span></div>
<div class="MsoNormal" style="text-align: center;">
<span lang="EN-US" style="font-size: 12pt;"></span></div>
<div style="line-height: 200%; margin-left: 18pt; text-align: left;">
<span lang="EN-US">Doenges,
Marilynn, E., et. al., 1999, <i>Rencana
Asuhan Keperawatan: Pedoman untuk Perencanaan dan Pendokumentasian
Perawatan Pasien, Edisi 3</i>, EGC, Jakarta.</span></div>
<div style="line-height: 200%; margin-left: 18pt; text-align: left;">
<span lang="EN-US">Ganong,
William, F., 1998<i>, Buku Ajar Fisiologi
Kedokteran, Edisi 17</i>, EGC, Jakarta.</span></div>
<div style="line-height: 200%; margin-left: 18pt; text-align: left;">
<span lang="EN-US">Mansjoer, A.,
et. al. 2001<i>, Kapita Selekta Kedokteran,
Jilid I, Edisi III, Cetakan IV</i>, Media Aekulapius. FK-UI, Jakarta.</span></div>
<div style="line-height: 200%; margin-left: 18pt; text-align: left;">
<span lang="EN-US">Oswari hanifah,
dkk<i>. 123 Penyakit dengan Gangguan Pada
Anak.</i> 2009. BIP : Jakarta</span></div>
<br />salnihttp://www.blogger.com/profile/00126668517852477742noreply@blogger.com0Universitas Sam Ratulangi, Jalan Kampus Selatan, Manado, Indonesia1.455717 124.8271631.453733 124.8246955 1.457701 124.8296305tag:blogger.com,1999:blog-8321145958076225978.post-4826830069083984032012-03-16T01:50:00.000-07:002012-03-16T01:51:18.643-07:00ASUHAN KEPERAWATAN PENYAKIT JANTUNG BAWAAN AS – TGA “ Transposition Of Great Arteries “<br />
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b><span style="font-size: 12pt; line-height: 115%;">KONSEP DASAR</span></b><span style="font-size: 12pt; line-height: 115%;"><o:p></o:p></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b><span style="font-size: 12pt; line-height: 115%;">I.</span></b><span style="font-size: 12pt; line-height: 115%;"> <b>Pengertian<o:p></o:p></b></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="font-size: 12pt; line-height: 115%;">Penyakit Jantung Bawaan ( PJB )
merupakan kelainan susunan jantung yang sudah dalam kandungan. Tetapi kelainan
jantung ini tidak memberikan gejala yang segera setelah bayi lahir, tidak
jarang kelainan ini.</span><span style="font-size: 12pt; line-height: 115%;">muncul setelah pasien berumur beberapa
bulan atau tahun. </span><i style="font-size: 12pt; line-height: 115%;">( Asuhan Keperawtan Bayi dan Anak, hal 118 )</i></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiWBd8yqp1184f2fJTculE4bM5sX4jjU96NI43S0k10PpNy8yQk0fJcTtFLBM2iVdwTNvrgf4Bmo3jP0RbtthGa9q5y4aXaL65foV40gza84p02QEQNW2KacTiSeInJIqFDtfkORPRFW0M/s1600/transpositiongreatarteries.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="color: black; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><img border="0" height="199" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiWBd8yqp1184f2fJTculE4bM5sX4jjU96NI43S0k10PpNy8yQk0fJcTtFLBM2iVdwTNvrgf4Bmo3jP0RbtthGa9q5y4aXaL65foV40gza84p02QEQNW2KacTiSeInJIqFDtfkORPRFW0M/s200/transpositiongreatarteries.jpg" width="200" /></span></a></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Kelainan jantung bawaan AS TGA ( Atrial
Septal Transposition Of The Great Arteries ) merupakan kelainan pada jantung
berupa celah atau defect antara ventrikel kiri dan ventrikel kanan, terjadi
perpindahan asal dari aorta dan arteri pulmonalis, dimana aorta keluar dari
ventrikel kanan dan arteri pulmonal dari ventrikel kiri. <i>( Ngastiah,hal
110 )</i></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b><span style="font-size: 12pt; line-height: 115%;">II.</span></b><span style="font-size: 12pt; line-height: 115%;"> <b>Etiologi</b><o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Penyakit jantung bawaan diduga terjadi
dimasa embrional. Disebabkan :<o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">a. Factor genetic.<o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">1. Adanya gen – gen mutan tunggal ( dominan autosomal, resesif
autosomal, atau terkait – X ) yang biasanya menyebabkan penyakit jantung bawaan
sebagai bagian dari suatu kompleks kelainan.<o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">2. Kelainan kromosom juga menyebabkan penyakit jantung kongenital sebagai
bagian suatu kompleks lesi.<o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">3. Factor gen multifaktorial, dipercaya merupakan dasar terjadinya
duktus anterious paten dan dasar penyakit congenital lainnya.<o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">b. Factor lingkungan.<o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">1. Lingkungan janin, ibu yang diabetic atau ibu yang meminum
progesterone saat hamil mungkin akan mengalami peningkatan resiko untuk
mempunyai anak dengan penyakit jantung congenital.<o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">2. Lesi viral. Emriopati rubella sering menyebabkan stenosis pulmonal
perifer, duktus arteosus paten dan kadang – kadang stenosis katup pulmonal.<o:p></o:p></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b><span style="font-size: 12pt; line-height: 115%;">III.</span></b><span style="font-size: 12pt; line-height: 115%;"> <b>Manifestasi Klinis</b><o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">a. Bayi lahir dalam keadaan sianosis, pucat kebiru – biruan yang
disebut <i>Picasso Blue</i>. Sianosis merata keseluruh tubuh kecuali jika
resistensi vascular paru sangat tinggi, dibagian tubuh sebelah atas akan
lebih sianotik dibandingbagian bawah.<o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">b. Pada foto merah terlihat jelas gambaran pembuluh darah abnormal.<o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">c. Pada umur tiga bulan, terjadi kelambatan penambahan berat badan dan
panjang badan serta perkembangan otak terganggu.<o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">d. Disertai pulmonal stenosis sering timbul serangan anoksia, yang
menandakan bahaya kematian.<o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">e. Bila terdapat gejala takipnea, maka tanda adanya gejala gagal
jantung.<o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">f. Pada aliran darah paru yang meningkat menunjukkan penampangan
anterior – posterior dada bertambah.<o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">g. Pada anak besar, tampak jelas <i>voussure cardiac </i>ke
kiri.</span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b><span style="font-size: 12pt; line-height: 115%;">IV.</span></b><span style="font-size: 12pt; line-height: 115%;"> <b>Patofosiologi</b><o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Kelainan jantung dapat terjadi pada masa
embrio ( hari ke – 10 sampai minggu ke – 8 ) karena penggunaan obat – obatan
oleh ibu seperti terapi progesterone, Toxoplasmosis, Rybella, Cytomegalovirus,
Herpes ( TORCH ) yang diderita ibu. Hal ini menyebabkan ketidaksempurnaan
pembelahan sel embrio untuk membentuk jantung janin.</span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b><span style="font-size: 12pt; line-height: 115%;">V.</span></b><span style="font-size: 12pt; line-height: 115%;"> <b>Penatalaksanaan Medik</b><o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Dengan operasi, memungkinkan pasien
dapat bertahan hidup setelah klien berumur 2 tahun. Jika sering mengalami <i>spell, </i>segera
operasi paliatif ( <i>BT shunt – </i>membuat saluran dari arteri
subklavia ke arteri pulmonal.). <i>( Pediatrica, hal III.29 </i>)</span></span></div>
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<br /></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b><span style="font-size: 12pt; line-height: 115%;">VI.</span></b><span style="font-size: 12pt; line-height: 115%;"> <b>Penyimpangan KDM</b><o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Penyakit yang diderita ibu saat hamil atau penggunaan
obat-obatan<o:p></o:p></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="position: relative; z-index: 1;"><span style="height: 33px; left: 319px; position: absolute; top: -2px; width: 12px;"><img height="33" src="file:///C:/Users/USER/AppData/Local/Temp/msohtmlclip1/01/clip_image003.gif" v:shapes="_x0000_s1026" width="12" /></span></span><span style="font-size: 12pt; line-height: 115%;"><o:p> </o:p></span></span></div>
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br clear="ALL" />
</span><br />
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<span style="height: 33px; left: 0px; margin-left: 319px; margin-top: 28px; position: absolute; width: 12px; z-index: 2;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><img height="33" src="file:///C:/Users/USER/AppData/Local/Temp/msohtmlclip1/01/clip_image004.gif" v:shapes="_x0000_s1027" width="12" /></span></span><span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Ketidaksempurnaan
Pembelahan sel membentuk jantung<o:p></o:p></span></span></div>
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<span style="height: 33px; left: 0px; margin-left: 319px; margin-top: 27px; position: absolute; width: 12px; z-index: 3;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><img height="33" src="file:///C:/Users/USER/AppData/Local/Temp/msohtmlclip1/01/clip_image005.gif" v:shapes="_x0000_s1028" width="12" /></span></span><span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Perpindahan letak
aorta Dan arteri pulmonalis<o:p></o:p></span></span></div>
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<span style="height: 38px; left: 0px; margin-left: 319px; margin-top: 25px; position: absolute; width: 12px; z-index: 4;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><img height="38" src="file:///C:/Users/USER/AppData/Local/Temp/msohtmlclip1/01/clip_image006.gif" v:shapes="_x0000_s1029" width="12" /></span></span><span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Aorta keluar dari
ventrikel Kanan dan arteri pulmonalis Dari ventrikel kiri jantung<o:p></o:p></span></span></div>
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<div align="center" class="MsoNormal" style="line-height: 115%; margin-bottom: 10.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; tab-stops: right 459.6pt; text-align: center; text-indent: 0cm;">
<span style="height: 264px; left: 0px; margin-left: 319px; margin-top: 25px; position: absolute; width: 12px; z-index: 6;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><img height="264" src="file:///C:/Users/USER/AppData/Local/Temp/msohtmlclip1/01/clip_image007.gif" v:shapes="_x0000_s1031" width="12" /></span></span><span style="height: 41px; left: 0px; margin-left: 125px; margin-top: 25px; position: absolute; width: 156px; z-index: 5;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><img height="41" src="file:///C:/Users/USER/AppData/Local/Temp/msohtmlclip1/01/clip_image008.gif" v:shapes="_x0000_s1030" width="156" /></span></span><span style="height: 46px; left: 0px; margin-left: 350px; margin-top: 25px; position: absolute; width: 180px; z-index: 8;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><img height="46" src="file:///C:/Users/USER/AppData/Local/Temp/msohtmlclip1/01/clip_image009.gif" v:shapes="_x0000_s1033" width="180" /></span></span><span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Kelainan pada struktur pulmonal dan kardiak<o:p></o:p></span></span></div>
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<span style="height: 35px; left: 0px; margin-left: 94px; margin-top: 22px; position: absolute; width: 12px; z-index: 12;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><img height="35" src="file:///C:/Users/USER/AppData/Local/Temp/msohtmlclip1/01/clip_image010.gif" v:shapes="_x0000_s1037" width="12" /></span></span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="font-size: 12pt; line-height: 115%;">Metabolisme tubuh
terganggu </span><u><span style="font-size: 12pt; line-height: 115%;">penurunan co b/d defek struktur</span></u><span style="font-size: 12pt; line-height: 115%;"><o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> <o:p></o:p></span></span></div>
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<span style="height: 38px; left: 0px; margin-left: 94px; margin-top: 26px; position: absolute; width: 12px; z-index: 7;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><img height="38" src="file:///C:/Users/USER/AppData/Local/Temp/msohtmlclip1/01/clip_image011.gif" v:shapes="_x0000_s1032" width="12" /></span></span><span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Penurunan ATP<o:p></o:p></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="font-size: 12pt; line-height: 115%;"> </span><span style="font-size: 12pt; line-height: 115%;"><o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Tubuh Lemas dan tak bertenaga <o:p></o:p></span></span></div>
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<span style="height: 38px; left: 0px; margin-left: 94px; margin-top: 2px; position: absolute; width: 12px; z-index: 16;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><img height="38" src="file:///C:/Users/USER/AppData/Local/Temp/msohtmlclip1/01/clip_image012.gif" v:shapes="_x0000_s1041" width="12" /></span></span><span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> <o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> <o:p></o:p></span></span></div>
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<span style="height: 66px; margin-left: 319px; margin-top: 25px; position: absolute; width: 12px; z-index: 10;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><img height="66" src="file:///C:/Users/USER/AppData/Local/Temp/msohtmlclip1/01/clip_image013.gif" v:shapes="_x0000_s1035" width="12" /></span></span><span style="height: 12px; margin-left: 201px; margin-top: 7px; position: absolute; width: 28px; z-index: 14;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><img height="12" src="file:///C:/Users/USER/AppData/Local/Temp/msohtmlclip1/01/clip_image014.gif" v:shapes="_x0000_s1039" width="28" /></span></span><span style="height: 12px; margin-left: 398px; margin-top: 7px; position: absolute; width: 30px; z-index: 9;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><img height="12" src="file:///C:/Users/USER/AppData/Local/Temp/msohtmlclip1/01/clip_image015.gif" v:shapes="_x0000_s1034" width="30" /></span></span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="font-size: 12pt; line-height: 115%;"> </span><i><u><span style="font-size: 12pt; line-height: 115%;">intoleransi aktifitas</span></u></i><span style="font-size: 12pt; line-height: 115%;"> sianosis saat janin lahir <u>Kekurangan O<sub>2</sub> dalam
tubuh</u> <o:p></o:p></span></span></div>
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<td height="0" width="539"></td>
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<td></td>
<td><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><img height="35" src="file:///C:/Users/USER/AppData/Local/Temp/msohtmlclip1/01/clip_image010.gif" v:shapes="_x0000_s1038" width="12" /></span></td>
</tr>
</tbody></table>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br clear="ALL" />
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="font-size: 12pt; line-height: 115%;"> </span><i><u><span style="font-size: 12pt; line-height: 115%;">gangguan
pertumbuhan<o:p></o:p></span></u></i></span></div>
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<span style="height: 38px; margin-left: 319px; margin-top: 26px; position: absolute; width: 12px; z-index: 15;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><img height="38" src="file:///C:/Users/USER/AppData/Local/Temp/msohtmlclip1/01/clip_image006.gif" v:shapes="_x0000_s1040" width="12" /></span></span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><u><span style="font-size: 12pt; line-height: 115%;">perubahan
struktur keluarga</span></u></i></span><span style="height: 12px; margin-left: 201px; margin-top: 5px; position: absolute; width: 26px; z-index: 11;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><img height="12" src="file:///C:/Users/USER/AppData/Local/Temp/msohtmlclip1/01/clip_image016.gif" v:shapes="_x0000_s1036" width="26" /></span></span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><u><span style="font-size: 12pt; line-height: 115%;"> </span></u></i><i><span style="font-size: 12pt; line-height: 115%;"> </span></i><i><span style="font-size: 12pt; line-height: 115%;">anak penyakit </span></i><span style="font-size: 12pt; line-height: 115%;">jantung</span><span style="font-size: 12pt; line-height: 115%;"> <u>dan<i> perkembangan</i></u></span><span style="font-size: 12pt; line-height: 115%;"><o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> <o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">pengobatan rutin yang harus dijalani anak<o:p></o:p></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b><span style="font-size: 12pt; line-height: 115%;">KONSEP KEPERAWATAN</span></b><span style="font-size: 12pt; line-height: 115%;"><o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b><span style="font-size: 12pt; line-height: 115%;">I.</span></b><span style="font-size: 12pt; line-height: 115%;"> <b>Pengkajian</b><o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">a. Usia. <o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Perlu diketahui pada
usia berapa gejala mulai muncul.<o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">b. Pertumbuhan dan perkembangan <b>. <o:p></o:p></b></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Terjadi gangguan
perkembangan fisik anak, terutama berat badan.<o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">c. Pola aktifitas. <o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Tidak mampu melakukan
banyak aktifitas karena akan menyebabkan sianosis.<o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">d. Tanda – tanda vital. <o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Suhu relative normal
bila tidak terjadi infeksi. Pada bayi akan menetek sering terhenti karena
kesulitan bernafas.<o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">e. Pemeriksaan penunjang, berupa :<o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">1. Ultra Sono Grafi ( USG ) untuk menentukan besar jantung, bentuk
vaskularisasi paru, sera untuk mengetahui keadaan thymus, trachea, dan
esophagus.<o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">2. Electro Cardiografi ( ECG ), untuk menetahui adanya aritmia atau
hipertropi.<o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">3. Echo Cardiografi, untuk mengetahui hemodinamik dan anatomi jantung.<o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">4. Kateterisasi dan Angigrafi, untuk mengetahui gangguan anatomi
jantung yang dilakukan dengan tindakan pembedahan.<o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">5. Pemeriksaan laboratorium, berupa pemeriksaan darah untuk serum
elektrolit, Hb, <i>packet cell volume </i>( PCV ) dan kadar gula.<o:p></o:p></span></span></div>
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<i><span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">( Asuhan Keperawatan Bayi dan Anak, hal. 120 )<o:p></o:p></span></span></i></div>
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<br /></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b><span style="font-size: 12pt; line-height: 115%;">II.</span></b><span style="font-size: 12pt; line-height: 115%;"> <b>Diagnose</b><o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">a. Penurunan cardiac output b/d defek struktur.<o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">b. Intoleransi aktifitas b/d sianosis<o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">c. Gangguan pertumbuhan dan perkembangan b/d ketidakkuatan oksigen dan
nutrient pada jaringan.<o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">d. Perubahan proses keluarga b/d mempunyai anak dengan penyakit
jantung.<o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b><span style="font-size: 12pt; line-height: 115%;">III.</span></b><span style="font-size: 12pt; line-height: 115%;"> <b>Tujuan dan Intervensi serta Rasional</b><o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">a. Penurunan cardiac output b/d defek struktur.<o:p></o:p></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span style="font-size: 12pt; line-height: 115%;">Tujuan : </span></i><span style="font-size: 12pt; line-height: 115%;">Pasien menunjukkan perbaikan curah jantung<o:p></o:p></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span style="font-size: 12pt; line-height: 115%;">Intervensi :</span></i><span style="font-size: 12pt; line-height: 115%;"><o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">1. Kaji CO klien<i>. Mengetahui CO klien untuk intervensi selanjutnya.</i> <o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">2. Beri istirahat yang cukup pada klien pada ruangan yang nyaman dan
tenang.<o:p></o:p></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span style="font-size: 12pt; line-height: 115%;">Ruangan tenang dan
nyaman mampu membuat klien rileks.</span></i><span style="font-size: 12pt; line-height: 115%;"><o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">3. Hindari suhu lingkungan yang ekstrem.<o:p></o:p></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span style="font-size: 12pt; line-height: 115%;">Hipoermia atau
hipertermia akan meningkatkan kebutuhan oksigen.</span></i><span style="font-size: 12pt; line-height: 115%;"><o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">4. Kolaborasi dengan tim dokter untuk pemberian Digoxin ( digitalisasi
) dan juga observasi TTV selama pemberian obat.<o:p></o:p></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span style="font-size: 12pt; line-height: 115%;">Tanda – tanda oksitasi
digitalis berupa nadi tidak teratur, mual dan muntah, maka hentikan pemberian
obat. Setelah membaik, lakukan pengobatan mulai dari awal.</span></i><span style="font-size: 12pt; line-height: 115%;"><o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">b. Intoleransi aktifitas b/d sianosis.<o:p></o:p></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span style="font-size: 12pt; line-height: 115%;">Tujuan : </span></i><span style="font-size: 12pt; line-height: 115%;">Bantu pemenuhan kebutuhan aktifitas anak.<o:p></o:p></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span style="font-size: 12pt; line-height: 115%;">Intervensi :</span></i><span style="font-size: 12pt; line-height: 115%;"><o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">1. Beri istirahat yang cukup dengan ruangan yang nyaman dan tenang.<i> Ruangan
tenang dan nyaman mampu membuat klien rileks.</i><o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">2. Bantu untuk melakukan aktifitas yang disukai.<o:p></o:p></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span style="font-size: 12pt; line-height: 115%;">Menghindari traumatic
care.</span></i><span style="font-size: 12pt; line-height: 115%;"><o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">3. Hindari perubahan suhu yang mendadak dan aktifitas yang berlebihan.<o:p></o:p></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span style="font-size: 12pt; line-height: 115%;">Perubahan suhu yang
mendadak memicu jantung untuk bekerja lebih keras guna memenuhi O<sub>2</sub>.</span></i><span style="font-size: 12pt; line-height: 115%;"><o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">4. Anjurkan orangtua untuk bermain bersama<o:p></o:p></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span style="font-size: 12pt; line-height: 115%;">Mengoptimalkan
perkembangan dan pertumbuhan anak, serta mengurangi dampak traumatic care.</span></i><span style="font-size: 12pt; line-height: 115%;"><o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">c. Gangguan pertumbuhan dan perkembangan b/d ketidakkuatan oksigen dan
nutrisi pada jaringan.<o:p></o:p></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span style="font-size: 12pt; line-height: 115%;">Tujuan : </span></i><span style="font-size: 12pt; line-height: 115%;">Anak mengikuti kurva pertumbuhan berat badan dan tinggi badan.<o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span style="font-size: 12pt; line-height: 115%;">Intervensi :</span></i><span style="font-size: 12pt; line-height: 115%;"><o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">1. Beri makanan yang cukup gizi.<o:p></o:p></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span style="font-size: 12pt; line-height: 115%;">Makanan cukup gizi
membantu pertumbuhan anak.</span></i><span style="font-size: 12pt; line-height: 115%;"><o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">2. Beri makanan yang mengandung sumber Fe.<o:p></o:p></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span style="font-size: 12pt; line-height: 115%;">Makanan sumber Fe
untuk membant umeningkatkan kadar oksigen dalam darah.</span></i><span style="font-size: 12pt; line-height: 115%;"><o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">3. Beri diet tinggi nutrisi yang seimbang.<o:p></o:p></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span style="font-size: 12pt; line-height: 115%;">Untuk mencapai
pertumbuhan yang ade kuat.</span></i><span style="font-size: 12pt; line-height: 115%;"><o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">4. Pantau tinggi dan berat badan, gambarkan pada grafik pertumbuhan.<o:p></o:p></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span style="font-size: 12pt; line-height: 115%;">Untuk menentukan
kecendrungan pertumbuhan.</span></i><span style="font-size: 12pt; line-height: 115%;"><o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">5. Lakukan aktifitas bermain bersama anak.<o:p></o:p></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span style="font-size: 12pt; line-height: 115%;">Untuk merangsang
perkembangan anak.</span></i><span style="font-size: 12pt; line-height: 115%;"><o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">6. Anjurkan orangtua untuk bermain bersama<o:p></o:p></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span style="font-size: 12pt; line-height: 115%;">Mengoptimalkan
perkembangan dan pertumbuhan anak, serta mengurangi dampak traumatic care.</span></i><span style="font-size: 12pt; line-height: 115%;"><o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">d. Perubahan proses keluarga b/d mempunyai anak dengan penyakit
jantung.<o:p></o:p></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span style="font-size: 12pt; line-height: 115%;">Tujuan :</span></i><span style="font-size: 12pt; line-height: 115%;"> Anak dan keluarga mengalami penurunan rasa takut dan cemas.<o:p></o:p></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span style="font-size: 12pt; line-height: 115%;">Intervensi :</span></i><span style="font-size: 12pt; line-height: 115%;"><o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">1. Diskusikan dengan orangtua dan anak tentang ketakutan mereka dan
masalah defek jantung serta gejala fisik pada anak.<o:p></o:p></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span style="font-size: 12pt; line-height: 115%;">Mengurangi ansietas
keluarga dan klien.</span></i><span style="font-size: 12pt; line-height: 115%;"><o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">2. Dorong keluarga untuk berpartisipasi dalam perawatan selama anak
dihospitalisasi.<o:p></o:p></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span style="font-size: 12pt; line-height: 115%;">Memudahkan kopping
yang lebih baik dirumah.</span></i><span style="font-size: 12pt; line-height: 115%;"><o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">3. Dorong keluarga untuk memasukkan orang lain dalam perawatan anak.<o:p></o:p></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span style="font-size: 12pt; line-height: 115%;">Mencegah kelelahan
klien.</span></i><span style="font-size: 12pt; line-height: 115%;"><o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">4. Bantu keluarga untuk menentukan aktifitas fisik dan metode disiplin
yang tepat untuk anak.<o:p></o:p></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span style="font-size: 12pt; line-height: 115%;">Memberi dukungan
kelurga untuk mengambil keputusan pada kegiatan anak.</span></i><span style="font-size: 12pt; line-height: 115%;"><o:p></o:p></span></span></div>
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<br /></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b><span style="font-size: 12pt; line-height: 115%;">IV.</span></b><span style="font-size: 12pt; line-height: 115%;"> <b>Evaluasi</b><o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">a. Penurunan cardiac output b/d defek struktur..<o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Evaluasi : frekuensi
jantung, tekanan darah dan perfusi perifer dalam batas normal.<o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">b. Intoleransi aktifitas.<o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Evaluasi : anak mampu
melaksanakan aktifitas sehari – hari.<o:p></o:p></span></span></div>
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<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">c. Gangguan pertumbuhan dan perkembangan b/d ketidakadekuatan oksigen
dan nutrisi pada jaringan.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-bottom: 10.0pt; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; text-indent: 0cm;">
<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Evaluasi : perkembangan
dan pertumbbuhan sesuai umur anak dan adekuat.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-bottom: 10.0pt; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18.0pt;">
<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">d. Perubahan proses keluarga b/d mempunyai anak dengan penyakit
jantung.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-bottom: 10.0pt; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; text-indent: 0cm;">
<span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Evaluasi :keluarga dan
klien menunjukkan kemampuan dan motivasi untuk perawatan rumah. <i>(
Pedoman Klinis Keperawatan Pediatrik )</i><o:p></o:p></span></span></div>
<div align="center" class="MsoNormal" style="line-height: 115%; margin-bottom: 10.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; text-align: center; text-indent: 0cm;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 115%; margin-bottom: 10.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; text-align: center; text-indent: 0cm;">
<b><span style="font-size: 12pt; line-height: 115%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">DAFTAR PUSTAKA<o:p></o:p></span></span></b></div>
<div align="center" class="MsoNormal" style="line-height: 115%; margin-bottom: 10.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; text-align: center; text-indent: 0cm;">
</div>
<div align="left" class="MsoNormal" style="line-height: 200%; margin-bottom: 10.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; text-align: left; text-indent: 0cm;">
<span style="font-size: 12pt; line-height: 200%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Mirzanie, Hanifah. 2006. Pediatrica. Tosca Enterprise
: Jogjakarta.<o:p></o:p></span></span></div>
<div align="left" class="MsoNormal" style="line-height: 200%; margin-bottom: 10.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; text-align: left; text-indent: 0cm;">
<span style="font-size: 12pt; line-height: 200%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Ngastiah. 2005. Perawatan Anak Sakit Edisi 2. EGC :
Jakarta.<o:p></o:p></span></span></div>
<div align="left" class="MsoNormal" style="line-height: 200%; margin-bottom: 10.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; text-align: left; text-indent: 0cm;">
<span style="font-size: 12pt; line-height: 200%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Nursalam. dkk. 2005. Asuhan Keperawatan Bayi dan
Anak. Salemba Medika : Jakarta.<o:p></o:p></span></span></div>
<div align="left" class="MsoNormal" style="line-height: 200%; margin-bottom: 10.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; text-align: left; text-indent: 0cm;">
<span style="font-size: 12pt; line-height: 200%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Rudolph, Abraham M. dkk. 2007. Buku Ajar
Pediatrik Rudolp Volume 3. EGC : Jakarta.<o:p></o:p></span></span></div>
<div align="left" class="MsoNormal" style="line-height: 200%; margin-bottom: 10.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; text-align: left; text-indent: 0cm;">
<span style="font-size: 12pt; line-height: 200%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Wong, Donna L. 2004. Pedoman Klinis Keperawatan
Pediatrik, edisi 4. Jakarta ; EGC.<o:p></o:p></span></span></div>
<br />
<div align="center" class="MsoNormal" style="line-height: 115%; margin-bottom: 10.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; text-align: center; text-indent: 0cm;">
<span style="color: #333333; font-family: 'Times New Roman', serif;"><br /></span></div>salnihttp://www.blogger.com/profile/00126668517852477742noreply@blogger.com0Universitas Sam Ratulangi, Jalan Kampus Selatan, Manado, Indonesia1.455717 124.8271631.453733 124.8246955 1.457701 124.8296305tag:blogger.com,1999:blog-8321145958076225978.post-41840735477318198262012-03-16T01:40:00.000-07:002012-03-16T01:40:44.737-07:00ASUHAN KEPERAWATAN PADA PASIEN DENGAN HIPERBILIRUBINEMIA<br />
<br />
A. Definisi:<br />
Keadaan icterus yang terjadi pada bayi baru lahir, yang dimaksud dengan ikterus<br />
yang terjadi pada bayi baru lahir adalah meningginya kadar bilirubin di dalam<br />
jaringan ekstravaskuler sehingga terjadi perubahaan warna menjadi kuning pada<br />
kulit, konjungtiva, mukosa dan alat tubuh lainnya.<br />
<br />
B. Masalah keperawatan dan masalah kolaborasi<br />
Masalah keperawatan<br />
1. kurangnya masukan cairan dan nutrisi.<br />
2. Resiko terjadi gangguan tumbuh<br />
kembang.<br />
3. Defisit pengetahuan<br />
4. Resiko gangguan integritas kulit.<br />
5. Potensial perubahan dalam menjadi<br />
ortu<br />
<br />
C. Pemeriksaan Diagnostik<br />
1. Bilirubin serum <br />
Masalah kolaborasi:<br />
1. potensial komplikasi : kern icterus.<br />
2. Potensial komplikasi : konjungtivitis.<br />
3. Potensial komplikasi : dehidrasi.<br />
4. Potensial komplikasi : distress<br />
pernapasan.<br />
Direct : > 1 mg / dl<br />
Indirect : > 10 mg % (BBLR), 12,5 mg % ( cukup bulan).<br />
Total : > 12 mg / dl<br />
2. Golongan darah ibu dan bayi uji COOMBS<br />
Inkompabilitas ABO – Rh<br />
3. Fungsi hati dan test tiroid sesuai indikasi.<br />
4. Uji serologi terhadap TORCH<br />
5. Hitung IDL dan urine ( mikroskopis dan biakan urine) indikasi infeksi.<br />
<br />
D. Diagnosa Keperawatan:<br />
1. Kurang intake cairan dan nutrisi berhubungan dengan anoreksia.<br />
2. Resiko gangguan tumbuh kembang sehubungan dengan fase lanjut<br />
hiperbilirubinemia.<br />
3. Defisit pengetahuan berhubungan dengan kurang pengalaman.<br />
4. Resiko gangguan integritas kulit berhubungan dengan efek fototerapi.<br />
5. Potensial perubahana peran orang tua berhubungan dengan gangguan interaksi<br />
orang tua – bayi karena tindakan fototerapi.<br />
6. Potensial komplikasi : kern icterus berhubungan dengan peningkatan bilirubin<br />
serum efek dari imatur hepar.<br />
7. Potensial komplikasi : konjungtivitis berhubungan dengan efek fototerapi.<br />
<br />
8. Potensial komplikasi : dehidrasi berhubungan dengan IWL dan defekasi yang<br />
meningkat efek sekunder dari fototerapi.<br />
9. Potensial komplikasi : distress pernapasan berhubungan dengan penurunan reflek<br />
pernapasan dan opistotonus.<br />
<br />
E. Diagnosa Keperawatan dan intervensinya<br />
1. Diagnosa Keperawatan 1 : Kurang intake cairan dan nutrisi berhubungan dengan<br />
anoreksia.<br />
Intervensi :<br />
a. berikan minum sesuai dengan kebutuhan.<br />
b. Karena bayi malas minum, berikan dengan sendok.<br />
c. Berikan minuman per sonde jika minuman tidak bisa diberikan melalui sendok.<br />
d. Monitor output, urine dan feces.<br />
<br />
2. Diagnosa Keperawatan 2 : Resiko gangguan tumbuh kembang sehubungan dengan<br />
fase lanjut hiperbilirubinemia.<br />
Intervensi :<br />
a. lakukan observasi tumbuh kembang anak sesuai dengan usia.<br />
b. Lakukan monitoring dengan DDST.<br />
c. Persiapkan kelurga dalam menerima anak dengan gangguan tumbuh kembang.<br />
<br />
3. Diagnosa keperawatan 3 :Defisit pengetahuan berhubungan dengan kurang<br />
pengalaman.<br />
Intervensi :<br />
a. berikan informasi tentang fisiologi dari penyakit anaknya.<br />
Jawab pertanyaan yang dlontarkan oleh orang tua bayi sesuai dengan<br />
konsep.<br />
Klarifikasi miskonsepsi.<br />
Bila perlu sediakan / berikan buku tentang hiperbilirubinemia.<br />
b. ikut sertakan keluarga dalam perawatan anaknya ( dengan jadwal dan waktu yang<br />
telah di tentukan).<br />
<br />
4. Diagnosa kepearawatan 4 : Resiko gangguan integritas kulit berhubungan dengan<br />
efek fototerapi.<br />
Intervensi :<br />
a. observasi keadaan kulit tiap 15 menit, catat dan laporkan bila ada rash.<br />
b. Gunakan sabun yang lembut untuk membersihkan dan hindari penggunaan cairan<br />
yang bersifat abrasi.<br />
c. Ubah posisi bayi tiap 1 jam saat terapi.<br />
d. Berikan perlindungan pada daerah genetalia selama terapi, dan jaga supaya tetap<br />
bersih dan kering.<br />
<br />
<br />
5. Diagnosa Keperawatan 5 : Potensial perubahan peran orang tua berhubungan dengan<br />
gangguan interaksi orang tua – bayi karena tindakan fototerapi.<br />
Intervensi :<br />
a. pertahankan kontak antara anak dengan orang tua, dengan cara libatkan keluarga<br />
dalam perawatan anaknya ( dengan jadwal dan waktu yang telah di tentukan).<br />
b. Beri penguatan penjelasan fototerapi, alasan intervensi dan rencana keperawatan.<br />
c. Tunjukkan batasan tugas orang tua dalam perawatan anak sakit dengan<br />
hiperbilirubinemia.<br />
d. Matikan lampu terapi dan lepaskan pelindung mata bayi bila orang tua berkunjung<br />
sesuai periode waktu yang telah dipesankan oleh dokter.<br />
<br />
6. Diagnosa keperawatan 6 : Potensial komplikasi : kern icterus berhubungan dengan<br />
peningkatan bilirubin serum efek dari imatur hepar.<br />
Intervensi :<br />
- kenali gejala dini / pencegahan peningkatan icterus.<br />
Jika bayi telah terlihat kuning, lakukan kontak dengan sinar matahari pagi<br />
selama 15- 30 menit pada pukul 7 – 8 pagi.<br />
Periksa/ monitor kadar bilirubin darah.<br />
Berikan intake cairan yang cukup sesuai dengan kebutuhan.<br />
Laporkan kepada dokter hasil pemeriksaan bilirubin darah, jika hasilnya 7<br />
mg % atau lebih.<br />
7. Diagnosa keperawatan 7 : Potensial komplikasi : konjungtivitis berhubungan dengan<br />
efek fototerapi.<br />
Intervensi :<br />
a. gunakan pelindung mata pada bayi saat terapi dilakukan.<br />
b. Observasi keadaan mata selama terapi tiap 15 menit.<br />
<br />
8. Diagnosa keperawatan 8 : Potensial komplikasi : dehidrasi berhubungan dengan IWL<br />
<br />
dan defekasi yang meningkat efek sekunder dari fototerapi.<br />
Intervensi :<br />
a. pertahankan intake cairan.<br />
b. Lanjutkan jadwal pemberian ASI / PASI<br />
c. Monitor intake dan output<br />
d. Lakukan penimbangan berat badan bayi tiap hari tanpa pakaian pada waktu dan<br />
timbangan yang sama.<br />
e. Berikan cairan melalui intra vena jika berat badan turun, suhu naik, defekasi naik.<br />
f. Monitor suhu tubuh, membran mukosa dan ketegangan fontanela.<br />
<br />
<br />
<br />
<br />
9. Diagnosa keperawatan 9 : Potensial komplikasi : distress pernapasan berhubungan<br />
dengan penurunan reflek pernapasan dan opistotonus.<br />
Intervensi :<br />
a. observasi tanda tanda vital, respiratory rate.<br />
b. Pertahankan pemantauan fungsi pernapasan bayi.<br />
c. Kolaborasi antibiotika.<br />
<br />
<br />
Buku Sumber:<br />
<br />
Carpenito L.J, 1997, Buku Saku Diagnosa Keperawatan Edisi 6, Jakarta: EGC<br />
<br />
Fakultas Kedokteran UI, 2000, Kapita Selekta Kedokteran edisi III jilid 2, Jakarta:<br />
Medi Aesculapius.<br />
<br />
Mayer M, dkk, 1995, Pediatric Nursing, Singapure, McGraw – Hill Clinical Care Plans.<br />
<br />
Nelson, 1990, Ilmu Kesehatan Anak bagian 1, Jakarta: EGC<br />
<br />
Ngastiyah, Perawatan Anak Sakit, Jakarta: EGC<br />
<br />
Staf pengajar IKA FK UI, 2001, Ilmu Kesehatan Anak bagian 3, Jakarta: Bagian IKA<br />
FK UI<br />
<br />
Tucker, dkk, 1998, Standar Perawatan Pasien edisi V volume 4, Jakarta: EGC<br />
<br />
<br />
<br />
<br />
<br />salnihttp://www.blogger.com/profile/00126668517852477742noreply@blogger.com0Universitas Sam Ratulangi, Jalan Kampus Selatan, Manado, Indonesia1.455717 124.8271631.453733 124.8246955 1.457701 124.8296305tag:blogger.com,1999:blog-8321145958076225978.post-58031703529091841652012-03-16T01:33:00.001-07:002012-03-16T01:33:23.371-07:00ASKEP KEHAMILAN DENGAN PENYAKIT JANTUNG<br />
<ol start="1" style="margin-top: 0cm;" type="A">
<li class="MsoNormal"><b><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Konsep Dasar<o:p></o:p></span></span></b></li>
</ol>
<div class="MsoNormal" style="text-indent: 18.0pt;">
<span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Kehamilan dengan
penyakit jantung selalu saling mempengaruhi karena kehamilan dapat memberatkan
penyakit jantung yang dideritanya. Penyakit jantung dapat mempengaruhi
pertumbuhan dan perkembangan janin dalam rahim. Jantung yang normal dapat
menyesuaikan diri terhadap segala perubahan
sistem jantung dan pembuluh darah yang disebabkan oleh kehamilan, yaitu
dorongan diafragma oleh besarnya janin yang dikandungnya sehingga dapat
mengubah posisi jantung dan pembuluh darah sehingga terjadi perubahan dari
kerja jantung. </span></span></div>
<div class="MsoNormal">
<span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Yang dapat mempengaruhi antara lain:</span></span></div>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Pengaruh peningkatan hormone tubuh Terjadi haemodelusi darah
dengan puncaknya pada kehamilan 28 – 32 minggu</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Kebutuhan janin untuk pertumbuhan dan perkembangan dalam rahim</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Kembalinya darah setelah placenta lahir karena kontraksi rahim
dan terhentinya terhentinya peredaran darah placenta </span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Saat post partum sering terjadi infeksi .</span></span></li>
</ul>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<br /></div>
<div class="MsoNormal">
<b><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Etiologi<o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Etiologi
kelainan jantung dapat berupa kelainan primer maupun sekunder. <o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Kelainan
Primer, kelainan primer dapat berupa kelainan kongenital, bentuk kelainan
katub,iskemik dan cardiomiopati. <o:p></o:p></span></span></div>
<div class="MsoNormal">
<span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Kelainan
Sekunder, kelainan sekunder berupa penyakit lain, seperti hipertensi, anemia
berat, hipervolumia, perbesaran rahim, dll<o:p></o:p></span></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Tanda dan Gejala<o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Tanda
:<o:p></o:p></span></span></div>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US">Nadi
: takikardia,</span><span lang="EN-US"> </span><span lang="EN-US">a<o:p></o:p></span></span></li>
<li class="MsoNormal"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US">Tekanan / palpasi vena jugularis: meninggi,</span><span lang="EN-US"> <o:p></o:p></span></span></li>
<li class="MsoNormal"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US">Impuls
apical: impuls ganda (sesuai dengan S4)</span><span lang="EN-US"> S4) <o:p></o:p></span></span></li>
<li class="MsoNormal"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US">Auskultasi
jantung</span><span lang="EN-US"> </span><span lang="EN-US"> <o:p></o:p></span></span></li>
<li class="MsoNormal"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US">Auskultasi paru</span><span lang="EN-US"> <o:p></o:p></span></span></li>
<li class="MsoNormal"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US">Edema</span><span lang="EN-US">
</span><span lang="EN-US">Ed<o:p></o:p></span></span></li>
<li class="MsoNormal"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US">Pulsus Alternans</span><span lang="EN-US"> <o:p></o:p></span></span></li>
<li class="MsoNormal"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US">Suara
paru kedua (P2)</span><span lang="EN-US"> </span><span lang="EN-US"> (P2) <o:p></o:p></span></span></li>
<li class="MsoNormal"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US">Efusi
pleura</span><span lang="EN-US"> </span><span lang="EN-US">si pleura <o:p></o:p></span></span></li>
<li class="MsoNormal"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US">Ascites</span><span lang="EN-US"> <o:p></o:p></span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Pembesaran jantung</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Aritmia</span></span></li>
</ul>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Gejala
:<o:p></o:p></span></span></div>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Cepat merasa
lelah <o:p></o:p></span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Jantungnya
berdebar – debar <o:p></o:p></span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Sesak napas
apabila disertai dengan sianosis <o:p></o:p></span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Edema tungkai
atau terasa berat pada <o:p></o:p></span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">kehamilan
muda<o:p></o:p></span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Mengeluh
tetap bertambah besarnya rahim yang tidak sesuai. <o:p></o:p></span></span></li>
</ul>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<br /></div>
<div class="MsoNormal">
<b><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Pemeriksaan
Penunjang<o:p></o:p></span></span></b></div>
<div class="MsoNormal" style="text-indent: 36.0pt;">
<span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">EKG, untuk
mengetahui kelainan irama dan gangguan konduksi, adanya kardiomegali, tanda
penyakit pericardium , iskemia atau infark, bisa ditemukan tanda-tanda aritmia.</span></span></div>
<div class="MsoNormal">
<span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Ekokardiografi, metode yang aman, cepat dan
terpercaya untuk mengetahui fungsi dan anatomi bilik, katup, dan pericardium.</span></span></div>
<div class="MsoNormal">
<span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Pemeriksaan radiologi untuk mengetahui
dehidrasi dalam kehamilan namun jika memang
diperlukan dapat dilakukan dengan memberikan pelindung di abdomen dan
pelvis.</span></span></div>
<div class="MsoNormal">
<br /></div>
<ol start="2" style="margin-top: 0cm;" type="A">
<li class="MsoNormal"><b><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ASUHAN KEPERAWATAN</span></span></b></li>
</ol>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Pengkajian<o:p></o:p></span></span></b></div>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Data Demografi </span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Nama </span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Umur </span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Pekerjaan </span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Alamat</span></span></li>
</ul>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><i><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Aktifasi dan istirahat<o:p></o:p></span></span></i></b></div>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Ketidakmampuan melakukan aktifitas normal</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Dispenia nocturnal karena pengerahan tenaga</span></span></li>
</ul>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><i><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Sirkulasi<o:p></o:p></span></span></i></b></div>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Takikardia, palpitasi, disritmia</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Riwayat penyakit jantung congenital</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Perubahan poksisi dan diafragma ke atas dan ukuran jantung
sebanding dengan uterus.</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Dapat mengalami pembesaran jantung dan murmur diastolic dan
sistolik secara kontinu.</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Peningkatan tekanan darah</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Clubbing dan sianosis</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Nadi mungkin menurun</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Dapat mengalami memar spontan, perdarahan lama, dan
trobositopenia.</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Riwayat hipertensi kronis</span></span></li>
</ul>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b><i><span lang="EN-US">Eliminasi</span></i></b><span lang="EN-US"><br />
Menurunnya keluaran urine</span></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<br /></div>
<div class="MsoNormal">
<b><i><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Makanan dan cairan<o:p></o:p></span></span></i></b></div>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Obesitas</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Mual dan muntah</span></span></li>
</ul>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<br /></div>
<div class="MsoNormal">
<b><i><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Malnutrisi<o:p></o:p></span></span></i></b></div>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: 36.0pt; text-align: left;"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Diabetes mellitus</span></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: 36.0pt; text-align: left;"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Dapat mengalami edema ekstrimitas bawah</span></span></li>
<li class="MsoNormal" style="mso-list: l0 level1 lfo1; tab-stops: 36.0pt; text-align: left;"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Nyeri dan rasa nyaman<br />
Dapat mengeluh nyeri dada dengan tanpa paktivitas</span></span></li>
</ul>
<div align="left" class="MsoNormal" style="margin-left: 36.0pt; text-align: left;">
<br /></div>
<div class="MsoNormal">
<b><i><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Pernafasan<o:p></o:p></span></span></i></b></div>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Pernafasan mungkin kurang dari 14 x / menit</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Krekle</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Hemoptisis</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Takipnea</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Dispnea</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Ortopnea</span></span></li>
</ul>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<br /></div>
<div class="MsoNormal">
<b><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Diagnosa
Keperawatan<o:p></o:p></span></span></b></div>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Resiko penurunan curah jantung berhubungan dengan peningkatan
volume sirkulasi, disritmia, perubahan kontratiktilitas miokard, dan
perubahan inotropik pada jantung.</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Kelebihan volum cairan berhubungan dengan peningkatan volum
sirkulasi, perubahan faal ginjal, intake cairan yang berlebihan.</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Penurunan perfusi jaringan berhubungan dengan perubahan volume
sirkulasi.</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Resiko infeksi berhubungan dengan tidak adekuat pertahanan
primer dan skunder, penyakit/kondisi kronis, ruang pengetahuan tentang
proses infeksi.</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Intoleransi aktifitas berhubungan dengan penurunan cardiac
output.</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Kurang pengetahuan ( kebutuhan belajar ) berhubungan dengan
kurangnnya informasi dan interpretasi yang salah.</span></span></li>
</ul>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Intervensi
Keperawatan<o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<b><i><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Mandiri<o:p></o:p></span></span></i></b></div>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Tentukan atau pantau klasifikasi fungsional klien</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Auskultasi bunyi napas klien</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Istirahat secara fisik dan mental</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Posisi tidur semifowler /fowler sesuai dengan kenyamanan klien</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Terapi oksigen (2-4 liter)</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Evaluasi DJJ, jumlah gerakan janin setiap hari dan evaluasi NST
sesuai dengan indikasi</span></span></li>
</ul>
<div class="MsoNormal">
<b><i><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Kolaborasi <o:p></o:p></span></span></i></b></div>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Pemeriksaan ECG, foto thorax, dan prosedur yang lain</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Obat-obatan : Antibiotic, digitalis, ACE inhibitor, beta
blocker, Ca antagonis, , vasodilatator, anti thrombus, anti nyeri,
penenang, anti-aritmia</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Atasi infeksi pernapasan dasar sesuai dengan kebutuhan</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Siapkan pasien terhadap perawatan di rumah sakit sesuai
kondisinya</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Batasi cairan dan natrium bila ada GJK</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Berikan diuretic ( mis: klorotiazid, hidroklorotiazid)</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Pantau pemeriksaan laboratorium sesuai indikasi GDA dan Hb/Ht</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Hitung SDP, kultur sekresi pernapasan bawah atau atas</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Libatkan tim pelayanan kesehatan dalam penyuluhan atau
perencanaan</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Berikan informasi yang tepat untuk protocol perawatan dalam
situasi komunitas / rumah sakit serta di rumah</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Identifikasi kelompok pendukung untuk klien beresiko tinggi</span></span></li>
</ul>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<br /></div>
<div class="MsoNormal">
<b><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Implementasi
<o:p></o:p></span></span></b></div>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Melaksanakan intervensi sesuai dengan rencana yang telah
dilakukan konsolidasi</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Ketrampilan interpersonal , intelektual, teknikal, dilakukan
dengan cermat dan efisien pada situasi yang tepat</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Keamanan dan kenyamanan fisik serta psikologisnya harus
dilindungi.</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Dokumentasi dan intervensi serta respon klien terhadap tindakan
medis dan keperawatan yang telah dilakukan.</span></span></li>
</ul>
<div class="MsoNormal">
<b><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Evaluasi<o:p></o:p></span></span></b></div>
<ul style="margin-top: 0cm;" type="disc">
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Mengidentifikasi / mengadopsi prilaku untuk meminimalkan
stressor dan memaksimalkan fungsi jantung</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Mendemonsrasikan sirkulasi plasenta, fungsi ginjal dengan
denyut jantung janin dan gerakan janin dalam batas normal dan secara
individu haluaran urin yang tepat.</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Adanya keseimbangan cairan yang stabil dengan tanda-tanda
vital, penambahan berat badan tepat, tidak adanya oedema.</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Menunjukkan tekanan darah , nadi, GDA, dan hitung SDP BDN dalam
keadaan normal.</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Mendemonstrasikan perfusi plasenta adekuat sesuai indikasi dari
janin reaktif dengan frekuensi jantung
direntang dari 120-160 dpm dan ukuran tepat untuk usia gestasi.</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Berkurang atau tidak adanya infeksi.</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Meningkatnya pengetahuan pasien terhadap penyakitnya sehingga
mempermudah dalam penyembuhan.</span></span></li>
<li class="MsoNormal"><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Tingkat kecemasan pasien berkurang. </span></span></li>
</ul>
<div class="MsoNormal">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<b><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">PENUTUP<o:p></o:p></span></span></b></div>
<div class="MsoNormal">
<br /></div>
<ol start="1" style="margin-top: 0cm;" type="A">
<li class="MsoNormal"><b><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">KESIMPULAN<o:p></o:p></span></span></b></li>
</ol>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Penyakit jantung
merupakan penyebab utama kematian maternal. Karena setiap kehamilan
mempengaruhi system kardiovaskuler ibu. Jantung normal dapat mengompensasikan
peningkatan beban kerja sehingga kehamilan dan kelahiran bayi ditoleransi
dengan baik. Selain itu, jantung yang normal dapat menyesuaikan diri terhadap
segala perubahan system jantung dan pembuluh darah yang disebabkan oleh
kehamilan , yaitu dorongan dafragma oleh besarnya janin yang dikandungnya
sehingga dapat mengubah posisi jantung dan pembuluh darah sehingga terjadi
perubahan dari kerja jantung. Namun
apabila hal ini tidak ditoleransi dengan
baik. Kegagalan jantung dapat terjadi. Penyakit jantung dapat mempengaruhi
pertumbuhan dan perkembangan janin dalam rahim. Etiologi kelainan jantung dapat
berupa kelainan primer dan sekunder. Mengetahui tanda dan gejala yang memicu
terjadinya penyakit jantung pada ibu hamil sangatlah penting dalam menentukan asuhan
dan diagnosa yang tepat dalam menanggulangi penyakit jantung. Selain hal itu,
pemerikasaan penunjang lewat ekokardiografi, juga penting untuk mengetahui
kelainan irama dan gangguan konduksi, adanya kardiomegali, tanda penyakit
pericardium , iskemia atau infark, bisa ditemukan tanda-tanda aritmia.
Pemeriksaan radiologi untuk mengetahui dehidrasi dalam kehamilan namun jika
memang diperlukan dapat dilakukan dengan
memberikan pelindung di abdomen dan pelvis. Intervensi keperawatan dapat
dilskukan dengan cara mandiri dan kolaborasi, hal ini penting dilakukan guna
meningkatkan kesehatan pasien. Penanganan
yang tepat dapat mengurangi kecemasan dan mempermudah penyembuhan
pasien.</span></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span></span></div>
<ol start="2" style="margin-top: 0cm;" type="A">
<li class="MsoNormal"><b><span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">SARAN<o:p></o:p></span></span></b></li>
</ol>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Dalam
menanggulangi penyakit jantung pada ibu hamil,
ketrampilan interpersonal , intelektual, teknikal, sangat penting
dilakukan dengan cermat dan efisien pada situasi yang tepat. Selain itu</span></span></div>
<div class="MsoNormal" style="margin-left: 36.0pt;">
<span lang="EN-US"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">keamanan dan
kenyamanan fisik serta psikologis dari pasien harus dilindungi dengan baik guna
mengurangi tingkat kecemasan dari pasien serta meminimalkan stressor dan
memaksimalkan fungsi jantung.</span></span></div>salnihttp://www.blogger.com/profile/00126668517852477742noreply@blogger.com1Universitas Sam Ratulangi, Jalan Kampus Selatan, Manado, Indonesia1.455717 124.8271631.453733 124.8246955 1.457701 124.8296305tag:blogger.com,1999:blog-8321145958076225978.post-49045769920501133162012-03-16T01:27:00.000-07:002012-03-16T01:27:33.328-07:00PENYAKIT MENULAR SEKSUAL ( PMS )<br />
<div align="center" class="MsoNormalCxSpFirst" style="text-align: center;">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">BAB I<o:p></o:p></span></b></div>
<div align="center" class="MsoNormalCxSpLast" style="text-align: center;">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">PENDAHULUAN<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpFirst" style="margin-left: 1.0cm; mso-add-space: auto; mso-list: l10 level1 lfo10; tab-stops: 1.0cm; text-indent: -21.25pt;">
<!--[if !supportLists]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">A.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Latar
Belakang<o:p></o:p></span></b></div>
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<br /></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Keperawatan merupakan suatu pelayanan
kesehatan integral yang profesional yang memandang manusia sebagai makhluk bio
psiko sosial spiritual. Keperawatan maternitas merupakan subspesialis dari
keperawatan Umum yang harus dimiliki perawat dalam kegiatan pelayanan kesehatan
baik secara individu,keluarga,kelompok maupun masyarakat.Maka makalah ini
mengangkat topik yang berhubungan dengan mata kuliah Keperawatan Maternitas
yaitu Penyakit Menular Seksual.<br />
PMS ( Penyakit Menular Seksual
) merupakan sekelompok penyakit yang disebabkan oleh infeksi berbagai jenis
mikroorganisme (virus, bakteri, protozoa dan jamur) yang menimbulkan gejala
klinik utama di saluran kemih dan reproduksi, yang jalur penularannya melalui
hubungan seksual baik pada pria maupun wanita.Diantaranya adalah gonorea ,herpes
genital,sifilis,klamidia, Trikomoniasis Vaginalis<span style="letter-spacing: -.1pt;"> </span></span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">,</span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Kandidiadis Vagina<span style="letter-spacing: -.1pt;"> </span></span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">,</span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Kutil
Kelamin<span style="letter-spacing: -.1pt;"> </span></span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">,</span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">HIV/AIDS<span style="letter-spacing: -.1pt;"> ,</span></span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Human Papilloma Virus (HPV).<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 0cm; mso-add-space: auto; tab-stops: 0cm;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Gejala PMS pada laki-laki lebih mudah dikenali,
dilihat, dan dirasakan, Oleh karena letak dan bentuk kelaminnya yang agak
menonjol.Sedangkan pada perempuan sebagian besar gejala yang timbul hampir tak
dapat dirasakan<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 0cm; mso-add-space: auto; tab-stops: 0cm;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Wanita, termasuk yang sedang hamil, merupakan
kelompok resiko tinggi terhadap PMS. Penyakit menular seksual dapat menimbulkan
morbiditas dan mortalitas terhadap ibu maupun bayi yang
dikandung/dilahirkannya. Oleh sebab itu penting dilakukannya penanggulangan
yang tepat yaitu secara preventif, promotif, kuratif dan rehabilitatif.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 1.0cm; mso-add-space: auto; mso-list: l10 level1 lfo10; tab-stops: 7.1pt; text-indent: -21.25pt;">
<!--[if !supportLists]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">B.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Tujuan<o:p></o:p></span></b></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Adapun
tujuan yang ingin dicapai dalam penulisan makalah ini adalah Mengetahui
Pengertian penyakit Menular Seksual,Menemukan jenis-jenis Penyakit Menular
Seksual dan melakukan penanggulangan secara promotif dan preventif yang
berhubungan dengan Penyakit Menular Seksual ( PMS ) melalui metode keperawatan.<o:p></o:p></span></div>
<div class="MsoListParagraph" style="margin-left: 1.0cm; mso-add-space: auto; mso-list: l10 level1 lfo10; tab-stops: 7.1pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">C.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Batasan
Masalah<o:p></o:p></span></b></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Adapun batasan masalah yang akan
dibahas yaitu :<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="margin-left: 71.45pt; mso-add-space: auto; mso-list: l1 level1 lfo13; tab-stops: 7.1pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">1)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Menjelaskan
pengertian Penyakit Menular Seksual<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 71.45pt; mso-add-space: auto; mso-list: l1 level1 lfo13; tab-stops: 7.1pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">2)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Memaparkan
cara penularan Penyakit Menular Seksual<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 71.45pt; mso-add-space: auto; mso-list: l1 level1 lfo13; tab-stops: 7.1pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">3)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Memaparkan
jenis-jenis Penyakit Menular Seksual<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 71.45pt; mso-add-space: auto; mso-list: l1 level1 lfo13; tab-stops: 7.1pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">4)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Menjelaskan
pencegahan Penyakit Menular Seksual<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 71.45pt; mso-add-space: auto; mso-list: l1 level1 lfo13; tab-stops: 7.1pt; text-indent: -18.0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br /></span></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 71.45pt; mso-add-space: auto; mso-list: l1 level1 lfo13; tab-stops: 7.1pt; text-indent: -18.0pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br /></span></div>
<div align="center" class="MsoNormalCxSpFirst" style="text-align: center;">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">BAB II<o:p></o:p></span></b></div>
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<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">PEMBAHASAN<o:p></o:p></span></b></div>
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<br /></div>
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<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">PENYAKIT
MENULAR SEKSUAL<o:p></o:p></span></b></div>
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<br /></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<span style="font-family: Arial, sans-serif;"><span style="line-height: 18px;"><br /></span></span></div>
<div class="MsoListParagraphCxSpFirst" style="margin-left: 21.3pt; mso-add-space: auto; mso-list: l13 level1 lfo11; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -21.3pt;">
<!--[if !supportLists]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">A.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pengertian
Penyakit Menular<o:p></o:p></span></b></div>
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<br /></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Penyakit
Menular Seksual (PMS) adalah penyakit yang ditularkan melalui hubungan seks,</span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"> </span><a href="http://aabisnis.blogspot.com/search/label/Kesehatan" target="_blank"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; text-decoration: none; text-underline: none;">penyakit</span></a><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> yang
dapat ditularkan dari seseorang kepada orang lain melalui </span><a href="http://dahlanforum.wordpress.com/2007/11/20/%C3%A2??free-sex-in-university-student%E2?%9D/" target="_blank"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; text-decoration: none; text-underline: none;">hubungan
seksual</span></a><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Penyakit menular seksual akan lebih beresiko bila melakukan hubungan
seksual dengan berganti-ganti pasangan baik melalui vagina, oral maupun anal.
PMS dapat menyebabkan infeksi alat reproduksi yang harus dianggap serius. <o:p></o:p></span></div>
<div class="MsoNormalCxSpFirst" style="mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: 38.4pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Bila tidak diobati secara tepat, infeksi dapat
menjalar dan menyebabkan penderitaan, sakit berkepanjangan, kemandulan dan
bahkan kematian. Wanita lebih beresiko untuk terkena PMS lebih besar daripada
laki-laki sebab mempunyai alat reproduksi yang lebih rentan. Dan seringkali
berakibat lebih parah karena gejala awal tidak segera dikenali, sedangkan
penyakit melanjut ke tahap lebih parah. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: 38.4pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Oleh karena letak dan bentuk kelaminnya yang agak
menonjol, gejala PMS pada laki-laki lebih mudah dikenali, dilihat, dan
dirasakan. Sedangkan pada perempuan sebagian besar gejala yang timbul hampir
tak dapat dirasakan. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: 38.4pt;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Gejala-gejala umum PMS pada laki-laki adalah : <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">• Bintik-bintik berisi cairan, borok, atau lecet pada daerah sekitar
kelamin. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">• Luka tidak sakit, keras dan berwarna merah pada sekitar daerah kelamin. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">• Adanya kutil yang tumbuh seperti jengger ayam. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">• Rasa gatal yang sangat hebat di sekitar kelamin. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">• Sakit luar biasa saat kencing. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">• Kencing nanah/darah dengan bau busuk. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">• Bengkak panas nyeri pada pangkal paha yang akhirnya menjadi borok. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">• Kehilangan berat badan secara drastis, diare berkepanjangan, dan berkeringat
saat malam. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Sedangkan pada perempuan meliputi : <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">• Rasa sakit atau nyeri saat kencing atau saat berhubungan seksual. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">• Rasa nyeri pada perut bagian bawah. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">• Keluarnya lendir pada vagina. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">• Keputihan berwarna putih susu, bergumpal, dan disertai rasa gatal pada
kelamin. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">• Keputihan berbusa dan berbau busuk. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">• Bercak-bercak darah setelah berhubungan seks. <o:p></o:p></span></div>
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<br /></div>
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<!--[if !supportLists]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">B.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Beberapa
Jenis PMS<o:p></o:p></span></b></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Ada banyak
jenis PMS yang telah ditemukan. Dan diantaranya yang <o:p></o:p></span></div>
<div class="MsoNormalCxSpFirst" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">paling sering ditemui dan berbahaya adalah : <o:p></o:p></span></div>
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<br /></div>
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<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; letter-spacing: -.1pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">1.</span></b><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Gonorea (GO)<span style="letter-spacing: -.1pt;"> <o:p></o:p></span></span></b></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Gonore (GO) adalah penyakit menular
seksual (PMS), yang disebabkan oleh bakteri Neisseria gonorrhoeae yang
menginfeksi lapisan dalam uretra, leher rahim, rektum (usus bagian bawah),
tenggorokan maupun bagian putih mata (Gonorhoaea Conjugtiva). Gonore bisa menyebar
melalui aliran darah kebagian tubuh lainnya, terutama kulit dan persendian.Ada
masa tenggang (masa inkubasi) selama 2 -10 hari setelah kuman masuk ke dalam
tubuh melalui hubungan seks. Tanda-tanda penyakitnya adalah nyeri, merah, bengkak
dan bernanah. </span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkKQ_J0MHwJTWX3EW67if2dg9wwPAbXSCOrdRMRi7LEB6hBP02nHtNWni3UwS7VgTrtUqPHSehqsKSci_Qvnav5V66ZKvHcx3qEZCHD-PMeQwdDVI2DZSOzcVAVgAG0XT2-QFyMvvIVS8/s1600/sipilis.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="131" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkKQ_J0MHwJTWX3EW67if2dg9wwPAbXSCOrdRMRi7LEB6hBP02nHtNWni3UwS7VgTrtUqPHSehqsKSci_Qvnav5V66ZKvHcx3qEZCHD-PMeQwdDVI2DZSOzcVAVgAG0XT2-QFyMvvIVS8/s200/sipilis.jpg" width="200" /></a></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Pada wanita, gonore bisa naik ke
saluran kelamin dan menginfeksi selaput di dalam panggul sehingga menimbulkan
nyeri panggul dan gangguan reproduksi. Diperkirakan terdapat lebih dari 150
juta kasus gonore di dunia setiap tahunnya, meskipun di beberapa negara
cenderung menurun, namun negara lainnya cenderung meningkat. Penularan penyakit
gonore (GO) yang lazimnya terjadi, adalah dengan </span><a href="http://dahlanforum.wordpress.com/2007/11/20/%C3%A2??free-sex-in-university-student%E2?%9D/" target="_blank"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; text-decoration: none; text-underline: none;">melakukan
hubungan seks</span></a><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">, ataupun dengan variasinya antara lain: </span><a href="http://amnanfaza.blogspot.com/2009/01/apa-hukum-oral-seks.html" target="_blank"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; text-decoration: none; text-underline: none;">oral-seks</span></a><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> (terjadinya
faringitis GO), anal-seks (terjadinya proktitis GO) juga terjadinya gonoblenorrhoea
pada mata bayi yang baru lahir dari ibu-</span><a href="http://mengerjakantugas.blogspot.com/search/label/Ibu" target="_blank"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; text-decoration: none; text-underline: none;">ibu</span></a><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> yang
menderita GO ataupun terjadinya kolpitis GO pada bayi atau anak wanita karena
orang tua atau pengasuh yang merawat sehariharinya menderita GO adalah
merupakan cara penularan lain yang dapat terjadi karena hidup yang tidak
higienis.</span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Ciri-ciri
orang yang terkena gonore adalah: apabila pria, ia akan merasa panas ketika
buang air kecil (kencing), dan bila diamati, ternyata setelah mengeluarkan air
seni, dari ujung alat kelaminnya akan terlihat adanya nanah yang ikut terbawa
keluar. Pada wanita gonore umumnya,60% kasus tidak menunjukkan gejala yakni tidak
menimbulkan rasa panas atau sakit, terkecuali jika ia terjangkit penyakit
keputihan dengan gejala keluarnya semacam lendir atau cairan kuning
kehijau-hijauan (semacam nanah), dalam jumlah yang cukup banyak. Selain
menimbulkan rasa panas dan bernanah, gonore juga dapat menyebabkan merah dan
bengkak pada ujung alat kelamin kaum pria, juga di sekeliling vagina (liang
senggama) kaum wanita yang terinfeksi gonore. Akibat penyakit GO, pada
laki-laki dan perempuan, seringkali berupa kemandulan. Pada perempuan bisa juga
terjadi radang panggul, dan dapat diturunkan kepada bayi yang baru lahir berupa
infeksi pada mata yang dapat menyebabkan kebutaan. <o:p></o:p></span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold;"> Pengobatan:</span><span class="apple-converted-space"><span style="font-family: "Arial","sans-serif";"> </span></span><span style="font-family: "Arial","sans-serif";">Infeksi dapat disembuhkan dengan
antibiotik.<span class="apple-converted-space"> </span>Namun tidak dapat
menghilangkan kerusakan yang timbul sebelum pengobatan dilakukan.<o:p></o:p></span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold;"> Konsekuensi yang mungkin timbul pada
orang yang terinfeksi:</span><span class="apple-converted-space"><span style="font-family: "Arial","sans-serif";"> </span></span><span style="font-family: "Arial","sans-serif";">Pada perempuan jika tidak diobati,
penyakit ini merupakan penyebab utama Penyakit Radang Panggul, yang kemudian
dapat menyebabkan kehamilan ektopik, kemandulan dan nyeri panggul kronis.<span class="apple-converted-space"> </span>Dapat menyebabkan kemandulan pada
pria.<span class="apple-converted-space"> </span>Gonore yang tidak diobati
dapat menginfeksi sendi, katup jantung dan/atau otak.<o:p></o:p></span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold;"> Konsekuensi yang mungkin timbul pada
janin dan bayi baru lahir:</span><span class="apple-converted-space"><span style="font-family: "Arial","sans-serif";"> </span></span><span style="font-family: "Arial","sans-serif";">Gonore dapat menyebabkan kebutaan dan
penyakit sistemik seperti meningitis dan arthritis sepsis pada bayi yang
terinfkesi pada proses persalinan.<span class="apple-converted-space"> </span>Untuk
mencegah kebutaan, semua bayi yang lahir di rumah sakit biasanya diberi tetesan
mata untuk pengobatan gonore.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold;"> Pencegahan:</span><span class="apple-converted-space"><span style="font-family: "Arial","sans-serif";"> </span></span><span style="font-family: "Arial","sans-serif";">Tidak melakukan hubungan seksual baik
vaginal, anal dan oral dengan orang yang terinfeksi adalah satu-satunya cara
yang 100% efektif untuk pencegahan.<span class="apple-converted-space"> </span>Kondom
dapat mengurangi tetapi tidak dapat menghilangkan sama sekali risiko penularan
penyakit ini.<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Penanganan </span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<br /></div>
<div class="MsoListParagraphCxSpFirst" style="mso-add-space: auto; mso-list: l2 level1 lfo8; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">1)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pada masa
kehamilan, berikan antibiotika seperti : a) Ampisilin 2 gram IV dosis awal, lanjutkan
dengan 3 x 1 gram per oral selama 7 hari. b) Ampisilin + Sulbaktan 2,25 gram
oral dosis tunggal. c) Spektinomisin 2 gram IM dosis tunggal. d) Seftriakson
500 mg IM dosis tunggal.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-add-space: auto; mso-list: l2 level1 lfo8; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">2)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Masa nifas,
berikan antibiotika seperti : a) Xiprofloksasin 1 gram dosis tunggal. b)
Trimethroprim + Sulfamethoksazol (160 mg + 800 mg) 5 kaplet dosis tunggal.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-add-space: auto; mso-list: l2 level1 lfo8; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">3)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Oftalmia
neonatorum (konjungtivitis) : a) Garamisin tetes mata 3 x 2 tetes. b)
Antibiotika – Ampisilin 50 mg/ kgBB IM selama 7 hari; Amoksisilin + asam
klamtanat 50 mg/ kgBB IM selama 7 hari; Seftriakson 50 mg/ kgBB IM dosis
tunggal.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-add-space: auto; mso-list: l2 level1 lfo8; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">4)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Lakukan
konseling tentang metode barier dalam melakukan hubungan seksual.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-add-space: auto; mso-list: l2 level1 lfo8; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">5)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Berikan
pengobatan yang sama pada pasangannya.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">6)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Buat jadual
kunjungan ulang dan pastikan pasangan & pasien akan menyelesaikan
pengobatan hingga tuntas.<o:p></o:p></span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto;">
<br /></div>
<div class="MsoNormalCxSpFirst" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; letter-spacing: -.1pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">2.</span></b><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Herpes Genital<span style="letter-spacing: -.1pt;"> <o:p></o:p></span></span></b></div>
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<br /></div>
<div class="MsoNormalCxSpMiddle" style="mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: 38.4pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Herpes genital adalah Penyakit yang disebabkan oleh
virus Herpes simplex dengan masa tenggang 4 - 7 hari sesudah virus masuk ke dalam
tubuh melalui hubungan seks.<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: 38.4pt;">
<span style="font-family: Arial, sans-serif;"><span style="line-height: 18px;"><br /></span></span></div>
<div class="MsoNormalCxSpMiddle" style="mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: 38.4pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Tanda utama dari genital
herpes adalah luka di sekitar vagina, penis, atau di daerah anus. Kadang-kadang
luka dari herpes genital muncul di skrotum, bokong atau paha.Gejala dari herpes
disebut juga outbreaks, muncul dalam dua minggu setelah orang terinfeksi dan
dapat saja berlangsung untuk beberapa minggu. <o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Adapun gejalanya sebagai berikut :<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial;">-<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Nyeri
dan disuria<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial;">-<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"> Uretral dan vaginal discharge<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial;">-<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Gejala
sistemik (malaise, demam, mialgia, sakit kepala)<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial;">-<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Limfadenopati
yang nyeri pada daerah inguinal<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial;">-<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Nyeri
pada rektum, tenesmus<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial;">-<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Bintil-bintil
berair seperti anggur di sekitar kelamin. </span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial;">-<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pecah, lalu
menyebabkan luka kering mengerak lalu hilang. </span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial;">-<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Terulang
lagi sampai seumur hidup. </span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"> <br />
Tanda :<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial;">-<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"> Eritem, vesikel, pustul, ulserasi multipel,
erosi, lesi dengan krusta tergantung pada tingkat infeksi.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial;">-<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Limfadenopati
inguinal<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial;">-<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"> Faringitis<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial;">-<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"> Cervisitis</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; mso-add-space: auto; mso-list: l6 level1 lfo12; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -21.3pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial;">a)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Herpes genital primer</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"><br />
Infeksi primer biasanya terjadi
seminggu setelah hubungan<span class="apple-converted-space"> </span><span style="background: #99FF99; mso-bidi-font-weight: bold;">seksual</span>(termasuk
hubungan oral atau anal). Tetapi lebih banyak terjadi setelah interval yang
lama dan biasanya setengah dari kasus tidak menampakkan gejala. Erupsi dapat
didahului dengan gejala prodormal, yang menyebabkan salah diagnosis sebagai
influenza. Lesi berupa papul kecil dengan dasar eritem dan berkembang menjadi
vesikel dan cepat membentuk erosi superfisial atau ulkus yang tidak nyeri,
lebih sering pada glans penis, preputium, dan frenulum, korpus penis lebih
jarang terlihat.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; mso-add-space: auto; mso-list: l6 level1 lfo12; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -21.3pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"><br /></span></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 14.2pt; mso-add-space: auto; mso-list: l6 level1 lfo12; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -14.2pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial;">b)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"> Herpes genital rekuren</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"><br />
Setelah terjadinya infeksi primer
klinis atau subklinis, pada suatu waktu bila ada faktor pencetus, virus akan
menjalani reaktivasi dan multiplikasi kembali sehingga terjadilah lagi rekuren,
pada saat itu di dalam hospes sudah ada antibodi spesifik sehingga kelainan
yang timbul dan gejala tidak seberat infeksi primer. Faktor pencetus antara
lain: trauma, koitus yang berlebihan, demam, gangguan pencernaan, kelelahan,
makanan yang merangsang, alkohol, dan beberapa kasus sukar diketahui
penyebabnya. Pada sebagian besar orang, virus dapat menjadi aktif dan
menyebabkan outbreaks beberapa kali dalam setahun. HSV berdiam dalam sel saraf
di tubuh kita, ketika virus terpicu untuk aktif, maka akan bergerak dari saraf
ke kulit kita. Lalu memperbanyak diri dan dapat timbul luka di tempat
terjadinya outbreaks.<o:p></o:p></span></div>
<div class="MsoNormalCxSpFirst">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Pada
perempuan, seringkali menjadi kanker mulut rahim beberapa tahun kemudian.</span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">.Konsekuensi yang Mungkin Terjadi pada Orang
yang Terinfeksi:<span class="apple-converted-space"> </span>Orang
yang terinfeksi dan memiliki luka akan meningkat risikonya untuk terinfeksi HIV
jika terpapar sebab luka tersebut menjadi jalan masuk virus HIV.Konsekuensi yang Mungkin Terjadi pada Janin
dan Bayi:<span class="apple-converted-space"> </span>Perempuan yang
mengalami episode pertama dari herpes genital pada saat hamil akan memiliki
risiko yang lebih tinggi untuk terjadinya kelahiran prematur.<span class="apple-converted-space"> </span>Kejadian akut pada masa persalinan
merupakan indikasi untuk dilakukannya persalinan dengan operasi cesar sebab
infeksi yang mengenai bayi yang baru lahir akan dapat menyebabkan kematian atau
kerusakan otak yang serius.</span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Komplikasi</span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> yang
biasanya muncull adalah Gangguan mobilitas, vaginitis, urethritis, sistitis dan
fisura ani herpetika terjadi bila mengenai region genetalia,Abortus,Anomali
kongenital,Infeksi pada neonatus (konjungtifitis/ keratis, ensefalitis,
vesikulitis kutis, ikterus, dan anomali konvulsi).<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: 38.4pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-weight: bold;">Pencegahan:</span><span class="apple-converted-space"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"> </span></span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Tidak melakukan
hubungan seks secara vaginal, anal dan oral dengan orang yang terinfeksi adalah
satu-satunya cara pencegahan yang 100% efektif mencegah penularan virus herpes
genital melalui hubungan seks.Kondom dapat mengurangi risiko tetapi tidak dapat
samasekali menghilangkan risiko tertular penyakit ini melalui hubungan seks.<span class="apple-converted-space"> </span>Walaupun memakai kondom saat melakukan
hubungan seks, masih ada kemungkinan untuk tertular penyakit ini yaitu melalui
adanya luka di daerah kelamin.<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br /></span></div>
<div class="MsoNormalCxSpMiddle">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Penanganan</span><span style="font-family: Arial, sans-serif; font-size: 12pt; line-height: 115%;"> </span></div>
<div class="MsoNormalCxSpMiddle" style="margin-left: 36.0pt; mso-add-space: auto; mso-list: l7 level1 lfo9; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; line-height: 115%; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Arial; mso-fareast-language: IN;">1)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Lakukan
pemeriksaan serologi (STS).<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-left: 36.0pt; mso-add-space: auto; mso-list: l7 level1 lfo9; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; line-height: 115%; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Arial; mso-fareast-language: IN;">2)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Atasi nyeri
dan demam dengan parasetamol 3 x 500 mg.<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-left: 36.0pt; mso-add-space: auto; mso-list: l7 level1 lfo9; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; line-height: 115%; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Arial; mso-fareast-language: IN;">3)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Bersihkan
lesi dengan larutan antiseptic dan kompres dengan air hangat.<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-left: 36.0pt; mso-add-space: auto; mso-list: l7 level1 lfo9; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; line-height: 115%; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Arial; mso-fareast-language: IN;">4)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Keringkan
dan oleskan acyclovir 5% topikal setelah nyeri berkurang.<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-left: 36.0pt; mso-add-space: auto; mso-list: l7 level1 lfo9; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; line-height: 115%; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Arial; mso-fareast-language: IN;">5)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Berikan
acyclovir tablet 200 mg tiap 4 jam.<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-left: 36.0pt; mso-add-space: auto; mso-list: l7 level1 lfo9; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; line-height: 115%; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Arial; mso-fareast-language: IN;">6)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Rawat inap
bila terjadi demam tinggi, nyeri hebat, retensi urin, konvulsi, neurosis,
reaksi neurologik lokal, ketuban pecah dini maupun partus prematurus.<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-left: 36.0pt; mso-add-space: auto; mso-list: l7 level1 lfo9; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; line-height: 115%; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Arial; mso-fareast-language: IN;">7)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Berikan
pengobatan pada pasangan berupa acyclovir oral selama 7 hari.<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-left: 36.0pt; mso-add-space: auto; mso-list: l7 level1 lfo9; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; line-height: 115%; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Arial; mso-fareast-language: IN;">8)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Bila
terpaksa partus pervaginam, hindari transmisi ke bayi atau penolong.<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle">
<br /></div>
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br clear="all" style="mso-special-character: line-break; page-break-before: always;" />
</span>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; letter-spacing: -.1pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">3.</span></b><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Sifilis (Raja Singa)</span></b></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbrB26YgqEfaB5SHNIs3ghBoJHj03ryUSTRJci4HF1-rUWORCVPC2YrCJ-qOTYJ5PnkENJ_R21fkWyedU9qHXCbk4atgxiBFd0Lj7vn2UXOMPHRPxepeRh28kq8WQDfJPd2zQiqJ3VNek/s1600/PMS.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbrB26YgqEfaB5SHNIs3ghBoJHj03ryUSTRJci4HF1-rUWORCVPC2YrCJ-qOTYJ5PnkENJ_R21fkWyedU9qHXCbk4atgxiBFd0Lj7vn2UXOMPHRPxepeRh28kq8WQDfJPd2zQiqJ3VNek/s200/PMS.jpg" width="200" /></a></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<span style="font-family: Arial, sans-serif;"><span style="line-height: 18px;"><b><br /></b></span></span></div>
<div class="MsoNormalCxSpMiddle">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Kuman
penyebabnya disebut Treponema pallidum. termasuk ordo Spirochaecrales, familia
Spirochaetaceae dan genus Treponema. Bentuk spiral teratur, panjang 6-15 µm,
lebar 0,15 µm, terdiri atas 8-24 lekukan. Pembiakan secara pembelahan
melintang, pada stadium aktif terjadi setiap 30 jam.Masa tanpa gejala
berlangsung 3-4 minggu, kadang-kadang sampai 13 minggu. Kemudian timbul
benjolan di sekitar alat kelamin. Kadang- kadang disertai pusing-pusing dan
nyeri tulang seperti flu, yang akan hilang sendiri tanpa diobati. Ada bercak
kemerahan pada tubuh sekitar 6-12 minggu setelah hubungan seks. Gejala ini akan
hilang dengan sendirinya dan seringkali penderita tidak memperhatikan hal ini. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Selama 2-3 tahun pertama
penyakit ini tidak menunjukkan gejala apa-apa, atau disebut masa laten. Setelah
5-10 tahun penyakit sifilis akan menyerang susunan syaraf otak, pembuluh darah
dan jantung. Pada perempuan hamil sifilis dapat ditularkan kepada bayi yang
dikandungnya dan bisa lahir dengan kerusakan kulit, hati, limpa dan
keterbelakangan mental. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: 14.4pt; margin-left: 0cm; margin-right: 0cm; margin-top: 7.2pt; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Sifilis tidak ditularkan tanpa
hubungan seksual, apalagi melalui benda mati seperti misalnya bangku, tempat
duduk toilet, handuk, gelas, atau benda-benda lain yang bekas digunakan atau
dipakai oleh pengindap. Sifilis merupakan penyakit kronis yang berkembang lewat
beberapa stadium.</span></div>
<div class="MsoNormalCxSpLast" style="margin-bottom: 14.4pt; margin-left: 0cm; margin-right: 0cm; margin-top: 7.2pt; mso-add-space: auto;">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Gambaran
klinis:<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpFirst" style="margin-bottom: 14.4pt; margin-left: 36.0pt; margin-right: 0cm; margin-top: 7.2pt; mso-add-space: auto; mso-list: l8 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">1)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Sifilis
primer, tanda klinis yang pertama muncul adalah tukak, dapat terjadi di mana
saja di daerah genitalia eksterna, 3 minggu setelah kontak. Lesi dapat khas,
akan tetapi dapat juga tidak khas. Jumlah tukak biasanya hanya satu, meskipun
dapat juga multipel. Lesi awal biasanya berupa papul yang mengalami erosi,
teraba keras karena terdapat indurasi.Permukaan dapat tertutup krusta dan
terjadi ulserasi.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 14.4pt; margin-left: 36.0pt; margin-right: 0cm; margin-top: 7.2pt; mso-add-space: auto; mso-list: l8 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">2)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Sifilis
sekunder, berupa berbagai ruam pada kulit, selaput lendir, dan organ tubuh.
Dapat disertai demam, malaise. Juga adanya kelainan kulit dan selaput lendir
dapat diduga sifilis sekunder.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 14.4pt; margin-left: 36.0pt; margin-right: 0cm; margin-top: 7.2pt; mso-add-space: auto; mso-list: l8 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">3)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Sifilis
laten merupakan stadium sifilis tanpa gejala klinis, akan tetapi pemeriksaan
serologis reaktif. Dalam perjalanan penyakit sifilis selalu melalui tingkat
laten, selama bertahun-tahun atau seumur hidup. Diagnosis sifilis laten
ditegakkan setelah diperoleh anamnesis yang jelas, hasil pemeriksaan fisik yang
menunjukkan adanya kelainan yang awal mulanya di sebabkan oleh sifilis.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="margin-bottom: 14.4pt; margin-left: 36.0pt; margin-right: 0cm; margin-top: 7.2pt; mso-add-space: auto; mso-list: l8 level1 lfo3; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">4)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Sifilis
lanjut berupa endorteritis obliterans pada bagian ujung arteriol dan pembuluh
darah kecil yang menyebabkan peradangan dan nekrosis.<o:p></o:p></span></div>
<div class="MsoNormalCxSpFirst">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Klasifikasi <o:p></o:p></span></b></div>
<div class="MsoNormalCxSpMiddle">
<br /></div>
<div class="MsoNormalCxSpMiddle">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Sifilis terbagi menjadi sifilis congenital dan sifilis
akuista.<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">1. Sifilis Kongenital, terbagi atas : a) Dini (sebelum
2 tahun); b) Lanjut (sesudah 2 tahun); Stigmata<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">2. Sifilis Akuista, terbagi : a) Klinik; b)
Epidemiologik<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<br /></div>
<div class="MsoNormalCxSpMiddle">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Menurut caranya sifilis dibagi menjadi tiga stadium
yaitu : <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Stadium I (SI); Stadium II (SII); Stadium III (SIII)<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<br /></div>
<div class="MsoNormalCxSpMiddle">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Secara epidemiologik, WHO membagi menjadi :<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto;">
<br /></div>
<ul type="disc">
<li class="MsoNormalCxSpMiddle"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Stadium
dini menular ( dalam waktu 2 tahun sejak infeksi), terdiri dari SI, SII,
stadium rekuren dan stadium laten dini.<o:p></o:p></span></li>
<li class="MsoNormalCxSpMiddle"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Stadium
lanjut tak menular (setelah 2 tahun sejak infeksi), terdiri atas stadium
laten lanjut dan SIII.<o:p></o:p></span></li>
</ul>
<div class="MsoNormalCxSpMiddle" style="margin-left: 36.0pt; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<br /></div>
<div class="MsoNormalCxSpLast">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Penanganan </span></b><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">:<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpFirst" style="mso-add-space: auto; mso-list: l12 level1 lfo6; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">1)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Menerapkan
prinsip pencegahan infeksi pada persalinan.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-add-space: auto; mso-list: l12 level1 lfo6; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">2)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Menerapkan
prinsip pencegahan infeksi pada penggunaan instrumen.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-add-space: auto; mso-list: l12 level1 lfo6; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">3)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pemberian
antibiotika, misal : Benzalin pensilin 4,8 juta unit IM setiap minggu dengan 4x
pemberian; Dofsisiklin 200 mg oral dosis awal, dilanjutkan 2×100 mg oral hingga
20 hari; Sefriakson 500 mg IM selama 10 hari.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-add-space: auto; mso-list: l12 level1 lfo6; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">4)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Sebelum
pemberian terapi pada bayi dengan dugaan/ terbukti menderita sifilis
kongenital, maka dilakukan pemeriksaan cairan serebrospinalis dan uji serologik
tiap bulan sampai negatif. Berikan antibiotik : Benzalin pensilin 200.000 IU/
kgBB per minggu hingga 4x pemberian; Sefriakson 50 mg/ kg BB dosis tunggal (per
hari 10 hari).<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-add-space: auto; mso-list: l12 level1 lfo6; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">5)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Lakukan
konseling preventif, pengobatan tuntas dan asuhan mandiri.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-add-space: auto; mso-list: l12 level1 lfo6; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">6)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Memastikan
pengobatan lengkap dan kontrol terjadwal.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="mso-add-space: auto; mso-list: l12 level1 lfo6; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">7)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pantau lesi
kronik atau gejala neurologik yang menyertai.<o:p></o:p></span></div>
<div class="MsoNormalCxSpFirst" style="margin-left: 36.0pt; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; letter-spacing: -.1pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">4.</span></b><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Klamidia<span style="letter-spacing: -.1pt;"> <o:p></o:p></span></span></b></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: 38.4pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Penyakit ini disebabkan oleh Chlamydia trachomatis.
Masa tanpa gejala ber-langsung 7 - 21 hari. Gejalanya adalah timbul peradangan
pada alat reproduksi laki-laki dan perempuan. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pada perempuan, gejalanya bisa berupa : <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">• Keluarnya cairan dari alat kelamin atau sering disebut keputihan encer
berwarna kuning kecoklatan. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">• Rasa nyeri di rongga pinggul. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">• Pendarahan setelah hubungan seksual. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<br /></div>
<div class="MsoNormalCxSpMiddle">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Sedangkan pada laki-laki, gejalanya bisa berupa :<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">• Keluar cairan bening dari saluran kencing. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">• Rasa nyeri saat kencing. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">• Infeksi lebih lanjut dapat menyebabkan banyak cairan keluar dan <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">bercampur nanah. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: 38.4pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Tidak jarang pula, gejala tidak muncul sama sekali,
padahal proses infeksi sedang berlangsung. Oleh karena itu penderita tidak
sadar sedang menjadi pembawa PMS dan menularkannya kepada pasangannya melalui
hubungan seksual. <o:p></o:p></span></div>
<div class="MsoNormalCxSpLast" style="mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: 38.25pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Akibat terkena Klamidia pada perempuan adalah cacatnya
saluran telur dan kemandulan, radang saluran kencing, robeknya saluran ketuban
sehingga terjadi kelahiran bayi sebelum waktunya (prematur). Sementara pada
laki-laki akibatnya adalah rusaknya saluran air mani dan mengakibatkan kemandulan,
serta radang saluran kencing. Pada bayi, 60% - 70% terkena penyakit mata atau
saluran pernafasan (pneumonia).<o:p></o:p></span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold;"> Konsekuensi yang mungkin terjadi
pada orang yang terinfeksi:<span class="apple-converted-space"> </span></span><span style="font-family: "Arial","sans-serif";">Pada perempuan, jika tidak diobati,
sampai 30% akan mengalami Penyakit Radang Panggul (PRP) yang pada gilirannya
dapat menyebabkan kehamilan ektopik, kemandulan dan nyeri panggul kronis.<span class="apple-converted-space"> </span>Pada laki-laki, jika tidak diobati,
klamidia akan menyebabkan epididymitis, yaitu sebuah peradangan pada testis
(tempat di mana sperma disimpan), yang mungkin dapat menyebabkan
kemandulan.Individu yang terinfeksi akan berisiko lebih tinggi untuk terinfeksi
HIV jika terpapar virus tersebut.<o:p></o:p></span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold;"> Konsekuensi yang mungkin terjadi
pada janin dan bayi baru lahir:</span><span class="apple-converted-space"><span style="font-family: "Arial","sans-serif";"> </span></span><span style="font-family: "Arial","sans-serif";">lahir premature, pneumonia pada bayi
dan infeksi mata pada bayi baru lahir yang dapat terjadi karena penularan
penyakit ini saat proses persalinan.<o:p></o:p></span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold;"> Pencegahan:</span><span class="apple-converted-space"><span style="font-family: "Arial","sans-serif";"> </span></span><span style="font-family: "Arial","sans-serif";">Tidak melakukan hubungan seksual
secara vaginal maupun anal dengan orang yang terinfeksi adalah satu-satunya
cara pencegahan yang 100% efektif.<span class="apple-converted-space"> </span>Kondom
dapat mengurangi tetapi tidak dapat menghilangkan sama sekali risiko tertular
penyakit ini.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold;">Penanganan <o:p></o:p></span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l5 level1 lfo7; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;">1)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Doksisiklin per oral 2x sehari selama
7 hari.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;">2)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Asitromisin dengan pemberian dosis
tunggal (kontraindikasi untuk ibu hamil, gunakan eritromisin, amoksilin,
azitromisin).<o:p></o:p></span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l5 level1 lfo7; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;">3)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Lakukan follow-up pada penderita
dengan :<br />
a) Apakah obat yang diberikan sudah diminum sesuai anjuran.<br />
b) Pasangan seksual juga harus diperiksa dan diobati.<br />
c) Jangan melakukan hubungan seks, bila pengobatan belum selesai.<br />
d) Lakukan periksa ulang 3-4 bulan setelah selesai pengobatan.<br />
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<!--[endif]--><o:p></o:p></span></div>
<span style="font-family: "Arial","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><br clear="all" style="mso-special-character: line-break; page-break-before: always;" />
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<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto;">
<br /></div>
<div class="MsoNormalCxSpFirst" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; letter-spacing: -.1pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">5.</span></b><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Trikomoniasis Vaginalis</span></b></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Trikomoniasis adalah PMS yang
disebabkan oleh infeksi protozoa parasit <span style="letter-spacing: -.1pt;">Tricho
monas</span> vaginalis. Trichomonas vaginalis, biasanya ditularkan melalui hubungan
seksual dan sering menyerang saluran kencing bagian bawah pada wanita. Masa
tunas Trichomonas vaginalis sulit untuk dipastikan, tetapi diperkirakan berkisar
antara 3 sampai 28 hari.<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: 14.4pt; margin-left: 0cm; margin-right: 0cm; margin-top: 7.2pt; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Pada wanita sering tidak menunjukkan
keluhan maupun gejala sama sekali. Bila ada keluhan biasanya berupa lendir
vagina yang banyak dan berbau. Lendir vagina yang klasik berwarna kehijauan dan
berbusa, biasanya hanya ditemukan pada 10 - 30% penderita. Lendir vagina sering
menimbulkan rasa gatal dan perih pada vulva serta kulit sekitarnya. Keluhan
lain yang mungkin terjadi adalah pendarahan setelah melakukan hubungan kelamin
dan perdarahan diantara menstruasi. Pada pemeriksaan penderita dengan gejala
vaginitis akut, tampak edema dan eritema pada labium yang terasa nyeri, sedangkan
pada vulva dan paha bagian atas kadang-kadang ditemukan abses-abses kecil dan
maserasi yang disebabkan oleh fermen proteolitik dalam tubuh.</span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Gejala dan tanda-tandanya adalah: <o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">• Keluar cairan vagina berwarna encer dan baunya busuk. <o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">• Vulva agak bengkak, gatal, dan tidak nyaman. <o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">• Nyeri saat kencing. <o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold;"> Pengobatan:</span><span class="apple-converted-space"><span style="font-family: "Arial","sans-serif";"> </span></span><span style="font-family: "Arial","sans-serif";">Penyakit ini dapat disembuhkan.<span class="apple-converted-space"> </span>Pasangan seks juga harus diobati.Konsekuensi yang Mungkin Terjadi pada Orang
yang Terinfeksi:<span class="apple-converted-space"> </span>Radang
pada alat kelamin pada perempuan yang terinfeksi trikomoniasis mungkin juga
akan meningkatkan risiko untuk terinfeksi HIV jika terpapar dengan virus
tersebut.Adanya trikomoniasis pada perempuan yang juga terinfeksi HIV akan
meningkatkan risiko penularan HIV pada pasangan seksualnya.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold;"> Konsekuensi yang Mungkin Terjadi
pada Janin dan Bayi:</span><span class="apple-converted-space"><span style="font-family: "Arial","sans-serif";"> </span></span><span style="font-family: "Arial","sans-serif";">Trikomoniasis pada perempuan hamil
dapat menyebabkan ketuban pecah dini dan kelahiran prematur.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold;"> Pencegahan:</span><span class="apple-converted-space"><span style="font-family: "Arial","sans-serif";"> </span></span><span style="font-family: "Arial","sans-serif";">Tidak melakukan hubungan seks secara
vaginal dengan orang yang terinfeksi adalah satu-satu cara pencegahan yang 100%
efektif mencegah penularan trikomoniasis melalui hubungan seksual.<span class="apple-converted-space"> </span>Kondon dan berbagai metode penghalang
sejenis yang lain dapat mengurangi tetapi tidak menghilangkan risiko untuk
tertular penyakit ini melalui hubungan seks.<span class="apple-converted-space"> </span>Hindari
untuk saling pinjam meminjam handuk atau pakaian dengan orang lain untuk
mencegah penularan non-seksual dari penyakit ini.<o:p></o:p></span></div>
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<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; letter-spacing: -.1pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">6.</span></b><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Kandidiadis Vagina<span style="letter-spacing: -.1pt;"> <o:p></o:p></span></span></b></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Kandidiasis vagina
merupakan keputihan yang disebabkan oleh jamur <o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Candidas
albicans.Infeksi biasanya bersifat local. Selain pada vulva atau vagina, juga
pada hidung, mulut, tenggorok, usus, dan kulit. Candida adalah mikroorganisme
oportunis, dapat dijumpai di seluruh badan, terutama dalam mulut, kolon, kuku,
vagina, dan saluran anorektal.Gejala yang biasanya muncul pada kandidosis
adalah keluhan panas, atau iritasi pada vulva dan keputihan yang tidak
berbau.Pada pemeriksaan terdapat vulvitis, dengan eritema dan edema vulva,
fisura perineal, pseudomembran dan lesi satelit papulopustular disekitarnya.
Gejala khas adalah rasa gatal atau iritasi disertai keputihan tidak berbau,
atau berbau asam (masam).Keputihan biasa banyak, putih keju atau seperti kepala
susu atau krim. Tetapi kebanyakkan sedikit dan cair, atau seperti susu pecah.
Pada dinding vagina biasanya dijumpai gumpalan keju.Pada vulva atau vagina
terdapat radang, disertai maserasi, pseudomembran fisura dan lesi satelit
papulopostula.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pada keadaan normal, jamur ini terdapat di kulit
maupun di dalam liang kemaluan perempuan. Tetapi pada keadaan tertentu, jamur
ini meluas dan berreplikasi secara tak terkendali sedemikian rupa sehingga
mengakibatkan infeksi dan terjadi keputihan. Gejalanya berupa keputihan
berwarna putih seperti susu, bergumpal, disertai rasa gatal panas dan kemerahan
pada kelamin dan di sekitarnya. <o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p> </o:p></span><span style="font-family: Arial, sans-serif; font-size: 12pt; line-height: 115%; text-indent: 38.4pt;">Penyakit ini tidak selalu tergolong PMS, tetapi
pasangan seksual dari perempuan yang terinfeksi jamur ini dapat mengeluh gatal
dengan gejala bintik-bintik kemerahan di kulit kelamin.</span></div>
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<br /></div>
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<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; letter-spacing: -.1pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">7.</span></b><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Kutil Kelamin<span style="letter-spacing: -.1pt;"> <o:p></o:p></span></span></b></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjP94OmUQc3C2WpMIVO4qnM7Q8AJ_VIWs_ECS6rbisji4EmmfmcOi9voinjHKkWHQoWuIL-fG7k_i9QHyKNn-pI7YkOagT538LF5urLltsXCRIeWbDNTb7sS2Pa0lG4imCejSTGbEUGwsU/s1600/kutil+kelamin.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjP94OmUQc3C2WpMIVO4qnM7Q8AJ_VIWs_ECS6rbisji4EmmfmcOi9voinjHKkWHQoWuIL-fG7k_i9QHyKNn-pI7YkOagT538LF5urLltsXCRIeWbDNTb7sS2Pa0lG4imCejSTGbEUGwsU/s200/kutil+kelamin.jpg" width="200" /></a></div>
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<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br /></span></b></div>
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<br /></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Penyebabnya adalah human
papilloma virus (HPV) dengan gejala <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">yang khas yaitu terdapat satu atau beberapa kutil di sekitar kemaluan. <o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pada perempuan, dapat mengenai kulit di daerah kelamin
sampai dubur, selaput lendir bagian dalam liang kemaluan sampai leher rahim.
Bila perempuan hamil, kutil dapat tumbuh sampai besar sekali. Kutil kelamin
kadang-kadang bisa mengakibatkan kanker leher rahim atau kanker kulit di
sekitar kelamin. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: 38.4pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pada laki-laki mengenai alat kelamin dan saluran
kencing bagian dalam. Kadang-kadang kutil tidak terlihat sehingga tidak
disadari. Biasanya laki-laki baru menyadari setelah ia menulari pasangannya. <o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> <o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Sampai sekarang belum ada obat yang dapat secara
tuntas menyembuhkan kutil kelamin. Pengobatan hanya sampai pada tahap menghilangkan
kutilnya saja. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; letter-spacing: -.1pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">8.</span></b><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">HIV/AIDS</span></b></div>
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<br /></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> AIDS adalah singkatan dari
Acquired Immuno Deficiency Syndrome. Penyakit <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">ini adalah kumpulan gejala akibat menurunnya sistem kekebalan tubuh yang
terjadi karena seseorang terinfeksi virus HIV. HIV sendiri adalah singkatan
dari <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Human Immunodeficiency <span style="letter-spacing: -.1pt;">Virus</span>.<span style="letter-spacing: -.1pt;"> </span>Orang yang terinfeksi oleh virus ini tidak
dapat mengatasi serbuan penyakit lain karena sistem kekebalan tubuhnya menurun
terus secara drastis.</span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> <o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Virus ini tergolong unik karena daur hidupnya. Virus
HIV yang hidup bebas di luar tidak dapat berkembang biak. Namun, jika virus
tersebut hinggap di sel hidup, ia akan mengubah sel tersebut menjadi pabrik
virus HIV. HIV hanya akan mengikatkan diri pada reseptor khusus di permukaan
sel. Reseptor ini hanya terdapat di sel darah putih, sel pencernaan, dan sel
otak. (Gambar 1). <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: 38.4pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">HIV menembus dinding sel melalui reseptor tersebut dan
melepaskan seluruh isi virus ke dalam sel tersebut (Gambar 2). <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: 38.4pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Enzim yang ada dalam tubuh virus merubah RNA
(Ribonucleat acid) rantai tunggal menjadi rantai ganda (DNA) agar sesuai dengan
DNA inangnya. (Gambar 3). DNA virus bergabung dengan DNA inang. Sel inang tidak
dapat mengetahui apa yang terjadi padanya. (Gambar 4). Sel inang lalu akan
menginstruksikan organel-organelnya untuk mereplikasi RNA guna membentuk HIV
baru. Dan pada akhirnya, virus HIV baru akan keluar dari sel inang dan siap
untuk menyerang sel lain. (Gambar 5). <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: 38.4pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Sesudah terjadi infeksi virus HIV, awalnya tidak
memperlihatkan gejala-gejala khusus. Baru beberapa minggu sesudah itu orang
yang terinfeksi sering kali menderita penyakit ringan sehari-hari seperti flu
atau diare. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: 38.4pt;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Penderita sering kali merasa sehat dan memang dari
luar memang tampak sehat. Sering kali 3-4 tahun penderita tidak memperlihatkan
gejala yang khas. Sesudahnya, tahun ke 5 atau 6 mulai timbul diare berulang,
penurunan berat badan secara mendadak, sering sariawan di mulut, dan terjadi
pembengkakan di daerah kelenjar getah bening. Kekebalan tubuh semakin lemah dan
akhirnya penderita mudah terjangkit berbagai macam penyakit. Sampai nanti
penderita meninggal perlahan. Belum ditemukan obat bagi penderitannya sampai
saat ini. Obat yang tersedia hanya dapat menolong penderita untuk
mempertahankan kesehatan tubuhnya. <o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: 38.4pt;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: 14.4pt; margin-left: 0cm; margin-right: 0cm; margin-top: 7.2pt; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Tanda-tanda dan gejala HIV/AIDS</span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: 14.4pt; margin-left: 0cm; margin-right: 0cm; margin-top: 7.2pt; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">• Penurunan
berat badan sehingga 10% yang tidak diketahui puncaknya<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: 14.4pt; margin-left: 0cm; margin-right: 0cm; margin-top: 7.2pt; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">• batuk yang
kronik dan berterusan<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: 14.4pt; margin-left: 0cm; margin-right: 0cm; margin-top: 7.2pt; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">• Demam yang
berpanjangan. Demam ini berlaku secara berkala ataupun berterusan<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: 14.4pt; margin-left: 0cm; margin-right: 0cm; margin-top: 7.2pt; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">•
Pembengkakan nodus limfa terutamanya di leher, ketiak dan selakangan.<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: 14.4pt; margin-left: 0cm; margin-right: 0cm; margin-top: 7.2pt; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">• Terserang
herpes zoster yang berulang-ulang. Herpes zoster merupakan infeksi saraf oleh
virus yang dicirikan oleh kehadiran lepuhan pada kulit.<o:p></o:p></span></div>
<div class="MsoNormalCxSpLast" style="margin-bottom: 14.4pt; margin-left: 0cm; margin-right: 0cm; margin-top: 7.2pt; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">• Kandidiasis di mulut dan tekak. Kandidiasis
merupakan sejenis penyakit yang disebabkan oleh sejenis kulat (fungus).<o:p></o:p></span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold;"> Pengobatan:</span><span class="apple-converted-space"><span style="font-family: "Arial","sans-serif";"> </span></span><span style="font-family: "Arial","sans-serif";">Belum ada pengobatan untuk infeksi
ini.<span class="apple-converted-space"> </span>Obat-obat anti retroviral
digunakan untuk memperpanjang hidup dan kesehatan orang yang
terinfeksi.Obat-obat lain digunakan untuk melawan infeksi oportunistik yang
juga diderita.<o:p></o:p></span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold;"> Konsekuensi yang Mungkin Terjadi
pada Orang yang Terinfeksi:</span><span class="apple-converted-space"><span style="font-family: "Arial","sans-serif";"> </span></span><span style="font-family: "Arial","sans-serif";">Hampir semua orang yang terinfeksi HIV
akhirnya akan menjadi AIDS dan meninggal karena komplikasi-komplikasi yang
berhubungan dengan AIDS.<o:p></o:p></span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold;"> Konsekuensi yang Mungkin Terjadi
pada Janin dan Bayi:</span><span class="apple-converted-space"><span style="font-family: "Arial","sans-serif";"> </span></span><span style="font-family: "Arial","sans-serif";">20-30% dari bayi yang lahir dari ibu
yang terinfeksi HIV akan terinfeksi HIV juga dan gejala-gejala dari AIDS akan
muncul dalam satu tahun pertama kelahiran.<span class="apple-converted-space"> </span>20%
dari bayi-bayi yang terinfeksi tersebut akan meninggal pada saat berusia 18
bulan.<span class="apple-converted-space"> </span>Obat antiretroviral yang
diberikan pada saat hamil dapat menurunkan risiko janin untuk terinfeksi HIV
dalam proporsi yang cukup besar.<span class="apple-converted-space"> </span>Lihat<span class="apple-converted-space"> </span></span><a href="http://www.w-cpc.org/pregnancy/teratogen.html#aids"><span style="font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold;">Prenatal
Risk Assessment: AIDS</span></a><span class="apple-converted-space"><span style="font-family: "Arial","sans-serif";"> </span></span><span style="font-family: "Arial","sans-serif";">untuk infomasi lebih lanjut tentang
AIDS dan kehamilan.<o:p></o:p></span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold;"> Pencegahan:</span><span class="apple-converted-space"><span style="font-family: "Arial","sans-serif";"> </span></span><span style="font-family: "Arial","sans-serif";">Tidak melakukan hubungan seksual
dengan orang yang terinfeksi, khususnya hubungan seks anal, di mana cairan
tubuh, darah, air mani atau secret vagina paling mungkin dipertukarkan, adalah
satu-satunya cara yang 100% efektif untuk mencegah penularan HIV melalui
hubungan seks.Kondom dapat menurunkan risiko penularan tetapi tidak
menghilangkan sama sekali kemungkinan penularan.<span class="apple-converted-space"> </span>Hindari pemakaian narkoba suntik dan
saling berbagi jarum suntik.<span class="apple-converted-space"> </span>Diskusikan
dengan petugas kesehatan tindakan kewaspadaan yang harus dilakukan untuk
mencegah penularan HIV, terutama saat harus menerima transfusi darah maupun
produk darah.<o:p></o:p></span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto;">
<br /></div>
<h2>
<span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">9. <a href="" name="hpv"> Human
Papilloma Virus (HPV)</a></span></h2>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto;">
<span class="apple-style-span"><span style="font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold;"> Human
Papiloma Virus (Virus papiloma manusia</span></span><span class="apple-converted-space"><span style="font-family: "Arial","sans-serif";"> )
</span></span><span class="apple-style-span"><span style="font-family: "Arial","sans-serif";">adalah</span></span><span class="apple-converted-space"><span style="font-family: "Arial","sans-serif";"> </span></span><a href="http://id.wikipedia.org/wiki/Virus"><span style="font-family: "Arial","sans-serif";">virus</span></a><span class="apple-converted-space"><span style="font-family: "Arial","sans-serif";"> </span></span><span class="apple-style-span"><span style="font-family: "Arial","sans-serif";">yang
menyerang</span></span><span class="apple-converted-space"><span style="font-family: "Arial","sans-serif";"> </span></span><a href="http://id.wikipedia.org/wiki/Kulit"><span style="font-family: "Arial","sans-serif";">kulit</span></a><span class="apple-converted-space"><span style="font-family: "Arial","sans-serif";"> </span></span><span class="apple-style-span"><span style="font-family: "Arial","sans-serif";">dan</span></span><span class="apple-converted-space"><span style="font-family: "Arial","sans-serif";"> </span></span><a href="http://id.wikipedia.org/wiki/Membran_mukosa"><span style="font-family: "Arial","sans-serif";">membran mukosa</span></a><span class="apple-converted-space"><span style="font-family: "Arial","sans-serif";"> </span></span><a href="http://id.wikipedia.org/wiki/Manusia"><span style="font-family: "Arial","sans-serif";">manusia</span></a><span class="apple-style-span"><span style="font-family: "Arial","sans-serif";">.</span></span><span style="font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold;">Cara
Penularannya melalui </span><span style="font-family: "Arial","sans-serif";">Hubungan
seksual vaginal, anal atau oral.Gejala-gejalanya
berupa tonjolan yang tidak sakit, kutil yang menyerupai bunga kol tumbuh
di dalam atau pada kelamin, anus dan tenggorokan.Pengobatan:<span class="apple-converted-space"> </span>Tidak
ada pengobatan untuk penyakit ini.<span class="apple-converted-space"> </span>Kutil
dapat dihilangkan dengan cara-cara kimia, pembekuan, terapi laser atau bedah.<o:p></o:p></span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold;"> Konsekuensi yang Mungkin Terjadi
pada Orang yang Terinfeksi:</span><span class="apple-converted-space"><span style="font-family: "Arial","sans-serif";"> </span></span><span style="font-family: "Arial","sans-serif";">HPV adalah virus yang menyebabkan
kutil kelamin.<span class="apple-converted-space"> </span>Beberapa strains
dari virus ini berhubungan kuat dengan kanker serviks sebagaimana halnya juga
dengan kanker vulva, vagina, penis dan anus.<span class="apple-converted-space"> </span>Pada
kenyataannya 90% penyebab kanker serviks adalah virus HPV.<span class="apple-converted-space"> </span>Kanker serviks ini menyebabkan
kematian 5.000 perempuan Amerika setiap tahunnya.<o:p></o:p></span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold;"> Konsekuensi yang Mungkin Terjadi
pada Janin dan Bayi:</span><span class="apple-converted-space"><span style="font-family: "Arial","sans-serif";"> </span></span><span style="font-family: "Arial","sans-serif";">Pada bayi-bayi yang terinfeksi virus
ini pada proses persalinan dapat tumbuh kutil pada tenggorokannya yang dapat
menyumbat jalan nafas sehingga kutil tersebut harus dikeluarkan.<o:p></o:p></span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold;"> Pencegahan:</span><span class="apple-converted-space"><span style="font-family: "Arial","sans-serif";"> </span></span><span style="font-family: "Arial","sans-serif";">Tidak melakukan hubungan seks secara
vaginal, anal dan oral dengan orang yang terinfeksi adalah satu-satunya cara
pencegahan yang 100% efektif mencegah penularan.<span class="apple-converted-space"> </span>Kondom hampir tidak berfungsi sama
sekali dalam mencegah penularan virus ini melalui hubungan seks.<o:p></o:p></span></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto;">
<br /></div>
<div style="line-height: 115%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto;">
<b><span style="font-family: "Arial","sans-serif";">Infeksi
Reproduksi lain yang berhubungan
penyakit menular seksual adalah</span></b><span style="font-family: "Arial","sans-serif";">
:<o:p></o:p></span></div>
<ul type="disc">
<li class="MsoNormalCxSpFirst"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Bakterial
Vaginosis<span class="apple-converted-space"> </span>– Menyebabkan
nyeri saat buang air kecil, jika tidak diobati dapat menyebabkan kegagalan
ginjal.<o:p></o:p></span></li>
<li class="MsoNormalCxSpMiddle"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Chancroid<span class="apple-converted-space"> </span>– Luka atau bintil yang besar dan
nyeri, dapat pecah.<o:p></o:p></span></li>
<li class="MsoNormalCxSpMiddle"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Granuloma
Inguinale<span class="apple-converted-space"> </span>– Menyebabkan
luka-luka yang tidak terasa sakit yang dapat membesar dan mudah berdarah.<o:p></o:p></span></li>
<li class="MsoNormalCxSpMiddle"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Lymphogranuloma
Venereum<span class="apple-converted-space"> </span>– Menyebabkan
lesi-lesi, luka dan abses pada lipat paha.<o:p></o:p></span></li>
<li class="MsoNormalCxSpMiddle"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Molluscum
Contagiosum<span class="apple-converted-space"> </span>– Virus ini
menyebabkan lesi-lesi yang halus dan mengkilap yang harus dihilangkan satu
per satu oleh dokter.<o:p></o:p></span></li>
<li class="MsoNormalCxSpMiddle"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Mucopurulent
Cervicitis (MPC)<span class="apple-converted-space"> </span>–
Menyebabkan keluarnya keputihan dari serviks, dapat menyebabkan Penyakit
Radang Panggul atau keguguran pada ibu hamil.<o:p></o:p></span></li>
<li class="MsoNormalCxSpMiddle"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Nongonococcal
Urethritis (NGU)<span class="apple-converted-space"> </span>– Mengenai
laki-laki dan dapat menyebabkan masalah pada saat buang air kecil, dapat
disebabkan oleh klamidia.<o:p></o:p></span></li>
<li class="MsoNormalCxSpMiddle"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Penyakit
Radang Panggul/Pelvic Inflammatory Disease (PID)<span class="apple-converted-space"> </span>– Dapat disebabkan oleh berbagai
bakteri, menular melalui hubungan seksual atau cara-cara lain.<span class="apple-converted-space"> </span>Dapat menyebabkan rasa nyeri,
kemandulan dan bahkan kematian.<o:p></o:p></span></li>
</ul>
<div class="MsoNormalCxSpLast" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<br /></div>
<div style="line-height: 115%;">
<b><span style="font-family: "Arial","sans-serif";">Sepuluh faktor resiko teratas yang
berpengaruh pada peluang Anda terkena PMS :<o:p></o:p></span></b></div>
<div style="line-height: 115%;">
<br /></div>
<div style="line-height: 115%; margin-left: 36.0pt; mso-add-space: auto; mso-list: l11 level1 lfo14; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><strong><span style="font-family: "Arial","sans-serif";">Seks
tanpa pelindung</span></strong><span style="font-family: "Arial","sans-serif";"><br />
Meski kondom tidak seratus persen melindungi Anda, ia tetap merupakan cara terbaik
untuk menghindarkan Anda dari infeksi. Penggunaan kondom dapat menurunkan laju
penularan PMS. Selain selibat, penggunaan kondom yang konsisten adalah proteksi
terbaik terhadap PMS. Biasakanlah memakai kondom.<o:p></o:p></span></div>
<div style="line-height: 115%; margin-left: 36.0pt; mso-add-space: auto; mso-list: l11 level1 lfo14; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><strong><span style="font-family: "Arial","sans-serif";">Berganti-ganti
pasangan</span></strong><span style="font-family: "Arial","sans-serif";"><br />
Anda tidak perlu belajar matematika untuk mengetahui bahwa semakin banyak
pasangan seksual Anda, kian besar kemungkinan Anda terekspos suatu PMS.
Apalagi, orang yang suka berganti pasangan cenderung memilih pasangan yang suka
berganti pasangan pula. Jadi, Anda tidak lepas dari pasangan-pasangannya
pasangan Anda.<o:p></o:p></span></div>
<div style="line-height: 115%; margin-left: 36.0pt; mso-add-space: auto; mso-list: l11 level1 lfo14; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><strong><span style="font-family: "Arial","sans-serif";"> Mulai aktif secara seksual pada usia dini</span></strong><span style="font-family: "Arial","sans-serif";"><br />
Kaum muda lebih besar kemungkinannya untuk terkena PMS daripada orang yang
lebih tua. Ada beberapa alasannya, yaitu wanita muda khususnya lebih rentan
terhadap PMS karena tubuh mereka lebih kecil dan belum berkembang sempurna
sehingga lebih mudah terinfeksi. Kaum muda juga tampaknya lebih jarang pakai
kondom, terlibat perilaku seksual beresiko dan berganti-ganti pasangan.<o:p></o:p></span></div>
<div style="line-height: 115%; margin-left: 36.0pt; mso-add-space: auto; mso-list: l11 level1 lfo14; text-indent: -18.0pt;">
<!--[if !supportLists]--><strong><span style="font-family: Symbol; font-weight: normal; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span></strong><!--[endif]--><strong><span style="font-family: "Arial","sans-serif";">Pengggunaan
alkohol</span></strong><span style="font-family: "Arial","sans-serif";"><br />
Konsumsi alkohol dapat berpengaruh terhadap kesehatan seksual. Orang yang biasa
minum alkohol bisa jadi kurang selektif memilih pasangan seksual dan menurunkan
batasan. Alkohol dapat membuat seseorang sukar memakai kondom dengan benar
maupun sulit meminta pasangannya menggunakan kondom.<strong><span style="font-weight: normal;"><o:p></o:p></span></strong></span></div>
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</span></span><!--[endif]--><strong><span style="font-family: "Arial","sans-serif";"> Penyalahgunaan obat</span></strong><span style="font-family: "Arial","sans-serif";"><br />
Prinsipnya mirip dengan alkohol, orang yang berhubungan seksual di bawah
pengaruh obat lebih besar kemungkinannya melakukan perilaku seksual
beresiko/tanpa pelindung. Pemakaian obat terlarang juga memudahkan orang lain
memaksa seseorang melakukan perilaku seksual yang dalam keadaan sadar tidak
akan dilakukan. Penggunaan obat dengan jarum suntik diasosiasikan dengan
peningkatan resiko penularan penyakit lewat darah, seperti <span class="ilad">hepatitis</span>
dan HIV, yang juga bisa ditransmisikan lewat seks.<o:p></o:p></span></div>
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</span></span><!--[endif]--><strong><span style="font-family: "Arial","sans-serif";">Seks
untuk uang/obat</span></strong><span style="font-family: "Arial","sans-serif";"><br />
Orang yang menjual seks untuk mendapatkan sesuatu posisi tawarnya rendah
sehingga sulit baginya untuk menegosiasikan hubungan seksual yang aman.
Kemudian, pasangan (pembeli jasa) memiliki resiko terinfeksi PMS yang lebih
besar. Jadi, baik pembeli maupun penjual sama-sama dirugikan.<o:p></o:p></span></div>
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</span></span><!--[endif]--><strong><span style="font-family: "Arial","sans-serif";">Hidup
di masyarakat yang prevalensi PMS-nya tinggi</span></strong><span style="font-family: "Arial","sans-serif";"><br />
Ketika seseorang tinggal di tengah komunitas dengan prevalensi PMS yang tinggi,
ketika berhubungan seksual (dengan orang di komunitas itu) ia lebih rentan
terinfeksi PMS.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><strong><span style="font-family: "Arial","sans-serif";">Monogami
</span></strong><span class="ilad"><span style="font-family: "Arial","sans-serif";">serial</span></span><span style="font-family: "Arial","sans-serif";"><br />
Monogami serial adalah mengencani/menikahi satu orang saja pada suatu masa,
tapi kalau diakumulasi jumlah orang yang dikencani/dinikahi juga banyak. Contoh
gampangnya (yang juga banyak terjadi di masyarakat kita) adalah orang yang
doyan kawin-cerai. Perilaku begini juga berbahaya, sebab orang yang
mempraktekkan monogami serial berpikir bahwa mereka saat itu memiliki hubungan
eksklusif sehingga akan tergoda untuk berhenti menggunakan pelindung ketika
berhubungan seksual. Sebenarnya monogami memang efektif mencegah PMS, tapi
hanya pada monogami jangka panjang yang kedua pasangan sudah dites kesehatan
reproduksi.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><strong><span style="font-family: "Arial","sans-serif";">Sudah
terkena suatu PMS</span></strong><span style="font-family: "Arial","sans-serif";"><br />
Kalau Anda sudah pernah berkenalan langsung dengan suatu PMS (apalagi sering),
Anda lebih rentan terinfeksi PMS jenis lainnya. Iritasi atau lepuh pada kulit
yang terinfeksi dapat <span class="ilad">menjadi</span> jalan masuk patogen lain
untuk menginfeksi. Karena Anda sudah pernah terinfeksi sekali, bisa jadi ada
faktor tertentu dalam gaya hidup Anda yang beresiko.<o:p></o:p></span></div>
<div style="line-height: 115%; margin-left: 36.0pt; mso-add-space: auto; mso-list: l11 level1 lfo14; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><strong><span style="font-family: "Arial","sans-serif";">Cuma
pakai pil KB untuk kontrasepsi</span></strong><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<div style="line-height: 115%; margin-left: 36.0pt; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif";">Kadang orang lebih menghindari
kehamilan daripada PMS sehingga mereka memilih pil KB sebagai alat kontrasepsi
utama. Karena sudah merasa terhindar dari kehamilan, mereka enggan memakai
kondom. Ini bisa terjadi ketika orang tidak ingin menuduh pasangannya berpenyakit
(sehingga perlu disuruh pakai kondom) atau memang tidak suka pakai kondom dan
menjadikan pil KB sebagai alasan. Yang jelas, perlindungan ganda (pil KB dan
kondom) adalah pilihan terbaik…meski tidak semua orang melakukannya.<o:p></o:p></span></div>
<span style="font-family: "Arial","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><br clear="all" style="mso-special-character: line-break; page-break-before: always;" />
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<br /></div>
<div align="center" class="MsoNormalCxSpMiddle" style="text-align: center;">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">BAB III<br />
PENUTUP<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--></span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
A. Kesimpulan<o:p></o:p></span></b></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
PMS biasanya ditularkan dari
satu orang kepada orang lainnya melalui hubungan heteroseksual, homoseksual
atau kontak intim melalui genitalia, mulut atau rectum.Beberapa penyakit
menular seksual yang dibahas didalam makalah ini mencangkup Gonorhea,
Syiphillis, Herpes genital dan HIV /AIDS.<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Gejala-gejala umum PMS
pada laki-laki adalah : Bintik-bintik berisi cairan, borok, atau lecet pada
daerah sekitar kelamin. Luka tidak sakit, keras dan berwarna merah pada sekitar
daerah kelamin. Adanya kutil yang tumbuh seperti jengger ayam. Rasa gatal yang
sangat hebat di sekitar kelamin. Sakit luar biasa saat kencing, Kencing
nanah/darah dengan bau busuk. ,Bengkak panas nyeri pada pangkal paha yang
akhirnya menjadi borok,Kehilangan berat badan secara drastis, diare
berkepanjangan, dan berkeringat saat malam. Sedangkan pada perempuan meliputi :
Rasa sakit atau nyeri saat kencing atau saat berhubungan seksual,Rasa nyeri
pada perut bagian bawah,Keluarnya lendir pada vagina,Keputihan berwarna putih
susu, bergumpal, dan disertai rasa gatal pada kelamin,Keputihan berbusa dan
berbau busuk,Bercak-bercak darah setelah berhubungan seks.<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> <br />
<o:p></o:p></span></div>
<div class="MsoNormalCxSpMiddle" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">B. Saran</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
Penulis mengharapkan agar tenaga kesehatan (khususnya mahasiswa kebidanan)
dapat mengetahui dan memanfaatkan makalah ini untuk menambah wawasan dalam
penyakit menular seksual dan dapat dicegah atau ditanggulangi di lingkungan
masyarakat.<br />
<br clear="all" style="mso-special-character: line-break; page-break-before: always;" />
<o:p></o:p></span></div>
<div align="center" class="MsoNormalCxSpLast" style="margin-bottom: 14.4pt; margin-left: 0cm; margin-right: 0cm; margin-top: 7.2pt; mso-add-space: auto; text-align: center;">
<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">DAFTAR PUSTAKA</span></b></div>
<div class="MsoNormalCxSpLast" style="margin-bottom: 14.4pt; margin-left: 0cm; margin-right: 0cm; margin-top: 7.2pt; text-align: center;">
</div>
<div class="MsoListParagraphCxSpFirst" style="margin-bottom: 0.0001pt; text-align: left; text-indent: -18pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Buku Acuan Nasional Pelayanan Kesehatan Maternal Dan Neonatal.</span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Yayasan
Bina Pustaka. Jakarta.Yatim, Faisal (2005). <o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 0.0001pt; text-align: left; text-indent: -18pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Chlamydia Dan Gonorea.</span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Harahap, M, 1984.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 0.0001pt; text-align: left; text-indent: -18pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Diamond,
Jared (1997). , Guns Kuman dan
Baja . New York: WW Norton. p.210. </span><a href="http://en.wikipedia.org/wiki/International_Standard_Book_Number" title="International Standard Book Number"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; text-decoration: none; text-underline: none;">ISBN </span></a><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><a href="http://en.wikipedia.org/wiki/Special:BookSources/848306667X" title="Special:BookSources/848306667X"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; text-decoration: none; text-underline: none;">848306667X</span></a><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> .<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 0.0001pt; text-align: left; text-indent: -18pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Farci P
(2003). "Delta hepatitis: pembaruan.". J Hepatol 39 (Suppl 1): S212-9. </span><a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; text-decoration: none; text-underline: none;">DOI</span></a><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> : </span><a href="http://dx.doi.org/10.1016%2FS0168-8278%2803%2900331-3"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; text-decoration: none; text-underline: none;">10.1016/S0168-8278 (03) 00331-3</span></a><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> . </span><a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; text-decoration: none; text-underline: none;">PMID </span></a><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><a href="http://www.ncbi.nlm.nih.gov/pubmed/14708706"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; text-decoration: none; text-underline: none;">14708706</span></a><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> .<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 0.0001pt; text-align: left; text-indent: -18pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">5.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Gilbert MT,
Rambaut A, Wlasiuk G, Leptospira TJ, Pitchenik AE, Worobey M (November
2007). </span><a href="http://www.pnas.org/cgi/pmidlookup?view=long&pmid=17978186"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; text-decoration: none; text-underline: none;">"Munculnya HIV / AIDS di
Amerika dan di luar"</span></a><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> . Proc. Natl.Acad. Sci. Amerika
Serikat 104 (47):
18566-70. </span><a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; text-decoration: none; text-underline: none;">DOI</span></a><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> :</span><a href="http://dx.doi.org/10.1073%2Fpnas.0705329104"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; text-decoration: none; text-underline: none;">10.1073/pnas.0705329104</span></a><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> . </span><a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; text-decoration: none; text-underline: none;">PMID </span></a><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><a href="http://www.ncbi.nlm.nih.gov/pubmed/17978186"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; text-decoration: none; text-underline: none;">17978186</span></a><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> . </span><a href="http://en.wikipedia.org/wiki/PubMed_Central" title="PubMed Central"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; text-decoration: none; text-underline: none;">PMC </span></a><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><a href="http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=2141817"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; text-decoration: none; text-underline: none;">2141817 </span></a><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">.Diakses 20
Maret 2010 .<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 0.0001pt; text-align: left; text-indent: -18pt;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">6.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">IA Aridoğan,
Ates A, V Izol, Ilkit M (2005). "Tinea cruris dalam praktek urologi
rutin". Urol. Int. 74 (4): 346-8. </span><a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; text-decoration: none; text-underline: none;">DOI</span></a><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> : </span><a href="http://dx.doi.org/10.1159%2F000084436"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; text-decoration: none; text-underline: none;">10.1159/000084436</span></a><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> . </span><a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; text-decoration: none; text-underline: none;">PMID </span></a><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><a href="http://www.ncbi.nlm.nih.gov/pubmed/15897702"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; text-decoration: none; text-underline: none;">15897702</span></a><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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(2006). Workowski </span><a href="http://www.cdc.gov/mmwr/PDF/rr/rr5511.pdf"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; text-decoration: none; text-underline: none;"> pedoman pengobatan penyakit menular seksual, 2006."</span></a><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> . MMWR Recomm Rep 55 (RR-11): 1-94. </span><a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; text-decoration: none; text-underline: none;">PMID</span></a><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><a href="http://www.ncbi.nlm.nih.gov/pubmed/16888612"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; text-decoration: none; text-underline: none;">16888612</span></a><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> .<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 12pt; line-height: 115%; text-indent: -18pt;">9.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><span style="font-family: Arial, sans-serif; font-size: 12pt; line-height: 115%; text-indent: -18pt;">Prayetni.
1996. Asuhan Keperawatan Ibu dengan Gangguan Sistem Reproduksi. Jakarta. Depkes
RI Pusat Pendidikan Tenaga Kesehatan Keluarga berencana dan Kesehatan
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<!--[if !supportLists]--><span style="font-family: Arial, sans-serif; font-size: 12pt; line-height: 115%;"><div style="text-align: left;">
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<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">10.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Mary-Ann
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<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">11.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Memahami Kesehatan Reproduksi Wanita.</span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Arcan. Jakarta.Rabe, Thomas, 2002. Buku Saku Ilmu Kandungan, Hipokrates,
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<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">12.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Oriel, JD
(1994). The Guratan Venus: A
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<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">13.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Penyakit Kandungan. Myoma, Kanker Rahim/ Leher Rahim Dan Indung Telur,
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co".Clin Liver Dis 8 (2): 445-60, viii. </span><a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; text-decoration: none; text-underline: none;">DOI</span></a><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> : </span><a href="http://dx.doi.org/10.1016%2Fj.cld.2004.02.005"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; text-decoration: none; text-underline: none;">10.1016/j.cld.2004.02.005</span></a><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> . </span><a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; text-decoration: none; text-underline: none;">PMID</span></a><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><a href="http://www.ncbi.nlm.nih.gov/pubmed/15481349"><span style="color: windowtext; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; text-decoration: none; text-underline: none;">15481349</span></a><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> .<o:p></o:p></span></li>
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M.</span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> <span style="border: none windowtext 1.0pt; mso-bidi-font-style: italic; mso-border-alt: none windowtext 0cm; padding: 0cm;">Pilihan Sehat untuk Pengendalian
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<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span></div>
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<br />salnihttp://www.blogger.com/profile/00126668517852477742noreply@blogger.com0Universitas Sam Ratulangi, Jalan Kampus Selatan, Manado, Indonesia1.455717 124.8271631.453733 124.8246955 1.457701 124.8296305tag:blogger.com,1999:blog-8321145958076225978.post-65546632418554192942012-03-16T00:50:00.000-07:002012-03-16T00:50:17.876-07:00ASKEP HYPERTENSI KEHAMILAN<br />
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<span style="font-family: Garamond, serif; font-size: 14pt; text-indent: -18pt;">PEMBAHASAN</span></div>
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TINJAUAN TEORITIS</div>
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<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">A.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">PENGERTIAN<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Pre-Eklamsia
adalah timbulnya hipertensi disertai proteinuria dan edema akibat kehamilan
setelah usia kehamilan 20 minggu atau segera setelah persalinan (Mansjoer, dkk,
2000: 197). Pre-Eklamsia adalah penyakit dengan tanda-tanda hipertensi edema
dan proteinuria yang timbul karena kehamilan (Wiknjosastro, 1999:282). Pre
Eklamsia adalah peningkatan tekanan darah dengan tekanan diastolik lebih dari
90 mmHg, kadang kala tanpa disertai dengan tanda-tanda khusus lainnya
(Prawirohardjo, 2006 : 209). Pre eklampsi adalah timbulnya hipertensi disertai
proteinuria dan edema akibat kehamilan setelah usia kehamilan 20 minggu atau
segera setelah persalinan (Setiowulan, 2002 : 270).<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Pre
eklampsi adalah suatu penyakit yang mempunyai gejala-gejala adanya trias yaitu hipertensi,
edema dan proteinuria yang biasanya terjadi pada tri mester ketiga kehamilan
atau awal masa post partum, keadaan ini dapat terjadi sebelumnya kecuali bila
ada hubungannya dengan molahydatidosa. Sedangkan eklampsia adalah jika telah
disertai gangguan pada susunan saraf pusat yang menimbulkan kejang dan koma.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">B.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">ETIOLOGI
& PATOFISIOLOGI<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Penyebab
pasti belum diketahui, teori yang dewasa ini banyak dikemukakan sebagai
penyebab pre eklampsi adalah iskemia plasenta atau kurangnya sirkulasi oksigen
ke dalam plasenta. Factor predisposisi untuk terjadinya pre eklampsi adalah :<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Diabetes
mellitus <o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">2.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Gangguan
ginjal kronik<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">3.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Hipertensi<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">5.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Polyhydramnion<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">6.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Molahydatidosa<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">7.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Hydropsfetalis<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">8.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Kehamilan
remaja (adolescence)<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">9.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Primi gravid
tua<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">10.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Kekurangan
gizi atau makanan yang dapat menyebabkan pre eklamsia<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman";">Pre eklampsia berhubungan dengan
implantasi abnormal placenta dan invasi dangkal tromboblastik yang mengakibatkan
berkurangnya perfusi placenta. Arteri spiralis maternal (arteri uterine)
gagal mengalami vasodilatasi fisiologis, sehingga aliran darah mengalami
hambatan. Gangguan aliran darah intervilosa berakibat ischemia dan hipoksia.
Tanda dan gejala muncul selama kehamilan trimester kedua. <o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman";">Pada pre eklampsi terdapat penurunan
plasma dalam sirkulasi dan terjadi peningkatan hematokrit, dimana perubahan
pokok pada pre eklampsi yaitu mengalami spasme pembuluh darah perlu adanya
kompensasi hipertensi (suatu usaha untuk mengatasi kenaikan tekanan perifer
agar oksigenasi jaringan tercukupi).</span></div>
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<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman";">Dengan adanya spasme pembuluh darah
menyebabkan perubahan-perubahan ke organ antara lain :<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman";">Otak <o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman";">resistensi pembuluh darah ke otak
meningkat akan terjadi edema yang menyebabkan kelainan serebral bisa
menimbulkan pusing dan kelainan visus pada mata.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">2.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman";">Ginjal <o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman";">Terjadi spasme arteriole glomerulus
yang menyebabkan aliran darah ke ginjal berkutang maka terjadi filtrasi
glomerulus negatif, dimana filtrasi natrium lewat glomerulus mengalami
penurunan sampai dengan 50 % dari normal yang mengakibatkan retensi garam dan air,
sehingga terjadi oliguri dan edema<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">3.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman";">URI <o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman";">Dimana aliran darah plasenta menurun
yan gmenyebabkan gangguan plasenta maka akan terjadi IUGR, oksigenisasi
berkurang sehingga akan terjadi gangguan pertumbuhan janin, gawat janin, serta
kematian janin dalam kandungan.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">4.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman";">Rahim <o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman";">Tonus otot rahim peka rangsang
terjadi peningkatan yang akan menyebabkan partus premature<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">5.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman";">Paru-paru<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman";">Dekompensasi cordis yang akan
menyebabkan edema paru dsehingga oksigenasi terganggu dan cyanosis akan terjadi
gangguan pola nafas. Juga mengalami aspirasi paru/abses paru yang bisa
menyebabkan kematian.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">6.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman";">Hepar <o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman";">Penurunan perfusi ke hati dapat
mengakibatkan edema hati dan perdarahan subskapular sehingga sering menyebabkan
nyeri episgastrium, serta ikterus.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">C.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">PATOLOGI<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Perubahan
pokok yang didapat pada pre eklamsia adalah spasmus pembuluh darah disertai
dengan retensi garam dan air. Kenaikan berat badan dan edema yang disebabkan
oleh penimbunan cairan yang berlebihan dalam ruang interstisial belum diketahui
penyebabnya. Telah diketahui bahwa pada pre eklamsi dijumpai kadar aldosteron
yang rendah dan konsentrasi prolaktin yang tinggi dari pada kehamilan yang
normal. Aldosteron penting untuk mempertahankan volume plasma dan mengatur
retensi air dan natrium. Pada pre eklamsia permeabilitas pembuluh darah meningkat.
Menurunnya aliran darah ke plasenta mengakibatkan gangguan fungsi plasenta.
Pada hipertensi yang agak lama pertumbuhan janin terganggu, pada hipertensi
yang lebih pendek bisa terjadi gawat janin sampai kematiannya karena kekurangan
oksigen.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Fungsi
ginjal pada pre eklamsi agak menurun bila dilihat dari uric acid. Filtrasi
glomerolus dapat turun sampai 50% dari normal, sehingga dapat menyebabkan
dieresis turun. Pada keadaan lanjut dapat terjadi oliguri dan anuri. Pada pre
eklamsi tampak adanya edema retina, spasmus setempat atau menyeluruh pada satu
atau beberapa arteri, jarang terlihat adanya perdarahan atau eksudat. Kematian
pada wanita pre eklamsi biasa disebabkan edema paru. Ini disebabkan karena
adanya dekompensasi kordis, bisa terjadi pula karena aspirasi pneumonia, kadang
ditemukan abses.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">D.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">GAMBARAN
KLINIS<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Tanda-tanda
objektif pre eklamsia adalah sebagai berikut :<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Hipertensi<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">2.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Edema <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l6 level1 lfo5; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">3.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Proteinuria<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l6 level1 lfo5; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">4.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Gejala
subjektif yang ditemukan antara lain :<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l6 level1 lfo5; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">5.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Sakit kepala
yangkeras karena vasopasmus atau edema otak<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l6 level1 lfo5; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">6.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Sakit ulu
hati karena regangan selaput hati oleh hemoragik atau edema atau perubahan pada
lambung.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 18.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">7. Gangguan
penglihatan yang disebabkan oleh vasopasmus, edema atau ablasio retina.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;"> <o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">E. KLASIFIKASI PRE
EKLAMSIA<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">1. pre eklamsia ringan.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">a. kenaikan
tekanan darah sistolik 30 mm Hg atau lebih tekanan diastolic 15 mm Hg<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">b.
pertambahan berat badan lebih dari 1,4 kg dalam seminggu trimester kedua, lebih
0,5 dalam trimester ketiga atau penambahan yang terjadi 2 kg perminggu dalam
beberapa waktu.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">c. proteinuria
1 mg dalam 24 jam atau lebih dari 1 gr/L<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">d. edema
tergantung pada kedua kelopak mata, wajah, jari-jari, tidak ada pergerakan kaki<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">e. output
berlawanan dengan intake output kurang dari 400 cc/24 jam <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">f. adanya
sakit kepala<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">g.
iritabilitas ringan<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">h. kreatinin
serum normal<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">i. elevasi
SGOT minimal sedangkan efek pada janin perfusi plasental<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">j. plasenta
tua pada premature<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">2. pre eklamsia berat <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">a. tekanan
darah meningkat menjadi 160/110 mm Hg atau lebih pada 2-6 jam dengan ibu hamil
dalam bedrest.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">b. Kenaikan
berat badan terjadi 2 kg minggu pada beberapa minggu <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">c.
proteinuria 5-10 gr/L dalam24 jam <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">d. edema
-2terjadi secara menyeluruh pada kelopak mata, wajah, jari-jari<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">e.
hiperfleksia -3 atau lebih<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">f. sakit
kepala yang berat<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">g. pandangan
kabur<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">h. photo
pobia<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">i. spasmus
arteri retina<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">j. output
kurang dari 100 cc/24 jam<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">k.
iritabilitas berat <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">l.
trombositopenia ada tanda-tanda peningkatan SGOT<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">m. perfusi
plasental : fungsi menurun ,denyut
jantung janin kecil dan lambat<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">n. plasenta
tua pada premature<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">o. pada
pengeluaran plasenta ternyata tidak sesuai dengan tuanya kehamilan, plasenta
lebih kecil dari ukuran normal.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<br /></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">F. PROGNOSA<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Prognosa
tergantung dari tingkat penyakit ini, pre eklamsi jarang menyebabkan kematian
ini. Dinegara maju kematian karena pre eklamsi kurang kebih 0,5 %. Akan tetapi
apabia terjadi eklamsia prognosa menjadi kurang baik, kematian pada eklamsia
adalah 5 %<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<br /></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">G. PENCEGAHAN<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">1.
pemeriksaan antenatal yang teratur dan teliti dapat menemukan tanda-tanda dini
pre eklamsia dan dalam hal ini harus dilakukan penanganan semestinya.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">2.
penerangan tentang manfaat istirahat dandiet berguna dalam pencegahan diet
tinggi protein, rendah lemak, karbohidrat dan penambahan berat badan yang
berlebih perlu diperhatikan <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">3. mengenal
secara dini tanda pre eklamsia dan merawatnya.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<br /></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">H. PENATALAKSANAAN<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">1. tujuan penanganan
adalah :<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">a. mencegah
terjadinya pre eklamsia berat dan eklamsia <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">b.
melahirkan janin hidup <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">c.
melahirkan janin dengan trauma sekecil-kecilnya.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">d. mencegah
hipertensi menetap<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">2. dasar pengobatan
pada pre eklamsia adalah :<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">a. istirahat<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">b. diet <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">c. sedatif<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">d. obat-obat
anti hipertensi<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">e. induksi
persalinan <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">3. penatalaksanaan pada
pre eklamsia ringan adalah :<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">a. istirahat
ditempat tidur<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">b. In<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">c. diet
tinggi protein <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">d. lakukan
monitor keadaan janin<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">e. timbang
berat badan<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">f. pemberian
penobarbitol 3x30 mg sehari<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">4. penatalaksanaan pada
pre eklamsia dalam ruang isolasi<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">a. istirahat
mutlak tempatkan dalam ruang isolasi<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">b. diet
tiggi protein dan rendah garam<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">c. berikan
suntikan sulfas magnesium 8 m, 8gr
intramuscular, 4 gr bokong kanan dan 4
gr bokong kiri.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">d. infuse
dextrose 5 % dan RI<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">e. obat anti
hipertensi<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">f. diuretika
tidak diberikan, kecuali terdapat edema umum, edema paru dan kegagalam jantung
kongestif<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">g. induksi
partus tanpa atau dengan amniostomi<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">h. kala II
harus dipersingkat dengan ekstra vakum
atau foreef<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">i. jangan
beri metergin kecuali jika ada perdarahan <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">j. bila ada
indikasi lakukan section caesaria<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">5. penanganan pada
eklamsia adalah :<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">a. lindungi
pasien dari injuri<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">b. hentikan
kejang dengan obat-obatan, misalnya magnesium sulfate, valium dan amobarbitol
sodium.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">c.
memperbaiki diuresis dengan memberikan infus glucose 5 % sampai 10 %<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">d.
mengusahakan supaya oksigen cukup dengan mempertahankan jalan napas<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<br /></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<b><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Asuhan
keperawatan <o:p></o:p></span></b></div>
<div class="MsoNoSpacing" style="margin-left: 31.5pt; mso-list: l8 level1 lfo1; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Pengkajian <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 72.0pt; mso-list: l4 level1 lfo7; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">a.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Hal-hal
perlu dikaji pada ibu hamil dengan pre eklamsi adalah <o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Riwayat kesehatan <o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Apakah primi gravid<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Lebih banyak terjadi pada usia kurang dari 20
tahun dan lebih dari 35 tahun<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Adakah penyakit hipertensi dalam keluarga<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Berat badan, kegemukan atau kurang gizi <o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Adakah riwayat penyakit gagal ginjal kronik<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Adakah kelurga yang menderita hipertensi dalam
kehamilan<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Adakah sakit kepala atau vertigo<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Adakah gangguan penglihatan seperti penglihatan
kabur<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Adakah sakit pada ulu hati, mual dan muntah<o:p></o:p></span></div>
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<br /></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">b.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Riwayat
obstetric<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Pernahkah melahirkan kembar<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Riwayat yang lalu dari penyebab hipertensi pada
kehamilan<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Hydramnion<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Molahydatidosa <o:p></o:p></span></div>
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<br /></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">c.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Pemeriksaan
fisik<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 72.0pt; mso-list: l5 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Tekanan darah, nadi dan pernapasan<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Tekanan darah 140/90 mm Hg atau selisih tekanan
sistolik 30 mm Hg dan tekanan diastolic 15 mm Hg<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Terdapat edema<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Adanya edema minimal ditemukan pada sekitar
tibia<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Edema pada extremitas bawah<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Edema pada tangan, muka, dinding abdomen dan
daerah saecrum<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Adanya peningkatan berat badan yang tiba-tiba <o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Kulit lembab warna kepucatan <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 72.0pt; mso-list: l5 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Irama nadi tidak teratur<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Eliminasi buang air kecil adanya proteinuria,
penurunan output ginjal, adanya oliguria yaitu pengeluaran urine kurang dari 30
ml/hari<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 72.0pt; mso-list: l5 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Apakah penglihatan kabur, sakit kepala, nyeri
ulu hati<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Berikan hipereflesia<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: 72.0pt; mso-list: l4 level1 lfo7; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">d.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Pemeriksaan
penunjang<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 54.0pt; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Pemeriksaan
penunjang antara lain : pada pre eklamsia ringan adalah urin lengkap, sedangkan
pada pre eklamsia berat atau eklamsia adalah hemoglobin. Hematokrit, urin
lengkap, asam urat darah , trombosit, fungsi hat dan fungsi ginjal.<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Data
yang diperoleh dari pemeriksaan tersebut adalah sebagai berikut :<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Proteinuria <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">1
+ : 30
mg/dl<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">2
+ : 100
mg/dl<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">3
+ : 300
mg/dl<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">4
+ : 2000
mg/dl<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 72.0pt; mso-list: l5 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Serum protein total dan albumin menurun<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 72.0pt; mso-list: l5 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Hematokrit meningkat<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Asam urat meningkat<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 72.0pt; mso-list: l5 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Blood urea nitrogen (BUN) meningkat<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 72.0pt; mso-list: l5 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Creatinin meningkat<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 72.0pt; mso-list: l5 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Serum glutamic oxaloacetic transaminase (SGOT)
dan lactic dehidrogenase meningkat<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 72.0pt; mso-list: l5 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Bilirubin meningkat<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 72.0pt; mso-list: l5 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Waktu pembekuan darah menurun <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 72.0pt; text-align: justify;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: 31.5pt; mso-list: l8 level1 lfo1; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Diagnosa
keperawatan <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Diagnosa
keperawatan dapat dirumuskan berdasarkan anallisa data yang diperoleh melalui
pengkajian.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Beberapa
diagnose keperawatan yang dapat terjadi pada pasien pr eklamsia atau eklamsi
antara lain :<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo8; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">a.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Potensial
bahaya fisik bagi ibu sehubungan dengan disfungsi organ akibat vasospasmus dan
peningkatan tekanan darah<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo8; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">b.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Potensial
bahaya bagi janin sehubungan dengan merunnya perfusi plasental <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo8; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">c.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Kurangnya
pengetahuan tentang pre eklamsia dan resikonya bagi ibu<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo8; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">d.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Kurangnya
pengetahuan tentang dat yang ditentukan<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo8; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">e.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Volume
cairan lebih dari normal. Edema sehubungan dengan retensi garam dan air<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo8; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">f.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Perubahan
nutrisi kurang dari yang dibutuhkan tubuh sehubungan dengan factor kontribusi
yang berkurang akibat diet rendah protein dan kalori <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo8; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">g.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Menurunnya
perfusi jaringan tubuh sehubungan dengan adanya vasospasme menyeluruh<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo8; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">h.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Cemas
terhadap kelangsungan janin yang dikandung sehubungan dengan efek dan dampak
dari penyakitnya <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l0 level1 lfo8; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">i.<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Intoleransi terhadap aktivitas sehubungan
dengan dampak dari penyakitnya<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<br /></div>
<div align="center" class="MsoNoSpacing" style="text-align: center;">
<b><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">RENCANA ASUHAN KEPERAWATAN <o:p></o:p></span></b></div>
<div align="center">
<table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-bottom-style: none; border-collapse: collapse; border-color: initial; border-image: initial; border-left-style: none; border-right-style: none; border-top-style: none; border-width: initial; margin-left: -4.05pt; width: 679px;">
<tbody>
<tr>
<td style="border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 36.45pt;" width="49">
<div align="center" class="MsoNoSpacing" style="text-align: center;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">NO.<o:p></o:p></span></div>
</td>
<td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 182.05pt;" width="243">
<div align="center" class="MsoNoSpacing" style="text-align: center;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">DIAGNOSA
KEPERAWATAN<o:p></o:p></span></div>
</td>
<td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 110.45pt;" width="147">
<div align="center" class="MsoNoSpacing" style="text-align: center;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">TUJUAN<o:p></o:p></span></div>
</td>
<td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 180.0pt;" width="240">
<div align="center" class="MsoNoSpacing" style="text-align: center;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">RENCANA
TINDAKAN<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 36.45pt;" valign="top" width="49">
<div align="center" class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l2 level1 lfo9; text-align: center; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;"><o:p> </o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 182.05pt;" valign="top" width="243">
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Potensial bahaya
fisik bagi ibu sehubungan dengna disfungsi organ akibat peningakatan tekanan
darah<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 110.45pt;" valign="top" width="147">
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Mengenal tanda-tanda
awal penyebab peningkatan tekanan darah <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 180.0pt;" valign="top" width="240">
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- Monitor tekanan darah <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- menjamin agar
posisi pasien tetap untuk beberapa saat pada waktu tekanan darah diukur<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- lakukan pemeriksaan
terhadap respon yang beresiko pada primi gravida pada kehamilan 28 sampai 32
pekan <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- monitor adanya
proteinuria<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- monitor adanya
edema patologik, khususnya pada tangan dan muka yang ditemukan pada
pemeriksaan fisik<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<br /></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 36.45pt;" valign="top" width="49">
<div align="center" class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l2 level1 lfo9; text-align: center; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">2.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;"><o:p> </o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 182.05pt;" valign="top" width="243">
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Potensial bahaya
fisik bagi janin sehubungan dengan merunnya perfusi plasental<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 110.45pt;" valign="top" width="147">
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Mengenal perubahan
kondisi pasien <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 180.0pt;" valign="top" width="240">
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- kaji tundus uteri yang berhubungan dengan
haid terakhir ibu dan data tafsiran persalinan. Kaji aktivitas janin<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- bantu dengan
pemeriksaan ultrasonografi <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- lakukan pemeriksaan
serial pada plasma ibu atau urina esteriol dan human plasental lactogen<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<br /></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 36.45pt;" valign="top" width="49">
<div align="center" class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l2 level1 lfo9; text-align: center; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">3.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;"><o:p> </o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 182.05pt;" valign="top" width="243">
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Kurangnya pengetahuan
ibu sehubungan dengan pre eklamsia dan resikonya bagi ibu<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 110.45pt;" valign="top" width="147">
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Ibu mengerti tentang
proses penyakitnya dan cara pencegahannya<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 180.0pt;" valign="top" width="240">
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- kaji pengetahuan ibu tentang proses
penyakitnya <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- beri informasi yang
dibutuhkan meliputi : patofisiologi, pengertian, akibatnya bagi ibu dan janin
serta rasionalnya dari tindakan.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- beri informasi
tentang tanda dan gejala dari pre eklamsia<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- beri informasi
tentang status kesehatan ibu, hasil pemeriksaan dan kondisi janin.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- ajarkan pada pasien
tentang cara memonitor perkembangan<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 36.45pt;" valign="top" width="49">
<div align="center" class="MsoNoSpacing" style="margin-left: 36.0pt; mso-list: l2 level1 lfo9; text-align: center; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-family: Garamond; mso-fareast-font-family: Garamond;">4.<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;"><o:p> </o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 182.05pt;" valign="top" width="243">
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Kurangnya pengetahuan
tentang diit yang telah ditentukan<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 110.45pt;" valign="top" width="147">
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Pasien menerima dan
belajar mengikuti diit yang sebenarnya<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 180.0pt;" valign="top" width="240">
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- beri penjelasan
tentang diit yang dijalaninya<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- beri konseling
tentang nutrisi <o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 36.45pt;" valign="top" width="49">
<div align="center" class="MsoNoSpacing" style="text-align: center;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">5.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 182.05pt;" valign="top" width="243">
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Volume cairan lebih
dari normal : edema sehubungan dengan retensi garam dan air<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 110.45pt;" valign="top" width="147">
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Pasien akan
mendiskusikan adanya edema dan mau melaksanakan rencana pengobatan secara
rutin <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 180.0pt;" valign="top" width="240">
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- timbang berat badan setiap hari dan kaji
adanya edema <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- anjurkan pasien
untuk istirahat<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- ukur tekanan darah
tiap 1-4 hari dengan posisi lengan sama<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- pertahankan
pemberian garam yang normal (4-6 g/24 jam) <o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 36.45pt;" valign="top" width="49">
<div align="center" class="MsoNoSpacing" style="text-align: center;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">6.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 182.05pt;" valign="top" width="243">
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Perubahan nutrisi
kurang dari yang dibutuhkan tubuh sehubungan dengan faktor konstribusi yang
berkurang akibat diit rendah protein dan kalori<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 110.45pt;" valign="top" width="147">
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Pasien mengerti
tentang diitnya dan pertambahan berat badan<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 180.0pt;" valign="top" width="240">
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- kaji tentang status nutrisi, keadaan
rambut, kuku serta berat badan dan tinggi fundus uteri pada kehamilan<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- beri penjelasan
tentang pertambahan berat badan yang normal pada kehamilan<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- beri informasi
secara lisan maupun tulisan tentang fungsi protein dan hubungannya dengan pre
eklamsia<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- beri informasi
tentang efek dari istirahat <o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 36.45pt;" valign="top" width="49">
<div align="center" class="MsoNoSpacing" style="text-align: center;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">7.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 182.05pt;" valign="top" width="243">
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Menurunnya perfusi
jaringan tubuh sehubungan dengan adanya vasospasmus menyeluruh <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 110.45pt;" valign="top" width="147">
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Oksigenisasi kejaringan
adekuat dan dapat dipertahankan<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 180.0pt;" valign="top" width="240">
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- anjurkan pasien untuk melakukan posisi
miring kekiri saat istirahat<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- lakukan pengawasan
pada janin pasa saat dilakukan tes <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- monitor tanda-tanda
vital pasien<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- monitor tentang
intake dan output pasien <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- beri pengobatan
untuk menurunkan tekanan darah <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- monitor status
neurologik pasien <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- monitor pemberian
cairan intravena untuk mencegah aliran cairan yang cepat <o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 36.45pt;" valign="top" width="49">
<div align="center" class="MsoNoSpacing" style="text-align: center;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">8.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 182.05pt;" valign="top" width="243">
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Cemas terhadap
kelangsungan janin yang dikandung sehubungan dengan efek dan dampak dari penyakitnya<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 110.45pt;" valign="top" width="147">
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Kecemasan pada pasien
dan keluarga dapat berkurang<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 180.0pt;" valign="top" width="240">
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- kaji tentang emosi, ketakutan dan kecemasan
pasien<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- beri support mental
dan sertakan keluarga<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 36.45pt;" valign="top" width="49">
<div align="center" class="MsoNoSpacing" style="text-align: center;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">9.<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 182.05pt;" valign="top" width="243">
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Intoleransi terhadap
aktivitas sehubungan dengan dampak dari penyakitnya<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 110.45pt;" valign="top" width="147">
<div class="MsoNoSpacing" style="text-align: justify;">
<br /></div>
</td>
<td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 180.0pt;" valign="top" width="240">
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- beri informasi tentang pentingnya istirahat<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- anjurkan pada
pasien untuk istirahat<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">- kaji keluarga
sebagai support sistem<o:p></o:p></span></div>
</td>
</tr>
</tbody></table>
</div>
<div class="MsoNoSpacing" style="text-align: justify;">
<br /></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">EVALUASI<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="text-align: justify;">
<br /></div>
<div class="MsoNoSpacing" style="margin-left: 72.0pt; mso-list: l5 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Ibu mampu menjelaskan tentang
preeclampsia-eklampsia, implikasi terhadap kehamilannya, penatalaksanaan
pengobatan, serta komplikasi yang mungkin terjadi.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="margin-left: 72.0pt; mso-list: l5 level1 lfo6; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Ibu tidak mengalami konvulsi eklamptik.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Ibu dan pemberi asuhan dapat melacak lebih awal
bila ada peningkatan keparahan penyakit, atau komplikasi dini yang mungkin
terjadi, sehingga tindakan pengobatan yang tepat dapat dilakukan.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 14.0pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Ibu melahirkan bayi yang sehat.<o:p></o:p></span></div>
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</span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">Kesejahteraan ibu dan bayi<o:p></o:p></span></div>
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<b><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">PENUTUP<o:p></o:p></span></b></div>
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<div class="MsoNoSpacing" style="margin-left: 31.5pt; mso-list: l8 level1 lfo1; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">KESIMPULAN
& SARAN<b><o:p></o:p></b></span></div>
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<b><span style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman";">Pre</span></b><b><span style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman";"> </span></b><b><span style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman";">e</span></b><b><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman";">k</span></b><b><span style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman";">lampsia</span></b><span style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman";"> dimulai pada kehamilan minggu
ke-20, sebagai akibat dari hipertensi. Berpengaruh pada ginjal dan pengeluaran
protein melalui urin, juga mempengaruhi otak, <b>pla</b></span><b><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman";">c</span></b><b><span style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman";">enta</span></b><b><span style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman";"> </span></b><span style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman";">dan hati (liver). Pada janin, <b>pre</b></span><b><span style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman";"> </span></b><b><span style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman";">e</span></b><b><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman";">k</span></b><b><span style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman";">lampsia</span></b><b><span style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman";"> </span></b><span style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman";">bisa menyebabkan berat badan lahir
rendah, keguguran, dan lahir prematur. Berdasarkan penelitian, <b>pre</b></span><b><span style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman";"> </span></b><b><span style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman";">eclampsia</span></b><span style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman";"> menjadi penyebab terbesar nomer 2 pada kasus keguguran atau
kematian janin. Gejala-gejala yang ditimbulkan berupa sering pusing,
penglihatan yang kabur dan sensitif terhadap sinar, juga <b>proteinuria </b>(protein
pada urin) pada pemerikaan </span><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman";">laboratorium</span><span style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman";"><br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--></span><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<span style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman";">Sejauh ini tidak ada penanganan khusus untuk <b>pre</b></span><b><span style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman";"> </span></b><b><span style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman";">e</span></b><b><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman";">k</span></b><b><span style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-bidi-font-style: italic; mso-fareast-font-family: "Times New Roman";">lampsia</span></b><b><span style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman";">,</span></b><span style="font-family: "Garamond","serif"; font-size: 14.0pt; mso-fareast-font-family: "Times New Roman";"> satu-satunya jalan adalah menjaga
kehamilan tetap sehat sehingga janin bisa lahir dengan selamat. Maka itu,
dianjurkan untuk calon ibu merencanakan kehamilannya. Selalu periksa tekanan
darah, sehingga selalu tetap normal dan tetap terkontrol, jauhi narkoba,
alkohol, dan rokok. Jika terpaksa harus mengkonsumsi obat, selalu konsultasikan
dengan dokter kandungan.<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;">DAFTAR
PUSTAKA<b><o:p></o:p></b></span></div>
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<span lang="EN-US" style="font-family: "Garamond","serif"; font-size: 14.0pt;"><br /></span></div>
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<!--[if !supportLists]--><span lang="EN-US">1.<span style="font-size: 7pt;"> <u>
</u></span></span><!--[endif]--><span lang="EN-US"><a href="http://ilmu-ilmukeperawatan.blogspot.com/2011/01/pre-eklampsi.html"><b><span style="color: black;">http://ilmu-ilmukeperawatan.blogspot.com/2011/01/pre-eklampsi.html</span></b></a></span><b><span lang="EN-US"><o:p></o:p></span></b></div>
<div class="MsoNoSpacing" style="margin-left: 49.5pt; mso-list: l9 level1 lfo10; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">2.</span><span lang="EN-US"><a href="http://stikesayaniyk.ac.id/attachments/article/76/ASUHAN%20KEPERAWATAN%20IBU%20HAMIL.pdf"><b><span style="color: black; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman"; mso-themecolor: text1;">http://stikesayaniyk.ac.id/attachments/article/76/ASUHAN%20KEPERAWATAN%20IBU%20HAMIL.pdf</span></b></a></span><b><span lang="EN-US"><o:p></o:p></span></b></div>
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<!--[if !supportLists]--><span lang="EN-US">3.<span style="font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US"><a href="http://www.bascommetro.com/2010/09/eklampsi-dan-pre-aklampsi.html"><b><span style="color: black; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman"; mso-themecolor: text1;">http://www.bascommetro.com/2010/09/eklampsi-dan-pre-aklampsi.html</span></b></a><o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US">4.<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span lang="EN-US">kelompok kerja keperawatan
(perawat Obstetri dan Ginekologi). <i>Standar
asuhan keperawatan obstetri dan ginekologi</i> : Bitung<o:p></o:p></span></b></div>
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<!--[if !supportLists]--><span lang="EN-US">5.<span style="font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US"><a href="http://www.site.stikesmuh-pkj.ac.id/d3-kebidanan/37-d3-kebidanan/96-standart-asuhan-klien-hipertensi-dalam-kehamilan.html"><b><span style="color: black; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: "Times New Roman"; mso-themecolor: text1;">http://www.site.stikesmuh-pkj.ac.id/d3-kebidanan/37-d3-kebidanan/96-standart-asuhan-klien-hipertensi-dalam-kehamilan.html</span></b></a></span></div>
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<!--[if !supportLists]--><span lang="EN-US">6.<span style="font-size: 7pt;">
</span></span><!--[endif]--><span lang="EN-US"><a href="http://www.googleteorikesehatan.com/"><b><span style="color: black; mso-themecolor: text1;">www.googleteorikesehatan.com</span></b></a><b><o:p></o:p></b></span></div>
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<!--[if !supportLists]--><span lang="EN-US">7.<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span lang="EN-US">Patricia
W.Ladewig,Marcial.London,SallyB.Olds,edisi 5,cetakan I 2006 <i>buku saku Asuhan Ibu & Bayi Baru Lahir</i>
EGC Medical Publisher<o:p></o:p></span></b></div>
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<!--[if !supportLists]--><span lang="EN-US">8.<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span lang="EN-US">NANDA,Nursing Diauperbidanhapsgnosis
and Classification,Philadelphia:lippincot<o:p></o:p></span></b></div>
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<!--[if !supportLists]--><span lang="EN-US">9.<span style="font-size: 7pt;">
</span></span><!--[endif]--><b><span lang="EN-US">Bagian Obstetri &
Ginekologi FK.Unpad,1993.Obstetri Fisiologi.Elemen Bandung<o:p></o:p></span></b></div>
<b><span style="font-family: Calibri, sans-serif; font-size: 11pt; line-height: 115%;">Carpenito,Lynda
Juall, 2001.buku saku diagnose keperawatan.edisi 8.EGC.Jakarta </span></b><br />salnihttp://www.blogger.com/profile/00126668517852477742noreply@blogger.com0Universitas Sam Ratulangi, Jalan Kampus Selatan, Manado, Indonesia1.455717 124.8271631.453733 124.8246955 1.457701 124.8296305tag:blogger.com,1999:blog-8321145958076225978.post-51749876788017479262012-03-15T23:33:00.000-07:002012-03-15T23:33:18.126-07:00REFLEKS BAYI<br />
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<span style="font-family: Arial, sans-serif;"><b><br /></b></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Refleks mengatur gerakan gerakan
bayi yang baru lahir. Sifat refleks ini adalah otomatis dan diluar kendali bayi
yang baru lahir tersebut. Refleks ini merupakan reaksi yang inheren (built in)
terhadap rangsangan tertentu dan bayi bayi kecil secara otomatis akan
memberikan respons penyesuaian diri terhadap lingkungan mereka, sebelum mereka
memiliki kesempatan untuk belajar lebih banyak<o:p></o:p></span></div>
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<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Beberapa
macam refleks pada bayi<o:p></o:p></span></b></div>
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<!--[if !supportLists]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Refleks moro
(moro reflex)</span></b></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Refleks moro
adalah suatu respon tiba tiba pada bayi yang baru lahir yang <o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">terjadi
akibat suara atau gerakan yangmengejutkan. Muncul sejak lahir, akan mereda 1
atau 2 minggu dan minghilang setelah 6 bulan.Ketika dikagetkan, bayi yang baru
lahir itu melengkungkan punggungnya, melemparkan kepalanya kebelakang, dan
merentangkan tangan dan kakinya.<o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Refleks moro adalah peninggalan
nenek moyang primate kita dan refleks ini merupakan upaya untuk mempertahankan
hidup. Refleks ini merupakan keadaan yang normal bagi semua bayi yang baru
lahir, juga cenderung menghilang pada usia 3 hingga 4 bulan. Sentuhan yang
lembut pada setiap bagian tubuh bayi akan menenangkan bayi yang sempat
terkejut. Memegang lengan bayi yang dilenturkan pada bahu akan menenangkan
bayi. <o:p></o:p></span></div>
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<br /></div>
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<br /></div>
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<!--[if !supportLists]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Refleks
menghisap (sucking reflex)</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif;"><br /></span></div>
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<br /></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Terjadi
ketika bayi yang baru lahir secara otomatis menghisap benda yang <o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">ditempatkan
di mulut mereka. Refleks menghisap memudahkan bayi yang baru lahir untuk
memperoleh makanan sebelum mereka mengasosiasikan puting susu dengan makanan.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 0cm; text-indent: 0cm;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Menghisap adalah refleks yang sangat
penting pada bayi. Refleks ini merupakan rute bayi menuju pengenalan akan
makanan. Kemampuan menghisap bayi yang baru lahir berbeda beda. Sebagian bayi
yang baru lahir menghisap dengan efisien dan bertenaga untuk memperoleh susu,
sementara bayi bayi lain tidak begitu terampil dan kelelahan bahkan sebelum
mereka kenyang.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 0cm; text-indent: 0cm;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Kebanyakan bayi yang baru lahir
memerlukan waktu beberapa minggu untuk mengembangkan suatu gaya menghisap yang
dikoordinasikan dengan cara ibu memegang bayi, cara susu keluar dari botol atau
payudara, serta dengan kecepatan dan temperamen bayi waktu menghisap. Refleks
menghisap adalah suatu contoh refleks yang muncul saat lahir dan kemudian akan
menghilang seiring dengan usia bayi. Paling kuat pada 4 bulan pertama dan
memudar setelah 6 bulan dan secara bertahap melebur dengan kegiatan yang
disadari.<o:p></o:p></span></div>
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<b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">2 Tahap Refleks menghisap :<o:p></o:p></span></b></div>
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<br /></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"> <b>Tahap
expression :</b> dilakukan pada saat puting susu diletakkan diantara bibir bayi
dan disentuhkan di permukaan langit-langitnya. Bayi akan secara langsung
menekan (mengenyot) puting dengan menggunakan lidah dan langit-langitnya untuk
mengeluarkan air susunya.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 0cm; text-indent: 0cm;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"> <b>Tahap
milking :</b> saat lidah bergerak dari areola menuju puting, mendorong air susu
dari payudara ibu untuk ditelan oleh bayi.<o:p></o:p></span></div>
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<!--[if !supportLists]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial; mso-fareast-language: IN;">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Refleks
menggenggam (grasping reflex)</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: Arial, sans-serif;"><br /></span></div>
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<br /></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Refleks
menggenggam tejadi ketika sesuatu menyentuh telapak tangan bayi. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 0cm; text-indent: 0cm;">
<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Bayi akan
merespons dengan cara menggenggamnya kuat kuat. Pada akhir bulan ketika,
refleks menggenggam berkurang dan bayi memperlihatkan suatu genggaman yang
lebih spontan, yang sering dihasilkan dari rangasangan visual. Misalnya, ketika
bayi melihat suatu gerakan yang berputar diatas tempat tidurnya, ia akan meraih
dan mencoba menggenggamnya. Ketika perkembangan motoriknya semakin lancar, bayi
akan menggenggam benda benda, menggunakannya secara hati hati, dan mengamati
benda benda tersebut. Biasanya reflek ini menghilang sekitar 3-4 bulan.<o:p></o:p></span></div>
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<br /></div>
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<!--[if !supportLists]--><span class="apple-converted-space"><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: Arial;">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;"> </span></span></b></span><!--[endif]--><b><i><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;">Reflek Babinsky</span></i></b><span class="apple-converted-space"><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"> </span></b></span><span class="apple-converted-space"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></span></div>
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<span style="font-family: Arial, sans-serif;"><br /></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"> Reflek babinsky muncul sejak lahir
dan berlangsung hingga kira-kira satu tahun. Reflek ini ditunjukkan pada saat
bagian samping telapak kaki digosok, dan menyebabkan jari-jari kaki menyebar
dan jempol kaki ekstensi. Reflek disebabkan oleh kurangnya myelinasi traktus
corticospinal pada bayi. Reflek babinsky juga merupakan tanda abnormalitas
saraf seperti lesi neuromotorik atas pada orang dewasa.</span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Dapat
berlanjut hingga 8 bulan, dan menghilang setelah 9-12 bulan.</span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-language: AR-SA; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;"><br clear="all" style="mso-special-character: line-break; page-break-before: always;" />
</span>
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<span style="font-family: Arial, sans-serif;"><b><br /></b></span></div>salnihttp://www.blogger.com/profile/00126668517852477742noreply@blogger.com0tag:blogger.com,1999:blog-8321145958076225978.post-37392195729865423112012-03-14T10:00:00.000-07:002012-03-14T10:00:25.666-07:00ASKEP IDIOPATHIC THROMBOCYTOPENIC PURPURA ( ITP )<div class="separator" style="clear: both; text-align: left;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Disusun oleh Kelompok II KMB 02 Kelas A2 PSIK FK UNSRAT MANADO</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br />
</span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">A. PENGERTIAN </span></div><div class="separator" style="clear: both; text-align: left;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br />
</span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjnNrwB6nUKR6cTCKKZbV9JZoRP8OclGcVM8nM-wKevfNnHBtynOcm0qYvj9ZDsukftaZLwqBSTRu_Z8-MXHLjh-oz2mDMMpds6bKqBvjfqn5R7CNAp31FR_MkqLZF72rUY64zBfOBUbRM/s1600/itp.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjnNrwB6nUKR6cTCKKZbV9JZoRP8OclGcVM8nM-wKevfNnHBtynOcm0qYvj9ZDsukftaZLwqBSTRu_Z8-MXHLjh-oz2mDMMpds6bKqBvjfqn5R7CNAp31FR_MkqLZF72rUY64zBfOBUbRM/s200/itp.jpg" width="200" /></span></a></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 14.2pt; text-align: justify; text-indent: -24px;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 24px;"><b><br />
</b></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 14.2pt; mso-add-space: auto; text-align: justify; text-indent: 36.0pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">ITP adalah jenis trombositopenia berat yang dapat mengancam kehidupan dengan jumlah trombosit < 10.000 mm3 yang ditandai dengan mudahnya timbul memar serta perdarahan subkutaneus yang multiple. Biasanya penderita menampakkan bercak-bercak kecil berwarnan ungu. Karena jumlah trombosit sangat rendah, maka pembentukan bekuan tidak memadai dan konstriksi pembuluh yang terlukan tidak adekuat.</span><span style="line-height: 150%;"><o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 14.2pt; mso-add-space: auto; text-align: justify; text-indent: 36.0pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">ITP adalah suatu keadaan perdarahan berupa petekie/ekimosis di kulit maupun selaput lendir dan berbagai jaringan deng</span><span style="line-height: 150%;">an</span><span style="line-height: 150%;"> <span lang="EN-US">penurunan jumlah trombosit karena sebab yang tidak diketahui.</span></span><span style="line-height: 150%;"><o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 14.2pt; mso-add-space: auto; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Purpura Trombositopenia Idiopatika adalah suatu kelainan yang didapat, yang ditandai oleh trombositopenia, purpura, dan etiologi yang tidak jelas.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 14.2pt; mso-add-space: auto; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br />
</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: left; text-indent: 60px;"><span style="line-height: 150%; text-indent: -18pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>B.</b> <b>ETIOLOGI</b></span></span></span></div><div class="MsoListParagraphCxSpFirst" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; mso-add-space: auto; text-align: justify; text-indent: 36.0pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Sampai saat ini penyebab dari ITP belum dapat diketahui dengan pasti. Ada yang menyebutkan bahwa ITP pada anak-anak biasanya didahului oleh infeksi virus. Namun dalam beberapa tahun belakangan ini telah ditemui bahwa pada kebanyakan penderita tersebut terdapat antibodi spesidik yang menghancurkan trombosit. Kadang-kadang peristiwa ini terjadi setelah transfusi, teapi biasanya sebagai akibat dari efek autoimun terhadap trombosit sendiri, yang sebabnya belum diketahui</span><span style="line-height: 150%;"><o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; mso-add-space: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; mso-add-space: auto; text-align: justify;"><span style="line-height: 18px;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br />
</span></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b><span lang="EN-US" style="line-height: 150%;">C.<span style="font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="EN-US" style="line-height: 150%;">EPIDEMOLOGI<o:p></o:p></span></b></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify; text-indent: 54.0pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Ada dua tipe ITP berdasarkan kalangan penderita. Tipe pertama umumnya menyerang kalangan anak-anak, sedangkan tipe lainnya menyerang orang dewasa. Anak-anak berusia 2 hingga 4 tahun yang umumnya menderita penyakit ini. Sedangkan ITP untuk orang dewasa, sebagian besar dialami oleh wanita muda, tapi dapat pula terjadi pada siapa saja. ITP bukanlah penyakit keturunan. (Family Doctor, 2006). <o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify; text-indent: 54.0pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ITP juga dapat dibagi menjadi dua, yakni akut ITP dan kronik ITP. Batasan yang dipakai adalah waktu jika dibawah 6 bulan disebut akut ITP dan diatas 6 bulan disebut kronik ITP. Akut ITP sering terjadi pada anak-anak sedangkan kronik ITP sering terjadi pada dewasa. (Imran, 2008)<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify; text-indent: 54.0pt;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; text-align: center;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b><span lang="EN-US" style="line-height: 150%;">Tabel Perbedaan ITP akut dengan ITP kronik</span></b><span lang="EN-US" style="line-height: 150%;"><o:p></o:p></span></span></div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; text-align: center;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">(Bakta, 2006; Mehta, et. al, 2006)<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 18.0pt;"><br />
</div><div align="center"> <table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; margin-left: 57.45pt; mso-padding-alt: 0cm 0cm 0cm 0cm; mso-yfti-tbllook: 1184;"><tbody>
<tr> <td style="border-bottom: windowtext; border-left: white; border-right: windowtext; border-style: solid; border-top: white; border-width: 1.0pt; mso-border-bottom-alt: windowtext 1.0pt; mso-border-left-alt: white .5pt; mso-border-left-themecolor: background1; mso-border-left-themecolor: background1; mso-border-right-alt: windowtext 1.0pt; mso-border-style-alt: solid; mso-border-top-alt: white .5pt; mso-border-top-themecolor: background1; mso-border-top-themecolor: background1; padding: 0cm 5.4pt 0cm 5.4pt; width: 144.3pt;" valign="top" width="192"></td> <td style="border-left: none; border: solid windowtext 1.0pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 108.0pt;" valign="top" width="144"> <div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: center; text-indent: 18.0pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ITP akut<o:p></o:p></span></span></div></td> <td style="border-left: none; border: solid windowtext 1.0pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 122.2pt;" valign="top" width="163"> <div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: center; text-indent: 18.0pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ITP kronik<o:p></o:p></span></span></div></td> </tr>
<tr> <td style="border-top: none; border: solid windowtext 1.0pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 144.3pt;" valign="top" width="192"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Awal penyakit<o:p></o:p></span></span></div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; padding: 0cm 5.4pt 0cm 5.4pt; width: 108.0pt;" valign="top" width="144"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: .9pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">2-6 tahun<o:p></o:p></span></span></div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; padding: 0cm 5.4pt 0cm 5.4pt; width: 122.2pt;" valign="top" width="163"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; tab-stops: 139.5pt; text-align: justify; text-indent: .75pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">20-40 tahun<o:p></o:p></span></span></div></td> </tr>
<tr> <td style="border-top: none; border: solid windowtext 1.0pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 144.3pt;" valign="top" width="192"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Rasio L:P<o:p></o:p></span></span></div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; padding: 0cm 5.4pt 0cm 5.4pt; width: 108.0pt;" valign="top" width="144"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: .9pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">1:1<o:p></o:p></span></span></div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; padding: 0cm 5.4pt 0cm 5.4pt; width: 122.2pt;" valign="top" width="163"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; tab-stops: 139.5pt; text-align: justify; text-indent: .75pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">1:2-3<o:p></o:p></span></span></div></td> </tr>
<tr> <td style="border-top: none; border: solid windowtext 1.0pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 144.3pt;" valign="top" width="192"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Trombosit<o:p></o:p></span></span></div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; padding: 0cm 5.4pt 0cm 5.4pt; width: 108.0pt;" valign="top" width="144"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: .9pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><20.000/mL<o:p></o:p></span></span></div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; padding: 0cm 5.4pt 0cm 5.4pt; width: 122.2pt;" valign="top" width="163"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; tab-stops: 139.5pt; text-align: justify; text-indent: .75pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">30.000-100.000/mL<o:p></o:p></span></span></div></td> </tr>
<tr> <td style="border-top: none; border: solid windowtext 1.0pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 144.3pt;" valign="top" width="192"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Lama penyakit<o:p></o:p></span></span></div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; padding: 0cm 5.4pt 0cm 5.4pt; width: 108.0pt;" valign="top" width="144"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: .9pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">2-6 minggu<o:p></o:p></span></span></div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; padding: 0cm 5.4pt 0cm 5.4pt; width: 122.2pt;" valign="top" width="163"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; tab-stops: 139.5pt; text-align: justify; text-indent: .75pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Beberapa tahun<o:p></o:p></span></span></div></td> </tr>
<tr> <td style="border-top: none; border: solid windowtext 1.0pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 144.3pt;" valign="top" width="192"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Perdarahan<o:p></o:p></span></span></div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; padding: 0cm 5.4pt 0cm 5.4pt; width: 108.0pt;" valign="top" width="144"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: .9pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Berulang<o:p></o:p></span></span></div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; padding: 0cm 5.4pt 0cm 5.4pt; width: 122.2pt;" valign="top" width="163"> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; tab-stops: 139.5pt; text-align: justify; text-indent: .75pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Beberapa hari/minggu<o:p></o:p></span></span></div></td> </tr>
</tbody></table></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify; text-indent: 54.0pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;"> </span><span lang="EN-US" style="line-height: 150%;"><o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b><span lang="EN-US" style="line-height: 150%;">D.<span style="font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="EN-US" style="line-height: 150%;">PATOLOGI DAN PATOFISIOLOGI ITP</span></b><b><span lang="EN-US" style="line-height: 150%;"><o:p></o:p></span></b></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 39.3pt; mso-add-space: auto; text-align: justify;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="apple-style-span"><b><span lang="EN-US" style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; line-height: 150%;">Patogenesis</span></b></span><span lang="EN-US" style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; line-height: 150%;"><br />
</span><span style="line-height: 150%;">1. </span><span lang="EN-US" style="line-height: 150%;">ITP akut :<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 57.3pt; mso-add-space: auto; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Proses alergi terhadap trombosit, megakariosit dan terhadap pembuluh darah.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 57.3pt; mso-add-space: auto; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Didapat antiplatelet aglutinin da atau lysin, akan tetapi sukar memperlihatkan aglutininl/lysin tersebut<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 57.3pt; mso-add-space: auto; mso-list: l2 level1 lfo3; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">2.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">ITP menahun <o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 57.3pt; mso-add-space: auto; text-align: justify; text-indent: 32.7pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Pengaruh hormonal memegang peranan pada tahap ini terutama terhadap terjadinya purpura dan trombositopenia sebelum menstruasi</span></span></div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: center;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="apple-style-span"><b><span lang="EN-US" style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; line-height: 150%;">Pato</span></b></span><span class="apple-style-span"><b><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; background-position: initial initial; background-repeat: initial initial; line-height: 150%;">fisiologi<o:p></o:p></span></b></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Diatas telah di singgung bahwa trombosit dapat dihancurkan oleh pembentukan antibodi yang diakibatkan oleh obat (seperti yang ditemukan pada kinidin dan senyawa emas) atau oleh autoantibodi (antibodi yang bekerja melawan jaringnnya sendiri).</span><span style="line-height: 150%;"><o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Antibodi tersebut menyerang trombosit sehingga lama hidup trombosit diperpendek. Seperti kita ketahui bahwa gangguan –gangguan autoimun yang bergantung pada antibodi manusia, palling sering menyerang unsur-unsur darah, terutama trombosit dan sel darah merah. Hal ini terkait dengan penyakit ITP, yang memiliki molekul-molekul IgG reaktif dalam sirkulasi dengan trombosit hospes.</span><span style="line-height: 150%;"><o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Meskipun terikat pada permuakaan trombosit, antibodi ini tidak menyebabkan lokalisasi protein komplemen atau lisis trombosit dalam sirkulasi bebas. Namun, trombosit yang mengandung molekul-molekul IgG lebih mudah dihilangkan dan dihancurkan oleh makrofag yang membawa reseptor membran untuk IgG dalam limpa dan hati.</span><span style="line-height: 150%;"><o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Manifestasi utama dari ITP dengan trombosit kurang dari 30.000/mm3 adalah tumbuhnya petechiae. Petechiae ini dapat muncul karena adanya antibodi IgG yang ditemukan pada membran trombosit yang akan mengakibatkan gangguan agregasi trombosit dan meningkatkan pembuangan serta penghancuran trombosit oleh sistem makrofag. Agregaasi trombosit yang terganggu ini akan menyebabkan penyumbatan kapiler-kapiler darah yang kecil. Pada proses ini dinding kapiler dirusak sehingga timbul perdarahan dalam jaringan</span><span style="line-height: 150%;"><o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Bukti yang mendukung mekanisme trombositopenia ini disimpulkan berdasarkan pemeriksaan pada penderita ITP dan orang-orang percobaan yang menunjukkan kekurangan trombosit berat tetapi singkat, setelah menerima serum ITP.</span><span style="line-height: 150%;"><o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Trombositopenia sementara, yang ditemukan pada bayi yang dilahirkan oleh ibu dengan ITP, juga sesuai dengan kerusakan yang disebabkan oleh IgG, karena masuknya antibodi melalui plasenta. ITP dapat juga timbul setelah infeksi, khususnya pada masa kanak-kanak, tetapi sering timbul tanpa peristiwa pendahuluan dan biasanya mereda setelah beberapa hari atau beberapa minggu.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 12.0pt; text-align: justify;"><b><span style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> Pencegahan</span></span></b></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Penyakit Idiopatik Trombositopeni Purpura (ITP) tidak dapat dicegah, tetapi dapat dicegah komplikasinya. Menghindari obat-obatan seperti aspirin atau ibuprofen yang dapat mempengaruhi platelet dan meningkatkan risiko pendarahan.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 36.0pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Lindungi dari luka yang dapat menyebabkan memar atau pendarahan. Lakukan terapi yang benar untuk infeksi yang mungkin dapat berkembang. Konsultasi ke dokter jika ada beberapa gejala infeksi, seperti demam. Hal ini penting bagi pasien dewasa dan anak-anak dengan ITP yang sudah tidak memiliki limfa.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: left; text-indent: 36pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;"><br />
</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: left; text-indent: 48px;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif; line-height: 150%; text-indent: -18pt;"><span lang="EN-US">E. <b>GEJALA DAN TANDA</b></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-indent: 54pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Bintik-bintik merah pada kulit (terutama di daerah kaki), seringnya bergerombol dan menyerupai rash. Bintik tersebut ,dikenal dengan petechiae, disebabkan karena adanya pendarahan dibawah kulit .<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-indent: 54pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Memar atau daerah kebiruan pada kulit atau membran mukosa (seperti di bawah mulut) disebabkan pendarahan di bawah kulit. Memar tersebut mungkin terjadi tanpa alasan yang jelas. Memar tipe ini disebut dengan purpura. Pendarahan yang lebih sering dapat membentuk massa tiga-dimensi yang disebut hematoma.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: 0.0001pt; text-indent: 54pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Hidung mengeluarkan darah atau pendarahan pada gusi. Ada darah pada urin dan feses. Beberapa macam pendarahan yang sukar dihentikan dapat menjadi tanda ITP. Termasuk menstruasi yang berkepanjangan pada wanita. Pendarahan pada otak jarang terjadi, dan gejala pendarahan pada otak dapat menunjukkan tingkat keparahan penyakit. Jumlah platelet yang rendah akan menyebabkan nyeri, fatigue (kelelahan), sulit berkonsentrasi, atau gejala yang lain. <o:p></o:p></span></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b><span lang="EN-US" style="line-height: 150%;">F. MANIFESTASI KLINIS<o:p></o:p></span></b></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 75.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">1.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">ITP akut :<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 93.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">o<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Hanya 16% yang betul-betul idiopatik<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 93.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">o<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Perdarahan dapat didahului oleh infeksi, pemberian obat-obatan atau menarche<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 93.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">o<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Pada permulaan perdarahan sangat hebat selain terjadi trombositopenia rusaknya megakariosit, juga terjadi perubahan pembuluh darah<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 93.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">o<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Sering terjadi perdarahan GIT, tuba falopi dan peritoneum<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 93.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">o<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Kelenjar lymphe, lien dan hepar jarang membesar<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 75.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">2.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">ITP menahun :<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 93.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">o<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Biasanya pada dewasa, terjadi beberapabulan sampai beberapa tahun, kadang menetap<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 93.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">o<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Permulaan tidak dapat ditentukan, ada riwayat perdarahan menahun, menstruasi yang lama<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 93.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">o<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Perdarahan relatif lebih ringan<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 93.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">o<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Jumlah trombosit 30.000-80.000/mm3<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 93.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">o<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Biasanya tanpa anemi, lekopeni dan splenomegali<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 93.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">o<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Penghancuran trombosit lebih dari normal<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 93.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">o<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Sering terjadi relaps dan remisi yang berulang-ulang<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 93.3pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 75.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">3.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">ITP recurrent<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 93.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">o<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Diantaranya episode perdarahan, trombosit normal dan tak ada purpura/petechiae dan masa hidup trombosit norma<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 93.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">o<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Hasil pengobatan dengn kortikosteroid baik<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 93.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">o<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Kadang tanpa pengobatan, dapat sembuh sendiri<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 93.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">o<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Remisi berkisar bebrapa minggu sam pai 6 bulan<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 75.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">4.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">ITP siklik<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 93.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">o<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Menstruasi hebat pada wanita. Secara umum, gambaran klinis ITP adalah :<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 111.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">·<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Adanya petechiae, echymose atau perdarahan <o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 111.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">·<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Trombositopenia<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 111.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">·<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Megakariosit dalam sumsum tulang normal / bertambah dengan morfologi abnormal<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 111.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">·<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Splenomegali atau tidak<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-indent: 54pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="margin-bottom: 0.0001pt; text-indent: -18pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US">G. </span><b style="line-height: 150%;"><span lang="EN-US" style="line-height: 150%;">PEMERIKSAAN PENUNJANG</span></b><b style="line-height: 150%;"><span lang="EN-US" style="line-height: 150%;"><o:p></o:p></span></b></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 42.6pt; text-indent: 14.7pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Pemeriksaan laboratorium yang dapat dilakukan adalah :<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 75.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">1.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Pada pemeriksaan darah lengkap. Pada pemeriksaan ini ditemukan bahwa : <o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 93.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">o<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Hb sedikit berkurang, eritrosit normositer, bila anemi berat hypochrome mycrosyter.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 93.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">o<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Lekosit meninggi pada fase perdarahan dengan dominasi PMN.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 93.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">o<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Pada fase perdarahan, jumlah trombosit rendah dan bentuknya abnormal.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 93.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">o<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Lymphositosis dan eosinofilia terutama pada anak<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 75.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">2.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Pemeriksaan darah tepi.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 39.3pt; text-indent: 32.7pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Hematokrit normal atau sedikit berkurang<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 75.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">3.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Aspirasi sumsum tulang<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-indent: 32.7pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Jumlah megakaryosit normal atau bertambah, kadang mudah sekali morfologi megakaryosit abnormal (ukuran sangat besar, inti nonboluted, sitoplasma berfakuola dan sedikit atau tanpa granula).</span><span style="line-height: 150%;"><o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-indent: 32.7pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Hitung (perkiraan jumlah) trombosit dan evaluasi hapusan darah tepi merupakan pemeriksaan laboratorium pertama yang terpentong. Karena dengan cara ini dapat ditentukan dengan cepat adanya trombositopenia dan kadang-kadang dapat ditentukan penyebabnya.</span><span style="line-height: 150%;"><o:p></o:p></span></span></div><div align="center" class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: center;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br />
</span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l39 level1 lfo1; text-indent: -18.0pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b><span lang="EN-US" style="line-height: 115%;">H TERAPI<o:p></o:p></span></b></span></div><div class="MsoListParagraphCxSpLast" style="margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 36pt; margin-right: 0cm; margin-top: 0cm; text-indent: 54pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Terapi ITP lebih ditujukan untuk menjaga jumlah trombosit dalam kisaran aman sehingga mencegah terjadinya pendarahan mayor. Selain itu, terapi ITP didasarkan pada berapa banyak dan seberapa sering pasien mengalami pendarahan dan jumlah platelet. Terapi untuk anak-anak dan dewasa hampir sama. Kortikosteroid (ex: prednison) sering digunakan untuk terapi ITP. kortikosteroid meningkatkan jumlah platelet dalam darah dengan cara menurunkan aktivitas sistem imun. Imunoglobulin dan anti-Rh imunoglobulin D. Pasien yang mengalami pendarahan parah membutuhkan transfusi platelet dan dirawat dirumah sakit .</span><span style="line-height: 150%;"><o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 36pt; margin-right: 0cm; margin-top: 0cm; text-indent: 54pt;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 36pt; margin-right: 0cm; margin-top: 0cm; text-indent: 54pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Terapi awal ITP (standar) :<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 36pt; margin-right: 0cm; margin-top: 0cm;"><i><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Prednison<o:p></o:p></span></span></i></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 36pt; margin-right: 0cm; margin-top: 0cm; text-indent: 49.5pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Terapi awal prednisoon atau prednison dosis 0,5-1,2 mg/kgBB/hari selama 2 minggu. respon terapi prednison terjadi dalam 2 minggu dan pada umumnya terjadi dalam minngu pertama, bila respon baik dilanjutkan sampai 1 bulan, kemudian tapering.<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 36pt; margin-right: 0cm; margin-top: 0cm;"><i><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Imunoglobulin intravena (IgIV)<o:p></o:p></span></span></i></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 36pt; margin-right: 0cm; margin-top: 0cm; text-indent: 54pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Imunoglobulin intravena dosis 1g/kg/hr selam 2-3 hari berturut-turutndigunakan bila terjadi pendarahan internal, saat AT(antibodi trombosit) <5000/ml meskipun telah mendapat terapi kortikosteroid dalam beberapa hari atau adanya purpura yang progresif. Pendekatan terapi konvensional lini kedua, untuk pasien yang dengan terapi standar kortikosteroid tidak membaik, ada beberapa pilihan terapi yang dapat digunakan . Luasnya variasi terapi lini kedua menggambarkan relatif kurangnya efikasi dan terapi bersifat individual.<o:p></o:p></span></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">1.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Steroid dosis tinggi<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Terapi pasien ITP refrakter selain prednisolon dapat digunakan deksametason oral dosis tinggi. Deksametason 40 mg/hr selama 4minggu, diulang setiap 28 hari untuk 6 siklus.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">2.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Metiprednisolon<br />
Metilprednisolon dosis tinggi dapat diberikan pd ITP anak dan dewasa yang resisten terhadap terapi prednison dosis konvensional. Dari hasil penelitian menggunakan dosis tinggi metiprednisolon 3o mg/kg iv kemudian dosis diturunkan tiap 3 hr samapi 1 mg/kg sekai sehari.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">3.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">IgIV dosis tinggi<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Imunoglobulin iv dosis tinggi 1 mg/kg/hr selama 2 hari berturut-turut, sering dikombinasi dengan kortikosteroid, akan meningkatkan AT dengan cepat. Efek samping, terutama sakit kepala, namun jika berhasil maka dapat diberikan secara intermiten atau disubtitusi dengan anti-D iv<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">4.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Anti-D iv<br />
Dosis anti-D 50-75 mg/ka/hr IV. Mekanisme kerja anti-D yakni destruksi sel darah merah rhesus D-positif yang secara khusus diberikan oleh RES terutama di lien, jadi bersaingdengan autoantibodi yang menyelimuti trombosit melalui Fc reseptor blockade.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">5.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Alkaloid vinka<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Misalnya vinkristin 1 mg atau 2 mg iv, vinblastin 5-10 mg, setiap minggu selama 4-6 minggu.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">6.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Danazol<br />
Dosis 200 mg p.o 4x sehari selama sedikitnya 6 bulan karena respon sering lambat. Bila respon terjadi, dosis diteruskan sampai dosis maksimal sekurang-kurangnya hr 1 tahun dan kemudian diturunkan 200mg/hr setiap 4 bulan.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">7.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Immunosupresif dan kemoterapi kombinasi<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Imunosupresif diperlukan pada pasien yang gagal beresponsdengan terapi lainya. Terapi dengan azatioprin (2 mg kg max 150 mg/hr) atau siklofosfamiddenga sebagai obat tunggal dapat dipertimbangkan dan responya bertandng tertahan sampai 5%.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">8.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Dapsone<br />
Dosis 75 mg p.o per hari, respon terjadi dalam 2 bulan. Pasien harus diperiksa G6PD, karena pasien dengan kabar G6PD yang rendah mempunyai risiko hemolisis yang serius.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 35.45pt; text-indent: -14.15pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b><span lang="EN-US" style="line-height: 150%;">I.<span style="font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="EN-US" style="line-height: 150%;">P</span></b><b><span style="line-height: 150%;">ROGNOSA</span></b><b><span lang="EN-US" style="line-height: 150%;"><o:p></o:p></span></b></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 57.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Pada umumnya baik. Pada anak kadang terjadi remisi lengkap tanpa pengobatan<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 57.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">± 90% penderita ITP mengalami remisi setelah mendapat pengobatan selama 3 minggu-3 bulan dan tidak timbul lagi gejala<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 57.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">10% jadi ITP menahun dan < 1% meninggal <o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 57.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Pada dewasa sering relaps dalam waktu 4-15 tahun <o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 57.3pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Prognosa lebih buruk pada wanita hamil dan bila ada komplikasi, terutama perdarahan otak yang dapat menyebabkan kematian<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 57.3pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="text-indent: -18pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b><span lang="EN-US"><span style="line-height: 24px;">J. </span><span style="font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b style="line-height: 150%;"><span lang="EN-US" style="line-height: 150%;">K</span></b><b style="line-height: 150%;"><span style="line-height: 150%;">OMPLIKASI</span></b><b style="line-height: 150%;"><span style="line-height: 150%;"> <span lang="EN-US"><o:p></o:p></span></span></b></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Komplikas</span><span style="line-height: 150%;">i </span><span lang="EN-US" style="line-height: 150%;">yang mungkin terjadi, antara lain :<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">-<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Hemorrhages<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">-<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Penurunan kesadaran<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 54pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">-<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Splenomegali <o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><br />
</div><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 115%;"><br clear="all" style="mso-special-character: line-break; page-break-before: always;" /> </span> </span><div class="MsoNormal"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: center;"><b><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br />
</span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: center;"><b><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">ASUHAN KEPERAWATAN <o:p></o:p></span></span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: center;"><b><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">IDIOPATHIC THROMBOCYTOPENIC PURPURA ( ITP )<o:p></o:p></span></span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: center;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: center;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b><span lang="EN-US" style="line-height: 150%;">1.<span style="font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="EN-US" style="line-height: 150%;">PENGKAJIAN</span></b><span lang="EN-US" style="line-height: 150%;"><o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 54pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">a.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Asimtomatik sampai jumlah trombosit menurun di bawah 20.000.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 54pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">b.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Tanda-tanda perdarahan.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Petekie terjadi spontan.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Ekimosis terjadi pada daerah trauma minor.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Perdarahan dari mukosa gusi, hidung, saluran pernafasan.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Menoragie.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Hematuria.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Perdarahan gastrointestinal.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 54pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">c.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Perdarahan berlebih setelah prosedur bedah.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 54pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">d.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Aktivitas / istirahat.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Gejala : - keletihan, kelemahan, malaise umum.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 121.5pt; margin-right: 0cm; margin-top: 0cm; text-indent: -9pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">-<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">toleransi terhadap latihan rendah.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Tanda : - takikardia / takipnea, dispnea pada beraktivitas / istirahat.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 96pt; margin-right: 0cm; margin-top: 0cm; text-indent: 12pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> - kelemahan otot dan penurunan kekuatan.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 54pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">e.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Sirkulasi.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Gejala : - riwayat kehilangan darah kronis, misalnya perdarahan GI kronis, <o:p></o:p></span></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> menstruasi berat.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 96pt; margin-right: 0cm; margin-top: 0cm;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> - palpitasi (takikardia kompensasi).<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Tanda : - TD: peningkatan sistolik dengan diastolic stabil.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 54pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">f.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Integritas ego.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Gejala : - keyakinan agama / budaya mempengaruhi pilihan pengobatan: <o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: 36pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> penolakan transfuse darah.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Tanda : - DEPRESI.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 54pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">g.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Eliminasi.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Gejala : - Hematemesis, feses dengan darah segar, melena, diare, konstipasi.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Tanda : - distensi abdomen.<o:p></o:p></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="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 54pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">h.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Makanan / cairan.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Gejala : - penurunan masukan diet.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 96pt; margin-right: 0cm; margin-top: 0cm; text-indent: 12pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> - mual dan muntah.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Tanda : - turgor kulit buruk, tampak kusut, hilang elastisitas.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 54pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">i.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Neurosensori.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Gejala : - sakit kepala, pusing.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 96pt; margin-right: 0cm; margin-top: 0cm; text-indent: 12pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> - kelemahan, penurunan penglihatan.<o:p></o:p></span></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Tanda : - epistaksis.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 96pt; margin-right: 0cm; margin-top: 0cm; text-indent: 12pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> - mental: tak mampu berespons (lambat dan dangkal).<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 54pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">j.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Nyeri / kenyamanan.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Gejala : - nyeri abdomen, sakit kepala.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Tanda : - takipnea, dispnea.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 54pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">k.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Pernafasan.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Gejala : - nafas pendek pada istirahat dan aktivitas.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Tanda : - takipnea, dispnea.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 54pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">l. Keamanan<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 96pt; margin-right: 0cm; margin-top: 0cm; text-indent: -42pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Gejala : penyembuhan luka buruk sering infeksi, transfuse darah sebelumnya.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 96pt; margin-right: 0cm; margin-top: 0cm; text-indent: -42pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Tanda : petekie, ekimosis.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 96pt; margin-right: 0cm; margin-top: 0cm; text-indent: -42pt;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b><span lang="EN-US" style="line-height: 150%;">2.<span style="font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="EN-US" style="line-height: 150%;">DIAGNOSA KEPERAWATAN</span></b><b><span lang="EN-US" style="line-height: 150%;"><o:p></o:p></span></b></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 54pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">a.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Gangguan pemenuhan nutrisi dan cairan kurang dari kebutuhan tubuh berhubungan dengan anoreksia.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 54pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">b.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Perubahan perfusi jaringan berhubungan dengan penurunan komponen seluler yang diperlukan untuk pengiriman oksigen dan nutrisi ke sel.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 54pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">c.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Gangguan pemenuhan kebutuhan oksigen berhubungan dengan penurunan kapasitas pembawa oksigen darah.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 54pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">d.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Intoleransi aktivitas berhubungan dengan kelemahan.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 54pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">e.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Kurang pengetahuan pada keluarga tentang kondisi dan kebutuhan pengobatan berhubungan dengan salah interpretasi informasi.<o:p></o:p></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="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="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b><span lang="EN-US" style="line-height: 150%;">3.<span style="font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="EN-US" style="line-height: 150%;">INTERVENSI KEPERAWATAN</span></b><span lang="EN-US" style="line-height: 150%;"><o:p></o:p></span></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 54pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">a.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Gangguan pemenuhan nutrisi dan cairan kurang dari kebutuhan tubuh berhubungan dengan anoreksia.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 54pt; margin-right: 0cm; margin-top: 0cm;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Tujuan:<o:p></o:p></span></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Menghilangkan mual dan muntah<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 54pt; margin-right: 0cm; margin-top: 0cm;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Criteria standart:<o:p></o:p></span></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Menunjukkan berat badan stabil<o:p></o:p></span></span></div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; text-align: center;"><b><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Intervensi keperawatan<o:p></o:p></span></span></b></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">1)<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Berikan nutrisi yang adekuat secara kualitas maupun kuantitas. <o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span lang="EN-US" style="line-height: 150%;">Rasional</span></i><span lang="EN-US" style="line-height: 150%;"> : mencukupi kebutuhan kalori setiap hari.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">2)<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Berikan makanan dalam porsi kecil tapi sering.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 126pt; margin-right: 0cm; margin-top: 0cm; text-indent: -54pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span lang="EN-US" style="line-height: 150%;">Rasional</span></i><span lang="EN-US" style="line-height: 150%;"> : porsi lebih kecil dapat meningkatkan masukan yang sesuai dengan kalori.<o:p></o:p></span></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">3)<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Pantau pemasukan makanan dan timbang berat badan setiap hari.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 130.5pt; margin-right: 0cm; margin-top: 0cm; text-indent: -58.5pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span lang="EN-US" style="line-height: 150%;">Rasional</span></i><span lang="EN-US" style="line-height: 150%;"> : anoreksia dan kelemahan dapat mengakibatkan penurunan berat badan dan malnutrisi yang serius.<o:p></o:p></span></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">4)<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Lakukan konsultasi dengan ahli diet.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 126pt; margin-right: 0cm; margin-top: 0cm; text-indent: -54pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span lang="EN-US" style="line-height: 150%;">Rasional</span></i><span lang="EN-US" style="line-height: 150%;"> : sangat bermanfaat dalam perhitungan dan penyesuaian diet untuk memenuhi kebutuhan nutrisi pasien.<o:p></o:p></span></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">5)<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Libatkan keluarga pasien dalam perencanaan makan sesuai dengan indikasi.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 130.5pt; margin-right: 0cm; margin-top: 0cm; text-indent: -58.5pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span lang="EN-US" style="line-height: 150%;">Rasional</span></i><span lang="EN-US" style="line-height: 150%;"> : meningkatkan rasa keterlibatannya, memberikan informasi pada keluarga untuk memahami kebutuhan nutrisi pasien.</span><span style="line-height: 150%;"><o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 130.5pt; margin-right: 0cm; margin-top: 0cm; text-indent: -58.5pt;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 54pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">b.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Perubahan perfusi jaringan berhubungan dengan penurunan komponen seluler yang diperlukan untuk pengiriman oksigen dan nutrisi ke sel.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 54pt; margin-right: 0cm; margin-top: 0cm;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Tujuan:<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Tekanan darah normal.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Pangisian kapiler baik.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 54pt; margin-right: 0cm; margin-top: 0cm;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Kriteria standart:<o:p></o:p></span></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Menunjukkan perbaikan perfusi yang dibuktikan dengan TTV stabil.<o:p></o:p></span></span></div><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 115%;"><br clear="all" style="mso-special-character: line-break; page-break-before: always;" /> </span> </span><div class="MsoNormal"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; text-align: center;"><b><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Intervensi keperawatan:<o:p></o:p></span></span></b></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">1)<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Awasi TTV, kaji pengisian kapiler.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 135pt; margin-right: 0cm; margin-top: 0cm; text-indent: -63pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span lang="EN-US" style="line-height: 150%;">Rasional</span></i><span lang="EN-US" style="line-height: 150%;"> : memberikan informasi tentang derajat/ keadekuatan perfusi jaringan dan membantu menentukan kebutuhan intervensi.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">2)<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Tinggikan kepala tempat tidur sesuai toleransi.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 126pt; margin-right: 0cm; margin-top: 0cm; text-indent: -54pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span lang="EN-US" style="line-height: 150%;">Rasional</span></i><span lang="EN-US" style="line-height: 150%;"> : meningkatkan ekspansi paru dan memaksimalkan oksigenasi untuk kebutuhan seluler.<o:p></o:p></span></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">3)<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Kaji untuk respon verbal melambat, mudah terangasang.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 120pt; margin-right: 0cm; margin-top: 0cm; text-indent: -48pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span lang="EN-US" style="line-height: 150%;">Rasional</span></i><span lang="EN-US" style="line-height: 150%;"> : dapat mengindikasikan gangguan fungsi serebral karena hipoksia.<o:p></o:p></span></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">4)<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Awasi upaya parnafasan, auskultasi bunyi nafas.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 130.5pt; margin-right: 0cm; margin-top: 0cm; text-indent: -58.5pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span lang="EN-US" style="line-height: 150%;">Rasional</span></i><span lang="EN-US" style="line-height: 150%;"> : dispne karena regangan jantung lama / peningkatan kompensasi curah jantung.</span><span style="line-height: 150%;"><o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 130.5pt; margin-right: 0cm; margin-top: 0cm; text-indent: -58.5pt;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 54pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">c.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Gangguan pemenuhan kebutuhan oksigen berhubungan dengan penurunan kapasitas pembawa oksigen darah.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 54pt; margin-right: 0cm; margin-top: 0cm;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Tujuan:<o:p></o:p></span></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Mengurangi distress pernafasan.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 54pt; margin-right: 0cm; margin-top: 0cm;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Criteria standart:<o:p></o:p></span></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Mempertahankan pola pernafasan normal / efektif<o:p></o:p></span></span></div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; text-align: center;"><b><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Intervensi keperawatan:<o:p></o:p></span></span></b></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">1)<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Kaji / awasi frekuensi pernafasan, kedalaman dan irama.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 130.5pt; margin-right: 0cm; margin-top: 0cm; text-indent: -58.5pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span lang="EN-US" style="line-height: 150%;">Rasional</span></i><span lang="EN-US" style="line-height: 150%;"> : perubahan (seperti takipnea, dispnea, penggunaan otot aksesoris) dapat menindikasikan berlanjutnya keterlibatan / pengaruh pernafasan yang membutuhkan upaya intervensi.<o:p></o:p></span></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">2)<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Tempatkan pasien pada posisi yang nyaman.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 126pt; margin-right: 0cm; margin-top: 0cm; text-indent: -54pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span lang="EN-US" style="line-height: 150%;">Rasional</span></i><span lang="EN-US" style="line-height: 150%;"> : memaksimalkan ekspansi paru, menurunkan kerja pernafasan dan menurunkan resiko aspirasi.<o:p></o:p></span></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">3)<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Beri posisi dan Bantu ubah posisi secara periodic.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 120pt; margin-right: 0cm; margin-top: 0cm; text-indent: -48pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span lang="EN-US" style="line-height: 150%;">Rasional</span></i><span lang="EN-US" style="line-height: 150%;"> : meningkatkan areasi semua segmen paru dan mobilisasikan sekresi.<o:p></o:p></span></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">4)<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Bantu dengan teknik nafas dalam.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 120pt; margin-right: 0cm; margin-top: 0cm; text-indent: -48pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span lang="EN-US" style="line-height: 150%;">Rasional</span></i><span lang="EN-US" style="line-height: 150%;"> : membantu meningkatkan difusi gas dan ekspansi jalan nafas kecil.</span><span style="line-height: 150%;"><o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 120pt; margin-right: 0cm; margin-top: 0cm; text-indent: -48pt;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 54pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">d.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Intoleransi aktivitas berhubungan dengan kelemahan.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 54pt; margin-right: 0cm; margin-top: 0cm;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Tujuan:<o:p></o:p></span></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Meningkatkan partisipasi dalam aktivitas.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 54pt; margin-right: 0cm; margin-top: 0cm;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Criteria standart:<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Menunjukkan peningkatan toleransi aktivitas.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm;"><br />
</div><div class="MsoNormal"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="line-height: 115%;"> </span><b><span lang="EN-US" style="line-height: 115%;">Intervensi keperawatan:</span></b><span lang="EN-US" style="line-height: 115%;"><o:p></o:p></span></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">1)<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Kaji kemampuan pasien untuk melakukan aktivitas normal, catat laporan kelemahan, keletihan.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 120pt; margin-right: 0cm; margin-top: 0cm; text-indent: -48pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span lang="EN-US" style="line-height: 150%;">Rasional</span></i><span lang="EN-US" style="line-height: 150%;"> : mempengaruhi pilihan intervensi.<o:p></o:p></span></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">2)<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Awasi TD, nadi, pernafasan.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 130.5pt; margin-right: 0cm; margin-top: 0cm; text-indent: -58.5pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span lang="EN-US" style="line-height: 150%;">Rasional</span></i><span lang="EN-US" style="line-height: 150%;"> : manifestasi kardiopulmonal dari upaya jantung dan paru untuk </span><span style="line-height: 150%;">me</span><span lang="EN-US" style="line-height: 150%;">mbawa jumlah oksigen ke jaringan.<o:p></o:p></span></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">3)<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Berikan lingkungan tenang.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 135pt; margin-right: 0cm; margin-top: 0cm; text-indent: -63pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span lang="EN-US" style="line-height: 150%;">Rasional</span></i><span lang="EN-US" style="line-height: 150%;"> : meningkatkan istirahat untuk menurunkan kebutuhan oksigen tubuh.<o:p></o:p></span></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">4)<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Ubah posisi pasien dengan perlahan dan pantau terhadap pusing.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 135pt; margin-right: 0cm; margin-top: 0cm; text-indent: -63pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span lang="EN-US" style="line-height: 150%;">Rasional</span></i><span lang="EN-US" style="line-height: 150%;"> : hipotensi postural / hipoksin serebral menyebabkan pusing, berdenyut dan peningkatan resiko cedera.</span><span style="line-height: 150%;"><o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 135pt; margin-right: 0cm; margin-top: 0cm; text-indent: -63pt;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 54pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">e.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Kurang pengetahuan pada keluarga tentang kondisi dan kebutuhan pengobatan berhubungan dengan salah interpretasi informasi.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 54pt; margin-right: 0cm; margin-top: 0cm;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Tujuan:<o:p></o:p></span></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Pemahaman dan penerimaan terhadap program pengobatan yang diresepkan.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 54pt; margin-right: 0cm; margin-top: 0cm;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Criteria standart:<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Menyatakan pemahaman proses penyakit.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Faham akan prosedur dagnostik dan rencana pengobatan.<o:p></o:p></span></span></div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; text-align: center;"><b><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Intervensi keperawatan:<o:p></o:p></span></span></b></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">1)<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Berikan informasi tntang ITP. Diskusikan kenyataan bahwa terapi tergantung pada tipe dan beratnya ITP.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 126pt; margin-right: 0cm; margin-top: 0cm; text-indent: -54pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span lang="EN-US" style="line-height: 150%;">Rasional</span></i><span lang="EN-US" style="line-height: 150%;"> : memberikan dasar pengetahuan sehingga keluarga / pasien dapat membuat pilihan yang tepat.<o:p></o:p></span></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">2)<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Tinjau tujuan dan persiapan untuk pemeriksaan diagnostic.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 120pt; margin-right: 0cm; margin-top: 0cm; text-indent: -48pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span lang="EN-US" style="line-height: 150%;">Rasional</span></i><span lang="EN-US" style="line-height: 150%;"> : ketidak tahuan meningkatkan stress.<o:p></o:p></span></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span lang="EN-US" style="line-height: 150%;">3)<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Jelaskan bahwa darah yang diambil untuk pemeriksaan laboratorium tidak akan memperburuk ITP.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 120pt; margin-right: 0cm; margin-top: 0cm; text-indent: -48pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><i><span lang="EN-US" style="line-height: 150%;">Rasional</span></i><span lang="EN-US" style="line-height: 150%;"> : merupakan kekwatiran yang tidak diungkapkan yang dapat memperkuat ansietas pasien / keluarga.</span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 36pt; margin-right: 0cm; margin-top: 0cm; text-indent: -18pt;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b><span lang="EN-US" style="line-height: 150%;">4.<span style="font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="EN-US" style="line-height: 150%;">IMPLEMENTASI KEPERAWATAN</span></b><b><span lang="EN-US" style="line-height: 150%;"><o:p></o:p></span></b></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 36pt; margin-right: 0cm; margin-top: 0cm; text-indent: 36pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Pelaksanaan sesuai dengan ITP dengan intervensi yang sudah ditetapkan (sesuai dengan literature).<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 36pt; margin-right: 0cm; margin-top: 0cm; text-indent: 36pt;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b><span lang="EN-US" style="line-height: 150%;">5.<span style="font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="EN-US" style="line-height: 150%;">EVALUASI</span></b><span lang="EN-US" style="line-height: 150%;"><o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 36pt; margin-right: 0cm; margin-top: 0cm; text-indent: 36pt;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Penilaian sesuai dengan criteria standart yang telah ditetapkan dengan perencanaan.<o:p></o:p></span></span></div><br />
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<div class="MsoListParagraphCxSpLast" style="line-height: 150%; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 36.0pt;"><br />
</div>salnihttp://www.blogger.com/profile/00126668517852477742noreply@blogger.com0tag:blogger.com,1999:blog-8321145958076225978.post-89080561388158951132012-03-14T09:31:00.000-07:002012-03-14T09:31:28.450-07:00Asuhan Keperawatan pada klien Leukemia<div align="center" class="MsoListParagraphCxSpFirst" style="margin-bottom: 0.0001pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; text-align: center;"><span style="font-family: 'Bodoni MT Black', serif;"><span style="font-size: 27px; line-height: 40px;"><br />
</span></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; mso-list: l4 level1 lfo1; text-indent: 0cm;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Britannic Bold","sans-serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: "Britannic Bold"; mso-fareast-font-family: "Britannic Bold";">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Britannic Bold","sans-serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Pengertian <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Leukemia adalah proliferasi sel darah putih yang masih imatur dalam jaringan pembentuk<br />
darah. (Suriadi, & Rita yuliani, 2001 : 175). Leukimia adalah proliferasi tak teratur atau akumulasi sel darah putih dalam sum-sum tulang menggantikan elemen sum-sum tulang normal.(Smeltzer, S C and Bare, B.G, 2002 : 248 ).<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Leukemia adalah suatu keganasan pada alat pembuat sel darah berupa proliferasio<br />
patologis sel hemopoetik muda yang ditandai oleh adanya kegagalan sum-sum tulang<br />
dalam membentuk sel darah normal dan adanya infiltrasi ke jaringan tubuh yang lain.<br />
(Arief Mansjoer, dkk, 2002 : 495).<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Berdasarkan dari beberapa pengetian diatas maka penulis berpendapat bahwa leukimia<br />
adalah suatu penyakit yang disebabkan oleh prolioferasi abnormal dari sel-sel leukosit<br />
yang menyebabkan terjadinya kanker pada alat pembentuk darah.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; mso-list: l4 level1 lfo1; text-indent: 0cm;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Britannic Bold","sans-serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: "Britannic Bold"; mso-fareast-font-family: "Britannic Bold";">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Britannic Bold","sans-serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Etiologi<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Penyebab yang pasti belum diketahui, akan tetapi terdapat faktor predisposisi yang menyebabkan terjadinya leukemia, yaitu :<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l22 level1 lfo5; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Faktor genetik : virus tertentu menyebabkan terjadinya perubahan struktur gen (Tcell Leukemia – Lhymphoma Virus/ HLTV).<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l22 level1 lfo5; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Radiasi.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l22 level1 lfo5; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Obat-obat imunosupresif, obat-obat kardiogenik seperti diethylstilbestrol.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l22 level1 lfo5; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Faktor herediter, misalnya pada kembar monozigot.<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l22 level1 lfo5; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">e.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kelainan kromosom, misalnya pada down sindrom. (Suriadi & Rita Yuliani, 2001 : hal. 177).<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Leukemia biasanya mengenai sel-sel darah putih. Penyebab dari sebagian besar jenis leukemia tidak diketahui. Pemaparan terhadap penyinaran (radiasi) dan bahan kimia tertentu (misalnya benzena) dan pemakaian obat antikanker, meningkatkan resiko terjadinya leukemia. Orang yang memiliki kelainan genetik tertentu (misalnya sindroma Down dan sindroma Fanconi), juga lebih peka terhadap leukemia.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><br />
</span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; mso-list: l4 level1 lfo1; text-indent: 0cm;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Britannic Bold","sans-serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: "Britannic Bold"; mso-fareast-font-family: "Britannic Bold";">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Britannic Bold","sans-serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Gambaran klinik <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Manifestasi klinik yang sering dijumpai pada penyakit leukemia adalah sebagai berikut :<o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; mso-list: l15 level1 lfo2; text-indent: 0cm;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pilek tidak sembuh-sembuh.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; mso-list: l15 level1 lfo2; text-indent: 0cm;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pucat, lesu, mudah terstimulasi.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; mso-list: l15 level1 lfo2; text-indent: 0cm;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Demam dan anorexia.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; mso-list: l15 level1 lfo2; text-indent: 0cm;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Berat badan menurun.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; mso-list: l15 level1 lfo2; text-indent: 0cm;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">e)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Petechiae, memar tanpa sebab.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; mso-list: l15 level1 lfo2; text-indent: 0cm;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">f)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Nyeri pada tulang dan persendian.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; mso-list: l15 level1 lfo2; text-indent: 0cm;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">g)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Nyeri abdomen.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; mso-list: l15 level1 lfo2; text-indent: 0cm;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">h)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Lumphedenopathy.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; mso-list: l15 level1 lfo2; text-indent: 0cm;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">i)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Hepatosplenomegaly.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; mso-list: l15 level1 lfo2; text-indent: 0cm;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">j)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Abnormal WBC.<br />
(Suriadi & Rita Yuliani, 2001 : hal. 177)<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto;"><br />
</div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; mso-list: l4 level1 lfo1; text-indent: 0cm;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Britannic Bold","sans-serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: "Britannic Bold"; mso-fareast-font-family: "Britannic Bold";">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Britannic Bold","sans-serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Insiden <o:p></o:p></span></div><div class="pl" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US">ALL (Acute Lymphoid Leukemia) adalah insiden paling tinggi terjadi pada anak-anak yang berusia antara 3 dan 5 tahun. Anak perempuan menunjukkan prognosis yang lebih baik daripada anak laki-laki. Anak kulit hitam mempunyai frekuensi remisi yang lebih sedikit dan angka kelangsungan hidup (survival rate) rata-rata yang juga lebih rendah. </span></div><div class="pl" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US">ANLL (Acute Nonlymphoid Leukemia) mencakup 15% sampai 25% kasus leukemia pada anak. Resiko terkena penyakit ini meningkat pada anak yang mempunyai kelainan kromosom bawaan seperti Sindrom Down. Lebih sulit dari ALL dalam hal menginduksi remisi (angka remisi 70%). Remisinya lebih singkat pada anak-anak dengan ALL. Lima puluh persen anak yang mengalami pencangkokan sumsum tulang memiliki remisi berkepanjangan. (Betz, Cecily L. 2002. hal : 300).</span></div><div class="pl" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; text-align: justify; text-indent: 36.0pt;"><br />
</div><div class="pl" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-list: l4 level1 lfo1; text-align: justify; text-indent: 0cm;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Britannic Bold","sans-serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: "Britannic Bold"; mso-fareast-font-family: "Britannic Bold";">5.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Britannic Bold","sans-serif"; font-size: 14.0pt; line-height: 150%;">Patofisiologi <o:p></o:p></span></div><div class="pl" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l13 level1 lfo6; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US">Normalnya tulang marrow diganti dengan tumor yang malignan, imaturnya sel blast.<br />
Adanya proliferasi sel blast, produksi eritrosit dan platelet terganggu sehingga akan<br />
menimbulkan anemia dan trombositipenia.</span><span lang="EN-US" style="font-family: "Britannic Bold","sans-serif"; font-size: 14.0pt; line-height: 150%;"><o:p></o:p></span></div><div class="pl" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l13 level1 lfo6; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US">Sistem retikuloendotelial akan terpengaruh dan menyebabkan gangguan sistem<br />
pertahanan tubuh dan mudah mengalami infeksi.</span><span lang="EN-US" style="font-family: "Britannic Bold","sans-serif"; font-size: 14.0pt; line-height: 150%;"><o:p></o:p></span></div><div class="pl" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l13 level1 lfo6; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US">Manifestasi akan tampak pada gambaran gagalnya bone marrow dan infiltrasi organ,<br />
sistem saraf pusat. Gangguan pada nutrisi dan metabolisme. Depresi sumsum tulang<br />
yang akan berdampak pada penurunan lekosit, eritrosit, faktor pembekuan dan<br />
peningkatan tekanan jaringan.</span><span lang="EN-US" style="font-family: "Britannic Bold","sans-serif"; font-size: 14.0pt; line-height: 150%;"><o:p></o:p></span></div><div class="pl" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l13 level1 lfo6; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US">Adanya infiltrasi pada ekstra medular akan berakibat terjadinya pembesaran hati, limfe,<br />
nodus limfe, dan nyeri persendian.</span><span lang="EN-US" style="font-family: "Britannic Bold","sans-serif"; font-size: 14.0pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">(Suriadi, & Yuliani R, 2001: hal. 175)<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; mso-list: l4 level1 lfo1; text-align: justify; text-indent: 0cm;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Britannic Bold","sans-serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: "Britannic Bold"; mso-fareast-font-family: "Britannic Bold";">6.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Britannic Bold","sans-serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Pemeriksaan Laboratorium dan Diagnostik <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l24 level1 lfo7; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Hitung darah lengkap complete blood cell (CBC). Anak dengan CBC kurang dari<br />
10.000/mm3 saat didiagnosis memiliki memiliki prognosis paling baik; jumlah lekosit<br />
lebih dari 50.000/mm3 adalah tanda prognosis kurang baik pada anak sembarang umur.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l24 level1 lfo7; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pungsi lumbal untuk mengkaji keterlibatan susunan saraf pusat.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l24 level1 lfo7; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Foto toraks untuk mendeteksi keterlibatan mediastinum.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l24 level1 lfo7; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Aspirasi sumsum tulang. Ditemukannya 25% sel blas memperkuat diagnosis.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l24 level1 lfo7; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">e.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pemindaian tulang atau survei kerangka untuk mengkaji keterlibatan tulang.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l24 level1 lfo7; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">f.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pemindaian ginjal, hati, limpa untuk mengkaji infiltrat leukemik.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l24 level1 lfo7; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">g.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Jumlah trombosit menunjukkan kapasitas pembekuan.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">(Betz, Cecily L. 2002. hal : 301-302).<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; text-align: justify; text-indent: 36.0pt;"><br />
</div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; mso-list: l4 level1 lfo1; text-indent: 0cm;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Britannic Bold","sans-serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: "Britannic Bold"; mso-fareast-font-family: "Britannic Bold";">7.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Britannic Bold","sans-serif"; font-size: 14.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Penatalaksanaan Medis <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Protokol pengobatan bervariasi sesuai jenis leukemia dan jenis obat yang diberikan pada anak. Proses induksi remisi pada anak terdiri dari tiga fase : induksi, konsolidasi, dan rumatan. Selama fase induksi (kira-kira 3 sampai 6 minggu) anak menerima berbagai agens kemoterapeutik untuk menimbulkan remisi. Periode intensif diperpanjang 2 sampai 3 minggu selama fase konsolidasi untuk memberantas keterlibatan sistem saraf pusat dan organ vital lain. Terapi rumatan diberikan selama beberapa tahun setelah diagnosis untuk memperpanjang remisi. Beberapa obat yang dipakai untuk leukemia anak-anak adalah prednison (antiinflamasi), vinkristin (antineoplastik), asparaginase (menurunkan kadar asparagin (asam amino untuk pertumbuhan tumor), metotreksat (antimetabolit), merkaptopurin, sitarabin (menginduksi remisi pada pasien dengan leukemia granulositik akut), alopurinol, siklofosfamid (antitumor kuat), dan daunorubisin (menghambat<br />
pembelahan sel selama pengobatan leukemia akut). </span><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">(Betz, Cecily L. 2002. : 302).</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: center;"><span lang="EN-US" style="font-family: "Bodoni MT Black","serif"; font-size: 18.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Konsep Keperawatan pada Klien Leukimia<o:p></o:p></span></div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: center;"><span lang="EN-US" style="font-family: "Bodoni MT Black","serif"; font-size: 18.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";"><br />
</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Menurut American Nursing Association (ANA) proses keperawatan adalah suatu metode<br />
yang sistematis yang diberikan kepada individu, keluarga dan masyarakat dengan berfokus pada respon unik dari individu, keluarga, dan masyarakat terhadap masalah kesehatan yang potensial maupun aktual. ( Marilynn E. Doengoes, dkk .2000 : 6 ). Di dalam memberikan asuhan keperawatan terdiri dari beberapa tahap atau langkah-langkah proses keperawatan yaitu ; pengkajian, diagnosa keperawatan, perencanaan, implementasi, dan evaluasi.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l20 level1 lfo26; text-indent: -18.0pt;"><!--[if !supportLists]--><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pengkajian <o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pengkajian adalah dasar utama dari proses keperawatan, pengumpulan data yang akurat<br />
dan sistematis akan membantu penentuan status kesehatan dan pola pertahanan klien, mengidentifikasi kekuatan dan kebutuhan klien serta merumuskan diagnosa keperawatan.(Budi Anna Keliat, 1994)<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pengkajian pada leukemia meliputi : <o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; mso-list: l23 level1 lfo3; text-indent: 0cm;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Riwayat penyakit.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; mso-list: l23 level1 lfo3; text-indent: 0cm;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kaji adanya tanda-tanda anemia :<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l26 level1 lfo8; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pucat<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l26 level1 lfo8; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kelemahan<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l26 level1 lfo8; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Sesak<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l26 level1 lfo8; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Nafas cepat<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; mso-list: l23 level1 lfo3; text-indent: 0cm;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kaji adanya tanda-tanda leukopenia :<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l7 level1 lfo9; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Demam<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l7 level1 lfo9; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Infeksi<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; mso-list: l23 level1 lfo3; text-indent: 0cm;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kaji adanya tanda-tanda trombositopenia :<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l17 level1 lfo10; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Ptechiae<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l17 level1 lfo10; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Purpura<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l17 level1 lfo10; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Perdarahan membran mukosa<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; mso-list: l23 level1 lfo3; text-indent: 0cm;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">5)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kaji adanya tanda-tanda invasi ekstra medulola :<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l9 level1 lfo11; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Limfadenopati<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l9 level1 lfo11; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Hepatomegali<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l9 level1 lfo11; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Splenomegali<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; mso-list: l23 level1 lfo3; text-indent: 0cm;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">6)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kaji adanya pembesaran testis.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; mso-list: l23 level1 lfo3; text-indent: 0cm;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">7)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kaji adanya :<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo12; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Hematuria<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo12; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Hipertensi<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo12; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Gagal ginjal<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo12; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Inflamasi disekitar rectal<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo12; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">e.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Nyeri <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">(Suriadi,R dan Rita Yuliani,2001 : 178)<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto;"><br />
</div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l20 level1 lfo26; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Diagnosa Keperawatan Diagnosa keperawatan menurut The North American Nursing <o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Diagnosis Association (NANDA) adalah “ suatu penilaian klinis tentang respon individu,keluarga, atau komunitas terhadap masalah kesehatan/proses kehidupan yang aktual dan potensial. Diagnosa keperawatan memberikan dasar untuk pemilihan intervensi keperawatan untuk mencapai tujuan diamana perawat bertanggung gugat “</span><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">(Wong,D.L, 2004 :331).</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Menurut Wong, D.L (2004 :596 – 610) , diagnosa pada anak dengan leukemia adalah : <o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo13; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Resiko infeksi berhubungan dengan menurunnya sistem pertahanan tubuh.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo13; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Intoleransi aktivitas berhubungan dengan kelemahan akibat anemia.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo13; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Resiko terhadap cedera : perdarahan yang berhubungan dengan penurunan jumlah<br />
trombosit.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo13; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Resiko tinggi kekurangan volume cairan berhubungan dengan mual dan muntah.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo13; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">e.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Perubahan membran mukosa mulut : stomatitis yang berhubungan dengan efek samping<br />
agen kemoterapi.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo13; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">f.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Perubahan nutrisi kurang dari kebutuhan tubuh yang berhubungan dengan anoreksia,<br />
malaise, mual dan muntah, efek samping kemoterapi dan atau stomatitis.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo13; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">g.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Nyeri yang berhubungan dengan efek fisiologis dari leukemia.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo13; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">h.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kerusakan integritas kulit berhubungan dengan pemberian agens kemoterapi,<br />
radioterapi, imobilitas.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo13; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">i.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Gangguan citra tubuh berhubungan dengan alopesia atau perubahan cepat pada<br />
penampilan.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo13; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">j.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Perubahan proses keluarga berhubungan dengan mempunyai anak yang menderita<br />
leukemia.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo13; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">k.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Antisipasi berduka berhubungan dengan perasaan potensial kehilangan anak.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto;"><br />
</div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l20 level1 lfo26; text-indent: -18.0pt;"><!--[if !supportLists]--><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Rencana keperawatan <o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Rencana keperawatan merupakan serangkaian tindakan atau intervensi untuk mencapai tujuan pelaksanaan asuhan keperawatan. Intervensi keperawatan adalah preskripsi untuk perilaku spesifik yang diharapkan dari pasien dan atau tindakan yang harus dilakukan oleh perawat.<br />
Berdasarkan diagnosa yang ada maka dapat disusun rencana keperawatan sebagai berikut<br />
(Wong,D.L,2004) :<o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l3 level1 lfo17; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Resiko infeksi berhubungan dengan menurunnya sistem pertahanan tubuh.</span></i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><br />
Kriteria hasil : Anak tidak mengalami gejala-gejala infeksi.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Intervensi :<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 72.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l19 level1 lfo14; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pantau suhu dengan teliti. Rasional : untuk mendeteksi kemungkinan infeksi. Tempatkan anak dalam ruangan khusus. Rasional : untuk meminimalkan terpaparnya anak dari sumber infeksi.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 72.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l19 level1 lfo14; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Anjurkan semua pengunjung dan staff rumah sakit untuk menggunakan teknik mencuci tangan dengan baik. Rasional : untuk meminimalkan pajanan pada organisme infektif.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 72.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l19 level1 lfo14; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Gunakan teknik aseptik yang cermat untuk semua prosedur invasif<br />
Rasional : untuk mencegah kontaminasi silang/menurunkan resiko infeksi.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 72.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l19 level1 lfo14; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Evaluasi keadaan anak terhadap tempat-tempat munculnya infeksi seperti tempat<br />
penusukan jarum, ulserasi mukosa, dan masalah gigi. Rasional : untuk intervensi dini penanganan infeksi.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 72.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l19 level1 lfo14; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">e.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Inspeksi membran mukosa mulut. Bersihkan mulut dengan baik<br />
Rasional : rongga mulut adalah medium yang baik untuk pertumbuhan organisme.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 72.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l19 level1 lfo14; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">f.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Berikan periode istirahat tanpa gangguan. Rasional : menambah energi untuk penyembuhan dan regenerasi seluler.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 72.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l19 level1 lfo14; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">g.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Berikan diet lengkap nutrisi sesuai usia. Rasional : untuk mendukung pertahanan alami tubuh.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 72.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l19 level1 lfo14; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">h.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Berikan antibiotik sesuai ketentuan. Rasional : diberikan sebagai profilaktik atau mengobati infeksi khusus.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; tab-stops: 184.75pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> <o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l3 level1 lfo17; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2)<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; line-height: normal;"> </span></span></i><!--[endif]--><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Intoleransi aktivitas berhubungan dengan kelemahan akibat anemia.<o:p></o:p></span></i></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kriteria hasil : terjadi peningkatan toleransi aktifitas.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Intervensi : <o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 72.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l21 level1 lfo15; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Evaluasi laporan kelemahan, perhatikan ketidakmampuan untuk berpartisipasi dalam aktifitas sehari-hari. Rasional : menentukan derajat dan efek ketidakmampuan.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 72.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l21 level1 lfo15; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Berikan lingkungan tenang dan perlu istirahat tanpa gangguan.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Rasional : menghemat energi untuk aktifitas dan regenerasi seluler atau penyambungan<br />
jaringan.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 72.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l21 level1 lfo15; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kaji kemampuan untuk berpartisipasi pada aktifitas yang diinginkan atau dibutuhkan. Rasional : mengidentifikasi kebutuhan individual dan membantu pemilihan intervensi.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 72.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l21 level1 lfo15; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Berikan bantuan dalam aktifitas sehari-hari dan ambulasi<br />
Rasional : memaksimalkan sediaan energi untuk tugas perawatan diri.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l3 level1 lfo17; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3)<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; line-height: normal;"> </span></span></i><!--[endif]--><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Resiko terhadap cedera/perdarahan yang berhubungan dengan penurunan jumlah<br />
trombosit.</span></i><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></i></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kriteria hasil : klien tidak menunjukkan bukti-bukti perdarahan.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Intervensi :<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo16; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Gunakan semua tindakan untuk mencegah perdarahan khususnya pada daerah ekimosis. Rasional : karena perdarahan memperberat kondisi anak dengan adanya anemia.Cegah ulserasi oral dan rektal. Rasional : karena kulit yang luka cenderung untuk berdarah.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo16; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Gunakan jarum yang kecil pada saat melakukan injeksi. Rasional : untuk mencegah perdarahan.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo16; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Menggunakan sikat gigi yang lunak dan lembut. Rasional : untuk mencegah perdarahan.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo16; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Laporkan setiap tanda-tanda perdarahan (tekanan darah menurun, denyut nadi cepat, dan pucat). Rasional : untuk memberikan intervensi dini dalam mengatasi perdarahan.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo16; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">e.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Hindari obat-obat yang mengandung aspirin. Rasional : karena aspirin mempengaruhi fungsi trombosit.<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo16; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">f.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Ajarkan orang tua dan anak yang lebih besar ntuk mengontrol perdarahan hidung.<br />
Rasional : untuk mencegah perdarahan.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l3 level1 lfo17; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4)<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; line-height: normal;"> </span></span></i><!--[endif]--><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Resiko tinggi kekurangan volume cairan berhubungan dengan mual dan muntah.<o:p></o:p></span></i></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kriteria hasil : <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 40.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l16 level1 lfo4; text-align: justify; text-indent: 0cm;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Tidak terjadi kekurangan volume cairan.<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 40.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l16 level1 lfo4; text-align: justify; text-indent: 0cm;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Pasien tidak mengalami mual dan muntah.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Intervensi :<o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l2 level1 lfo18; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Berikan antiemetik awal sebelum dimulainya kemoterapi. Rasional : untuk mencegah mual dan muntah.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l2 level1 lfo18; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Berikan antiemetik secara teratur pada waktu dan program kemoterapi. Rasional : untuk mencegah episode berulang.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l2 level1 lfo18; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kaji respon anak terhadap anti emetic. Rasional : karena tidak ada obat antiemetik yang secara umum berhasil.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l2 level1 lfo18; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Hindari memberikan makanan yang beraroma menyengat.<br />
Rasional : bau yang menyengat dapat menimbulkan mual dan muntah.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l2 level1 lfo18; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">e.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Anjurkan makan dalam porsi kecil tapi sering. Rasional : karena jumlah kecil biasanya ditoleransi dengan baik.<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l2 level1 lfo18; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">f.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Berikan cairan intravena sesuai</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">ketentuan. Rasional : untuk mempertahankan hidrasi.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l3 level1 lfo17; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">5)<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; line-height: normal;"> </span></span></i><!--[endif]--><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Perubahan membran mukosa mulut : stomatitis yang berhubungan dengan efek samping<br />
agen kemoterapi.<o:p></o:p></span></i></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kriteria hasil : pasien tidak mengalami mukositis oral.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Intervensi :<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l25 level1 lfo19; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Inspeksi mulut setiap hari untuk adanya ulkus oral. Rasional : untuk mendapatkan tindakan yang segera.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l25 level1 lfo19; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Hindari mengukur suhu oral. Rasional : untuk mencegah trauma.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l25 level1 lfo19; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Gunakan sikat gigi berbulu lembut, aplikator berujung kapas, atau jari yang dibalut kasa. Rasional : untuk menghindari trauma.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l25 level1 lfo19; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Berikan pencucian mulut yang sering dengan cairan salin normal atau tanpa larutan bikarbonat. Rasional : untuk menuingkatkan penyembuhan.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l25 level1 lfo19; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">e.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Gunakan pelembab bibir. Rasional : untuk menjaga agar bibir tetap lembab dan mencegah pecah-pecah (fisura).<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l25 level1 lfo19; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">f.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Hindari penggunaan larutan lidokain pada anak kecil<br />
Rasional : karena bila digunakan pada faring, dapat menekan refleks muntah yang<br />
mengakibatkan resiko aspirasi dan dapat menyebabkan kejang.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l25 level1 lfo19; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">g.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Berikan diet cair, lembut dan lunak. Rasional : agar makanan yang masuk dapat ditoleransi anak.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l25 level1 lfo19; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">h.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Inspeksi mulut setiap hari. Rasional : untuk mendeteksi kemungkinan infeksi.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l25 level1 lfo19; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">i.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Dorong masukan cairan dengan menggunakan sedotan.<br />
Rasional : untuk membantu melewati area nyeri.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l25 level1 lfo19; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">j.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Hindari penggunaa swab gliserin, hidrogen peroksida dan susu magnesia.<br />
Rasional : dapat mengiritasi jaringan yang luka dan dapat membusukkan gigi,<br />
memperlambat penyembuhan dengan memecah protein dan dapat mengeringkan mukosa.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l25 level1 lfo19; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">k.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Berikan obat-obat anti infeksi sesuai ketentuan. Rasional : untuk mencegah atau mengatasi mukositis.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l25 level1 lfo19; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">l.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Berikan analgetik. Rasional : untuk mengendalikan nyeri.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l3 level1 lfo17; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">6)<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; line-height: normal;"> </span></span></i><!--[endif]--><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Perubahan nutrisi kurang dari kebutuhan tubuh yang berhubungan dengan anoreksia, malaise, mual dan muntah, efek samping kemoterapi dan atau stomatitis.<o:p></o:p></span></i></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kriteria Hasil : pasien mendapat nutrisi yang adekuat.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Intervensi : <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l8 level1 lfo20; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Dorong orang tua untuk tetap rileks pada saat anak makan.<br />
Rasional : jelaskan bahwa hilangnya nafsu makan adalah akibat langsung dari mual dan muntah serta kemoterapi.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l8 level1 lfo20; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Izinkan anak memakan semua makanan yang dapat ditoleransi, rencanakan untuk memperbaiki kualitas gizi pada saat selera makan anak meningkat. Rasional : untuk mempertahankan nutrisi yang optimal.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l8 level1 lfo20; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Berikan makanan yang disertai suplemen nutrisi gizi, seperti susu bubuk atau suplemen yang dijual bebas. Rasional : untuk memaksimalkan kualitas intake nutrisi.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l8 level1 lfo20; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Izinkan anak untuk terlibat dalam persiapan dan pemilihan makanan.<br />
Rasional : untuk mendorong agar anak mau makan.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l8 level1 lfo20; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">e.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Dorong masukan nutrisi dengan jumlah sedikit tapi sering.<br />
Rasional : karena jumlah yang kecil biasanya ditoleransi dengan baik.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l8 level1 lfo20; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">f.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Dorong pasien untuk makan diet tinggi kalori kaya nutrient.<br />
Rasional : kebutuhan jaringan metabolik ditingkatkan begitu juga cairan untuk<br />
menghilangkan produk sisa suplemen dapat memainkan peranan penting dalam<br />
mempertahankan masukan kalori dan protein yang adekuat.<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l8 level1 lfo20; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">g.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Timbang BB, ukur TB dan ketebalan lipatan kulit trisep. Rasional : membantu dalam mengidentifikasi malnutrisi protein kalori, khususnya bila<br />
BB dan pengukuran antropometri kurang dari normal.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; tab-stops: 347.75pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"> <o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l3 level1 lfo17; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">7)<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; line-height: normal;"> </span></span></i><!--[endif]--><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Nyeri yang berhubungan dengan efek fisiologis dari leukemia.<o:p></o:p></span></i></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kriteria hasil : pasien tidak mengalami nyeri atau nyeri menurun sampai tingkat yang dapat diterima anak.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><br />
Intervensi :<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l6 level1 lfo21; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Mengkaji tingkat nyeri dengan skala 0 sampai 5. Rasional : informasi memberikan data dasar untuk mengevaluasi kebutuhan atau<br />
keefektifan intervensi.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l6 level1 lfo21; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Jika mungkin, gunakan prosedur-prosedur (misal pemantauan suhu non invasif, alat akses vena. Rasional : untuk meminimalkan rasa tidak aman.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l6 level1 lfo21; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Evaluasi efektifitas penghilang nyeri dengan derajat kesadaran dan sedasi<br />
Rasional : untuk menentukan kebutuhan perubahan dosis. Waktu pemberian atau obat.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l6 level1 lfo21; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Lakukan teknik pengurangan nyeri non farmakologis yang tepat. Rasional : sebagai analgetik tambahan.<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l6 level1 lfo21; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">e.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Berikan obat-obat anti nyeri secara teratur. Rasional : untuk mencegah kambuhnya nyeri.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l3 level1 lfo17; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">8)<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; line-height: normal;"> </span></span></i><!--[endif]--><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kerusakan integritas kulit berhubungan dengan pemberian agens kemoterapi,<br />
radioterapi, imobilitas.<o:p></o:p></span></i></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kriteria hasil : pasien mempertahankan integritas kulit.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Intervensi :<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l14 level1 lfo22; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Berikan perawatan kulit yang cemat, terutama di dalam mulut dan daerah perianal. Rasional : karena area ini cenderung mengalami ulserasi.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l14 level1 lfo22; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Ubah posisi dengan sering. Rasional : untuk merangsang sirkulasi dan mencegah tekanan pada kulit.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l14 level1 lfo22; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Mandikan dengan air hangat dan sabun ringan. Rasional : mempertahankan kebersihan tanpa mengiritasi kulit.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l14 level1 lfo22; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kaji kulit yang kering terhadap efek samping terapi kanker. Rasional : efek kemerahan atau kulit kering dan pruritus, ulserasi dapat terjadi dalam area<br />
radiasi pada beberapa agen kemoterapi.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l14 level1 lfo22; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">e.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Anjurkan pasien untuk tidak menggaruk dan menepuk kulit yang kering. Rasional: membantu mencegah friksi atau trauma kulit.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l14 level1 lfo22; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">f.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Dorong masukan kalori protein yang adekuat. Rasional : untuk mencegah keseimbangan nitrogen yang negative.<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l14 level1 lfo22; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">g.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Pilih pakaian yang longgar dan lembut diatas area yang teradiasi. Rasional : untuk meminimalkan iritasi tambahan.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l3 level1 lfo17; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">9)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Gangguan citra tubuh berhubungan dengan alopesia atau perubahan cepat pada<br />
penampilan.</span></i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><br />
Kriteria hasil : pasien atau keluarga menunjukkan perilaku koping positif.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Intervensi :<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l27 level1 lfo23; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Dorong anak untuk memilih wig (anak perempuan) yang serupa gaya dan warna rambut anak sebelum rambut mulai rontok. Rasional : untuk membantu mengembangkan penyesuaian rambut terhadap kerontokan rambut.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l27 level1 lfo23; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Berikan penutup kepala yang adekuat selama pemajanan pada sinar matahari, angin atau dingin. Rasional : karena hilangnya perlindungan rambut.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l27 level1 lfo23; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Anjurkan untuk menjaga agar rambut yang tipis itu tetap bersih, pendek dan halus. Rasional : untuk menyamarkan kebotakan parsial.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l27 level1 lfo23; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Jelaskan bahwa rambut mulai tumbuh dalam 3 hingga 6 bulan dan mungkin warna atau teksturnya agak berbeda. Rasional : untuk menyiapkan anak dan keluarga terhadap perubahan penampilan rambut baru.<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l27 level1 lfo23; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">e.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Dorong hygiene, berdan, dan alat alat yang sesuai dengan jenis kelamin, misalnya wig, skarf, topi, tata rias, dan pakaian yang menarik. Rasional : untuk meningkatkan penampilan.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l3 level1 lfo17; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">10)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Perubahan proses keluarga berhubungan dengan mempunyai anak yang menderita leukemia.<br />
</span></i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kriteria hasil : pasien atau keluarga menunjukkan pengetahuan tentang prosedur diagnostic atau terapi.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Intervensi :<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l11 level1 lfo24; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Jelaskan alasan setiap prosedur yang akan dilakukan pda anak. Rasional : untuk meminimalkan kekhawatiran yang tidak perlu. <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l11 level1 lfo24; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Jadwalkan waktu agar keluarga dapat berkumpul tanpa gangguan dari staff. Rasional: untuk mendorong komunikasi dan ekspresi perasaan.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l11 level1 lfo24; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Bantu keluarga merencanakan masa depan, khususnya dalam membantu anak menjalani kehidupan yang normal. Rasional : untuk meningkatkan perkembangan anak yang optimal.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l11 level1 lfo24; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Dorong keluarga untuk mengespresikan perasaannya mengenai kehidupan anak<br />
sebelum diagnosa dan prospek anak untuk bertahan hidup. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Rasional : memberikan kesempatan pada keluarga untuk menghadapi rasa takut secara<br />
realistis.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l11 level1 lfo24; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">e.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Diskusikan bersama keluarga bagaimana mereka memberitahu anak tentang hasil<br />
tindakan dan kebutuhan terhadap pengobatan dan kemungkinan terapi tambahan.<br />
Rasional : untuk mempertahankan komunikasi yang terbuka dan jujur.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l11 level1 lfo24; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">f.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Hindari untuk menjelaskan hal-hal yang tidak sesuai dengan kenyataan yang ada.<br />
Rasional : untuk mencegah bertambahnya rasa khawatiran keluarga.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l3 level1 lfo17; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">11)<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; line-height: normal;"> </span></span></i><!--[endif]--><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Antisipasi berduka berhubungan dengan perasaan potensial kehilangan anak.</span></i><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></i></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kriteria hasil : pasien atau keluarga menerima dan mengatasi kemungkinan kematian anak.<br />
Intervensi :<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo25; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kaji tahapan berduka terhadap anak dan keluarga. Rasional : pengetahuan tentang proses berduka memperkuat normalitas perasaan atau reaksi terhadap apa yang dialami dan dapat membantu pasien dan keluarga lebih efektif menghadapi kondisinya.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo25; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Berikan kontak yang konsisten pada keluarga. Rasional : untuk menetapkan hubungan saling percaya yang mendorong komunikasi.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo25; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Bantu keluarga merencanakan perawatan anak, terutama pada tahap terminal. Rasional : untuk meyakinkan bahwa harapan mereka diimplementasikan.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 58.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo25; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d.<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Fasilitasi anak untuk mengespresikan perasaannya melalui bermain<br />
Rasional : memperkuat normalitas perasaan atau reaksi terhadap apa yang dialami.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l20 level1 lfo26; text-indent: -18.0pt;"><!--[if !supportLists]--><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Implementasi <o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Implementasi keperawatan adalah pelaksanaan dari perencanaan keperawatan yang telah dibuat untuk mencapai hasil yang efektif. Dalam pelaksanaan implementasi keperawatan, penguasaan keterampilan dan pengetahuan harus dimiliki oleh setiap perawat sehingga pelayanan yang diberikan baik mutunya. Dengan demikian tujuan dari rencana yang telah ditentukan dapat tercapai (Wong. D.L.2004:hal.331). <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l20 level1 lfo26; text-indent: -18.0pt;"><!--[if !supportLists]--><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">5.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Evaluasi <o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Evaluasi adalah suatu penilaian terhadap keberhasilan rencana keperawatan untuk memenuhi kebutuhan-kebutuhan klien. Menurut Wong. D.L, (2004 hal 596-610) hasil yang diharapkan pada klien dengan leukemia adalah :<o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Anak tidak menunjukkan tanda-tanda infeksi.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Berpartisipasi dalam aktifitas sehari-sehari sesuai tingkat kemampuan, adanya laporan<br />
peningkatan toleransi aktifitas.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Anak tidak menunjukkan bukti-bukti perdarahan.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Anak menyerap makanan dan cairan, anak tidak mengalami mual dan muntah.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">5)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Membran mukosa tetap utuh, ulkus menunjukkan tidak adanya rasa tidak nyaman.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">6)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Masukan nutrisi adekuat.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">7)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Anak beristirahat dengan tenang, tidak melaporkan dan atau menunjukkan bukti-bukti<br />
ketidaknyamanan, tidak mengeluhkan perasaan tidak nyaman.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">8)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kulit tetap bersih dan utuh.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">9)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Anak mengungkapkan masalah yang berkaitan dengan kerontokan rambut, anak<br />
membantu menentukan metode untuk mengurangi efek kerontokan rambut dan<br />
menerapkan metode ini dan anak tampak bersih, rapi, dan berpakaian menarik.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">10)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Anak dan keluarga menunjukkan pemahaman tentang prosedur, keluarga menunjukkan<br />
pengetahuan tentang penyakit anak dan tindakannya. Keluarga mengekspresikan perasaan serta kekhawatirannya dan meluangkan waktu bersama anak.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">11)<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Keluarga tetap terbuka untuk konseling dan kontak keperawatan, keluarga dan anak<br />
mendiskusikan rasa takut, kekhawatiran, kebutuhan dan keinginan mereka pada tahap<br />
terminal, pasien dan keluarga mendapat dukungan yang adekuat.<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; tab-stops: 0cm; text-align: justify;"><b><span lang="EN-US" style="font-family: "Baskerville Old Face","serif"; font-size: 18.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman";">Sumber</span></b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">: <o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l5 level1 lfo28; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Sunar Trenggana, Dr. Leukemia ; Penuntun bagi orang tua Bagian Ilmu Kesehatan<br />
Anak, FK UNHAS/SMF Anak RS DR. Wahidin Sudirohusodo Makassar.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l5 level1 lfo28; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Susan Martin Tucker, Mary M. Canabbio, Eleanor Yang Paquette, Majorie Fife Wells,<br />
1998, Standar Perawatan Pasien, volume 4, EGC.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l5 level1 lfo28; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Abdoerrachman MH, dkk, 1998, Ilmu Kesehatan Anak, Buku I, penerbit Fakultas<br />
Kedokteran UI, Jakarta.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l5 level1 lfo28; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Anna Budi Keliat, SKp, MSc., 1994, Proses Keperawatan, EGC.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l5 level1 lfo28; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Marilynn E. Doenges, Mary Prances Moorhouse, Alice C. Beissler, 1993, Rencana<br />
Asuhan Keperawatan, EGC.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l5 level1 lfo28; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Rosa M Sacharin, 1996, Prinsip Keperawatan Pediatrik, edisi 2, Jakarta.<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l5 level1 lfo28; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;">Ø<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Soeparman, Sarwono Waspadji, 1998, Ilmu Penyakit Dalam, jilid II, Balai Penerbit<br />
FKUI, Jakarta.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div>salnihttp://www.blogger.com/profile/00126668517852477742noreply@blogger.com0Universitas Sam Ratulangi, Jalan Kampus Selatan, Manado, Indonesia1.455717 124.82716299999993-9.460461 109.88575649999993 12.371895 139.76856949999993tag:blogger.com,1999:blog-8321145958076225978.post-55475377472789347002012-03-14T09:17:00.000-07:002012-03-14T09:17:26.970-07:00ANEMIA<div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; mso-add-space: auto; mso-list: l0 level1 lfo1; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><b><span lang="EN-US" style="line-height: 150%;">A.<span style="font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="EN-US" style="line-height: 150%;">Latar Belakang<o:p></o:p></span></b></span></div><div class="MsoNormal" style="margin-left: 18.0pt; text-align: justify; text-indent: 18.0pt;"><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;">Anemia adalah suatu keadaan dimana kadar hemoglobin (Hb) dalam darah kurang dari normal. Faktor-faktor penyebab anemia gizi besi adalah status gizi yang dipengaruhi oleh pola makanan, social ekonomi keluarga, lingkungan dan status kesehatan. Khumaidi (1989) mengemukakan bahwa faktor-faktor yang melatarbelakangi tingginya prevalensi anemia gizi besi di negara berkembang adalah keadaan sosial ekonomi rendah meliputi pendidikan orang tua dan penghasilan yang rendah serta kesehatan pribadi di lingkungan yang buruk. <o:p></o:p></span></span></div><div class="MsoNormal" style="margin-left: 18.0pt; text-align: justify; text-indent: 18.0pt;"><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;">Meskipun anemia disebabkan oleh berbagai faktor, namun lebih dari 50 % kasus anemia yang terbanyak diseluruh dunia secara langsung disebabkan oleh kurangnya masukan zat gizi besi. Selain itu penyebab anemia gizi besi dipengaruhi oleh kebutuhan tubuh yang meningkat, akibat mengidap penyakit kronis dan kehilangan darah karena menstruasi dan infeksi parasit (cacing). Di negara berkembang seperti Indonesia penyakit kecacingan masih merupakan masalah yang besar untuk kasus anemia gizi besi, karena diperkirakan cacing menghisap darah 2-100 cc setaip harinya. Kekurangan zat besi dapat menimbulkan gangguan atau hambatan pada pertumbuhan, baik sel tubuh maupun sel otak. Kekurangan kadar Hb dalam darah dapat menimbulkan gejala lesu, lemah, letih, lelah dan cepat lupa.<o:p></o:p></span></span></div><div class="MsoNormal" style="margin-left: 18.0pt; text-align: justify; text-indent: 18.0pt;"><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;"> Akibatnya dan menurunkan prestasi belajar, olah raga dan produktifitas kerja. Selain itu anemia gizi besi akan menurunkan daya tahan tubuh dan mengakibatkan mudah terkena infeksi. Upaya pencegahan dan penanggulangan anemia yang telah dilakukan selama ini ditujukan pada ibu hamil, sedangkan remaja putri secara dini belum terlalu diperhatikan. Agar anemia bisa dicegah atau diatasi maka harus banyak mengkonsumsi makanan yang kaya zat besi. Selain itu penanggulangan anemia defisiensi besi dapat dilakukan dengan pencegahan infeksi cacaing dan pemberian tablet Fe yang dikombinasikan dengan vitamin C.</span></span></div><div class="MsoNormal" style="margin-left: 18.0pt; text-align: justify; text-indent: 18.0pt;"><span lang="EN-US" style="font-family: Times, 'Times New Roman', serif; line-height: 115%; text-indent: 18pt;">B. </span><b style="font-family: Times, 'Times New Roman', serif; line-height: 150%; text-indent: -18pt;"><span style="line-height: 150%;"><span style="font-weight: normal; line-height: normal;"> </span></span></b><b style="font-family: Times, 'Times New Roman', serif; line-height: 150%; text-indent: -18pt;"><span style="line-height: 150%;">Pengertian</span></b></div><div class="MsoNormal" style="margin-left: 18.0pt; text-indent: 18.0pt;"><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;">Anemia adalah istilah yang menunjukan rendahnya hitungan sel darah merah dan kadar hemoglobin dan hematokrit di bawah normal (Smeltzer, 2002 : 935).<o:p></o:p></span></span></div><div class="MsoNormal" style="margin-left: 18.0pt; text-indent: 18.0pt;"><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;">Secara laboratories, anemia dijabarkan sebagai penurunan kadar hemoglobin serta hitung eritrosit dan hematokrit dibawah normal.<o:p></o:p></span></span></div><div class="MsoNormal" style="margin-left: 18.0pt; text-indent: 18.0pt;"><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;">Batasan umum digunakan adalah criteria WHO pada tahun 1968. Dinyatakan anemia bila terdapat nilai dengan criteria sebagai berikut .<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpFirst" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l4 level1 lfo3; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Laki-laki dewasa Hb <13gr/dl<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l4 level1 lfo3; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Perempuan dewasa tidak hamil Hb <12gr/dl<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l4 level1 lfo3; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Perempuan hamil Hb < 11gr/dl<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l4 level1 lfo3; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Anak usia 6-14 tahun Hb <12gr/dl<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l4 level1 lfo3; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">Ø<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Anak usia 6 bulan-6tahun Hb <11gr/dl<o:p></o:p></span></span></div><div class="MsoNormal"><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;"> Untuk anemia di klinik, rumah sakit, atau praktek klinik pada umumnya dinyatakan anemia bila terdapat nilai sebagai berikut.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpFirst" style="margin-left: 54.0pt; mso-add-space: auto; mso-list: l2 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">·<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Hb < 10gr/dl<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 54.0pt; mso-add-space: auto; mso-list: l2 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">·<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Hematokrit < 30%<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 54.0pt; mso-add-space: auto; mso-list: l2 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">·<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Eritrosit < 2,8 juta/mm<sup>3</sup><o:p></o:p></span></span></div><div class="MsoNormal" style="margin-left: 36.0pt;"><br />
</div><div class="MsoNormal"><b><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;">Derajat anemia<o:p></o:p></span></span></b></div><div class="MsoNormal"><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;">Derajat anemia ditentukan oleh Hb. Klasifikasi derajat anemia yang umum dipakai adalah sebagai berikut.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpFirst" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l1 level1 lfo4; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">§<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Ringan sekali Hb 10 gr/dl-13 gr/dl<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l1 level1 lfo4; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">§<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Ringan Hb 8 gr/dl-9,9 gr/dl<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l1 level1 lfo4; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">§<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Sedang Hb 6 gr/dl-7,9 gr/dl<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l1 level1 lfo4; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">§<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Berat Hb <6 gr/dl<o:p></o:p></span></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><b><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;">Prevalensi <o:p></o:p></span></span></b></div><div class="MsoNormal"><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;">Perkiraan prevalensi anemia di Indonesia menurut Husiani, dkk. Tergambar dalam table dibawah ini.<o:p></o:p></span></span></div><div align="center" class="MsoNormal" style="text-align: center;"><br />
</div><div align="center" class="MsoNormal" style="text-align: center;"><b><i><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;">Prevalensi anemia di Indonesia<o:p></o:p></span></span></i></b></div><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 1184;"><tbody>
<tr> <td style="border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 239.4pt;" valign="top" width="319"> <div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;"><b><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;">Kelompok populasi<o:p></o:p></span></span></b></div></td> <td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 239.4pt;" valign="top" width="319"> <div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;"><b><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;">Angka prevalensi<o:p></o:p></span></span></b></div></td> </tr>
<tr> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 239.4pt;" valign="top" width="319"> <div class="MsoListParagraph" style="margin-bottom: 0.0001pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US">1. </span><!--[endif]--><span lang="EN-US">Anak prasekolah <o:p></o:p></span></span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 239.4pt;" valign="top" width="319"> <div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;">30-40%<o:p></o:p></span></span></div></td> </tr>
<tr> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 239.4pt;" valign="top" width="319"> <div class="MsoListParagraph" style="margin-bottom: 0.0001pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US">2. </span><!--[endif]--><span lang="EN-US">Anak usia sekolah <o:p></o:p></span></span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 239.4pt;" valign="top" width="319"> <div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;">25-35%<o:p></o:p></span></span></div></td> </tr>
<tr> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 239.4pt;" valign="top" width="319"> <div class="MsoListParagraph" style="margin-bottom: 0.0001pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US">3. </span><!--[endif]--><span lang="EN-US">Dewasa tidak hamil<o:p></o:p></span></span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 239.4pt;" valign="top" width="319"> <div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;">30-40%<o:p></o:p></span></span></div></td> </tr>
<tr> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 239.4pt;" valign="top" width="319"> <div class="MsoListParagraph" style="margin-bottom: 0.0001pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US">4. </span><!--[endif]--><span lang="EN-US">Hamil<o:p></o:p></span></span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 239.4pt;" valign="top" width="319"> <div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;">50-70%<o:p></o:p></span></span></div></td> </tr>
<tr> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 239.4pt;" valign="top" width="319"> <div class="MsoListParagraph" style="margin-bottom: 0.0001pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US">5. </span><!--[endif]--><span lang="EN-US">laki- laki dewasa<o:p></o:p></span></span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 239.4pt;" valign="top" width="319"> <div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;">20-30%<o:p></o:p></span></span></div></td> </tr>
<tr> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 239.4pt;" valign="top" width="319"> <div class="MsoListParagraph" style="margin-bottom: 0.0001pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US">6. </span><!--[endif]--><span lang="EN-US">pekerja berpenghasilan rendah<o:p></o:p></span></span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 239.4pt;" valign="top" width="319"> <div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;">30-40%<o:p></o:p></span></span></div></td> </tr>
</tbody></table><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;">Untuk angka prevalensi anemia di dunia snagat bervariasi, bergantung pada goegrafi dan taraf sosial ekonomi masyarakat.<o:p></o:p></span></span></div><div class="MsoNormal"><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;"><br />
</span></span></div><div class="MsoNormal"><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;"><b>C</b>. </span><b style="line-height: 115%; text-indent: -18pt;"><span lang="EN-US">Etiologi</span></b></span></div><div class="MsoNormal"><span lang="EN-US" style="line-height: 115%;"></span></div><div style="margin-left: 18pt; text-indent: -18pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"> <!--[endif]--><o:p></o:p></span></span></div><div style="text-indent: 18pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;">Penyebab tersering dari anemia adalah kekurangan zat gizi yang diperlukan untuk sintesis eritrosit, antara lain besi, vitamin B12 dan asam folat. Selebihnya merupakan akibat dari beragam kondisi seperti perdarahan, kelainan genetik, penyakit kronik, keracunan obat, dan sebagainya.<o:p></o:p></span></span></div><div style="text-indent: 18pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"><br />
<span class="fullpost">Penyebab umum dari anemia:<o:p></o:p></span></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"> Perdarahan hebat<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"> Akut (mendadak)<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"> Kecelakaan<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"> Pembedahan<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"> Persalinan<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"> Pecah pembuluh darah<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"> Penyakit Kronik (menahun)<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"> Perdarahan hidung<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"> Wasir (hemoroid)<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"> Ulkus peptikum<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"> Kanker atau polip di saluran pencernaan<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"> Tumor ginjal atau kandung kemih<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"> Perdarahan menstruasi yang sangat banyak<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"> Berkurangnya pembentukan sel darah merah<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"> Kekurangan zat besi<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"> Kekurangan vitamin B12<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"> Kekurangan asam folat<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"> Kekurangan vitamin C<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"> Penyakit kronik<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"> Meningkatnya penghancuran sel darah merah<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"> Pembesaran limpa<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"> Kerusakan mekanik pada sel darah merah<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"> Reaksi autoimun terhadap sel darah merah<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"> Hemoglobinuria nokturnal paroksismal<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"> Sferositosis herediter<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"> Elliptositosis herediter<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"> Kekurangan G6PD<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"> Penyakit sel sabit<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"> Penyakit hemoglobin C <o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"> Penyakit hemoglobin S-C<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"> Penyakit hemoglobin E<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"> Thalasemia (Burton, 1990).<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"><br />
</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="EN-US"></span></div><div class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;"><span style="font-family: Times, 'Times New Roman', serif;"><b><span lang="EN-US" style="line-height: 115%;">D.<span style="font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="EN-US" style="line-height: 115%;">Patofisiologi <o:p></o:p></span></b></span></div><div class="MsoNormal" style="text-indent: 36pt;"><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;">Timbulnya anemia mencerminkan adanya kegagalan sumsum tulang atau kehilangan sel darah merah berlebihan atau kedunya. Kegagalan sumsum tulang dapat terjadi akibat kekurangan nutrisi, pajanan toksik, invasi tumor, atau akibat penyebab yang tidak diketahui. <o:p></o:p></span></span></div><div class="MsoNormal" style="text-indent: 36pt;"><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;">Sel darah merah dapat hilang melalui perdarahan atau hemolisis (destruksi) pada kasus yang disebut terakhir, masalah dapat akibat efek sel darah merah yang tidak sesuai dengan ketahanan sel darah merah normal atau akibat beberapa factor diluar sel darah merah yang menyebabkan destruksi sel darah merah.<br />
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<!--[endif]--><o:p></o:p></span></span></div><div class="MsoNormal" style="text-indent: 36pt;"><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;">Lisis sel darah merah (disolusi) terjadi terutama dalam system fagositik atau dalam system retikuloendotelial terutama dalam hati dan limpa. Sebagai hasil samping proses ini bilirubin yang sedang terbentuk dalam fagosit akan masuk dalam aliran darah. Setiap kenaikan destruksi sel darah merah (hemolisis) segera direpleksikan dengan meningkatkan bilirubin plasma (konsentrasi normalnya 1 mg/dl atau kurang ; kadar 1,5 mg/dl mengakibatkan ikterik pada sclera.<o:p></o:p></span></span></div><div class="MsoNormal" style="text-indent: 36pt;"><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">Anemia merupakan penyakit kurang darah yang ditandai rendahnya kadar hemoglobin (Hb) dan sel darah merah (eritrosit). Fungsi darah adalah membawa makanan dan oksigen ke seluruh organ tubuh. Jika suplai ini kurang, maka asupan oksigen pun akan kurang. Akibatnya dapat menghambat kerja organ-organ penting, Salah satunya otak. Otak terdiri dari 2,5 miliar sel bioneuron. Jika kapasitasnya kurang, maka otak akan seperti komputer yang memorinya lemah, Lambat menangkap. Dan kalau sudah rusak, tidak bisa diperbaiki (Sjaifoellah, 1998).<br />
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<!--[endif]--></span><span lang="EN-US" style="line-height: 115%;"><o:p></o:p></span></span></div><div class="MsoNormal"><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;">Pada dasarnya gejala anemia timbul karena dua hal berikut.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpFirst" style="text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">1.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Anoksia organ target karena berkurangya jumlah oksigen yang dapat dibawah oleh darah ke jaringan.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpLast" style="text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">2.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Mekanisme kompensasi tubuh terhadap anemia<o:p></o:p></span></span></div><div class="MsoNormal"><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;">Kombinasi kedunya ini akan menimbulkan gejala yang timbul disebut <b>Sindrom anemia<o:p></o:p></b></span></span></div><div class="MsoNormal"><br />
</div><div class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;"><span style="font-family: Times, 'Times New Roman', serif;"><b><span lang="EN-US" style="line-height: 115%;">E.<span style="font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="EN-US" style="line-height: 115%;">Manifestasi klinik<o:p></o:p></span></b></span></div><div class="MsoNormal" style="text-indent: 18pt;"><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;">Gejala umum anemia disebut juga sebagai sindromo anemia atau <i>anemic syndrome.</i> Gejala umum anemia atau sindrom anemia adalah gejala yang timbul pada semua jenis anemia pada kadar hemoglobin yang sudah menurun sedemikian rupa di bawah tiitik tertentu. Gejala ini timbul karena anoksia organ target dan mekanisme kompensasi tubuh terhadap penurunan hemoglobin. Gejala-gejala tersebut diklasifikasikan menurut organ yang terkena.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpFirst" style="text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">1.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">System kardiovaskuler : lesu, cepat lelah, palpitasi, takikardi, sesak nafas saat beraktivitas, angina pectoris, dan gagal jantung.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">2.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">System saraf : sakit kepala, pusing, telinga mendering, mata berkunang, kelemahan otot, iritabilitas, lesu, perasaan dingin pada ekstermitas.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">3.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">System urogenital : gangguan haid dan libido menurun.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpLast" style="text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">4.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Epitel : warna pucat pada kulit dan mukosa, elastisitas kulit menurun, serta rambut tipis dan halus.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpLast" style="text-indent: -18pt;"><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;"><br />
</span></span></div><div class="MsoNormal"><b><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;">Gejala khas masing-masing Anemia<o:p></o:p></span></span></b></div><div class="MsoNormal"><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;">Gejala khas yang menjadi ciri dari masing-masing jenis anemiaadalah sebagai berikut.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpFirst" style="text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">1.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Anemia defisiansi besi : disfagia, atrofi papil lidah, stomatitis angularis.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">2.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Anemia dafesiansi asam folat : lidah merah <i>( buffy tongue</i>).<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">3.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Anemia hemolitik : ikterus dan hepatosplenomegali.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpLast" style="text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">4.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Anemia aplastik : perdarahan kulit atau mokusa dan tanda-tanda infeksi<o:p></o:p></span></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><b><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;">Gejala akibat penyakit dasar<o:p></o:p></span></span></b></div><div class="MsoNormal"><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;">Gejala penyakit dasar yang menjadi penyebab anemi. Gejal ini timbul karena penyakit-penyakit yang mendasari anemia tersebut. Misalnya anemia defisiensi besi yang disebabkan oleh infeksi cacing tambang berat akan menimbulkan gejala seperti pembesaran parotis dan telapak tanga berwarna kuning seperti jemari.<o:p></o:p></span></span></div><div class="MsoNormal"><br />
</div><div class="MsoListParagraph" style="margin-left: 18pt; text-indent: -18pt;"><span style="font-family: Times, 'Times New Roman', serif;"><b><span lang="EN-US" style="line-height: 115%;">F.<span style="font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="EN-US" style="line-height: 115%;">Klasifikasi Anemia<o:p></o:p></span></b></span></div><div class="MsoNormal"><br />
</div><div class="MsoListParagraphCxSpFirst" style="text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">1.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Anemia Aplastik<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle"><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;">Merupakan Anemia Normokromik, normositer yang disebabkan oleh disfungsi sum-sum tulang, sedangkan sel darah merah yang mati tidak diganti.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle"><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;">Gejala : <o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 54pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">a.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Sindrom Anemia : gejala anemia bervariasi, mulai ringan sampai berat.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 54pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">b.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Gejala perdarahan: paling sering timbul dalam bentuk perdarahan seperti petekie dan ekimosis<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 54pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">c.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Tanda-tanda infeksi dapat berupa ulserasi mulut atau tenggorokan, dan sepsis.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 54pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">d.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Organomegali dapat berupa hepatomegali dan splenomegali<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">2.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Anemia Defisiensi Besi<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle"><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;">Adalah anemia yang timbul akibat kosongnya cadangan besi tubuh, sehingga penyediaan besi untuk eritropoesis berkurang yang pada akhirnya pembentukan hemoglobin berkurang.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle"><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;">Gejala:<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 54pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">a.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Gejala umum anemia : Jika kadar hemoglobin turun dibawah 7-8 g/dl. Badan akan lemah, lesu cepat lelah, mata berkunang-kunang, serta telinga mendenging.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 54pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">b.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Gejala khas akibat defisiensi besi : Koilorikia (kuku sendok), Atrifi papil lidah (permukaan lidah menjadi licin dan mengkilap), stomatitis angularis (adanya peradangan pada sudut mulut sehingga tampak sebagai bercak berwarna putih pucat), Disfagia(nyeri menelan)<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">3.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Anemia Megalobalastik<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle"><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;">Adalah anemia yang khas ditandai oleh adanya sel megaloblash dalam sum-sum tulang. Sel megaloblash adalah sel precursor eritrosit dengan bentuk sel yang besar disertai adanya kes, dimana maturasi sitoplasma normal tetapi inti besar dengan susunan kromosom yang longgar.Anemia yang disebabkan karena defisiensi Vit B12 dan asam folat<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle"><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;">Gejala:<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 54pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">a.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Ikterus ringan akibat pemecahan globin<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 54pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">b.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Glositis dengan lidah berwarna merah, stomatitis angularis<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 54pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">c.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Purpura trobositopeni karena maturasi megakariosit terganggu.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">4.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Anemia Hemolitik<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle"><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;">Adalah anemia yang disebabkan oleh proses hemolisis yaitu pemecahan eritrosit dalam pembuluh darah sebelum waktunya.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">5.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Anemia sel sabit<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle"><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;">Sejenis anemia kongenital dimana sel darah merah berbentuk menyerupai sabit, karena adanya hemoglobin abnormal.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle"><br />
</div><div class="MsoListParagraphCxSpLast" style="margin-left: 18pt; text-indent: -18pt;"><span style="font-family: Times, 'Times New Roman', serif;"><b><span lang="EN-US" style="line-height: 115%;">G.<span style="font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="EN-US" style="line-height: 115%;">Pemeriksaan Diagnostik<o:p></o:p></span></b></span></div><div class="MsoNormal"><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;">1 . Pemeriksaan laboratorium hematologis<o:p></o:p></span></span></div><div class="MsoNormal"><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;">pemeriksaan laboratorium hematologis dilakuka secar a bertahap sebagai berikut.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpFirst" style="text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">a.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Tes penyaring : kadar hemoglobin apusan darah tepi<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">b.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Pemeriksaan rutin : leukosit, tromosit, LED.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpLast" style="text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">c.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Pemeriksaan sumsum tulang <o:p></o:p></span></span></div><div class="MsoNormal"><span lang="EN-US" style="line-height: 115%;"><span style="font-family: Times, 'Times New Roman', serif;">2 .Pemeriksaan labiratorium nonhematologis, meliputi :<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpFirst" style="text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">a.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Faal ginjal <o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">b.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Faal endokrin<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">c.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Asam urat<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">d.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Faal hati<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpMiddle" style="text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">e.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Biakan kuman<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpLast"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span lang="EN-US" style="line-height: 150%;"><span style="font-family: Times, 'Times New Roman', serif;">PEMERIKSAAN PENUNJANG<o:p></o:p></span></span></b></div><ul style="margin-top: 0cm;" type="disc"><li class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l2 level1 lfo10; tab-stops: list 36.0pt; text-align: justify;"><span lang="FI" style="line-height: 150%;"><span style="font-family: Times, 'Times New Roman', serif;">Uji Hematologi/Lab. Darah : untuk menentukan jenis dan penyebab anemia<o:p></o:p></span></span></li>
</ul><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 150%;">-<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Kadar Hb/Hmt<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 150%;">-<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Indeks eritrosit, leukosit dan trombosit<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 150%;">-<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Kadar Fe, asam folat, Vitamin B12<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 150%;">-<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Waktu pendarahan, waktu protrombin dan waktu tromboplastin<o:p></o:p></span></span></div><ul style="margin-top: 0cm;" type="disc"><li class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l2 level1 lfo10; tab-stops: list 36.0pt; text-align: justify;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: Times, 'Times New Roman', serif;">Aspirasi dan biopsy sumsum tulang<o:p></o:p></span></span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l2 level1 lfo10; tab-stops: list 36.0pt; text-align: justify;"><span lang="EN-US" style="line-height: 150%;"><span style="font-family: Times, 'Times New Roman', serif;">Penatalaksanaan<o:p></o:p></span></span></li>
</ul><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 150%;">-<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Ditujukan untuk mencari penyebab<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; margin-left: 72pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 150%;">-<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 150%;">Mengganti darah yang hilang<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;"><span lang="FI" style="line-height: 150%;"><span style="font-family: Times, 'Times New Roman', serif;">Dan penatalaksanaan tergantung dari jenis anemia (Aplasti, hemolitik, defisiensi besi, megaloblastik, dll)<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;"><span lang="FI" style="line-height: 150%;"><span style="font-family: Times, 'Times New Roman', serif;"><br />
</span></span></div><div class="MsoListParagraphCxSpFirst" style="margin-left: 18pt; text-indent: -18pt;"><span style="font-family: Times, 'Times New Roman', serif;"><b><span lang="EN-US" style="line-height: 115%;">H.<span style="font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><b><span lang="EN-US" style="line-height: 115%;">Penatalaksanaan Keperawatan<o:p></o:p></span></b></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 18pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 18pt;"><b style="font-family: Times, 'Times New Roman', serif; line-height: 150%; text-align: justify; text-indent: -18pt;"><span lang="EN-US">PENGKAJIAN</span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 54pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><strong><span lang="EN-US" style="line-height: 115%;">a.<span style="font-weight: normal; line-height: normal;"> </span></span></strong><!--[endif]--><strong><span lang="EN-US" style="line-height: 115%;">Pengumpulan data<o:p></o:p></span></strong></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 31.5pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">1.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Identifikasi klien : nama klien, jenis kelamin, status perkawinan, agama, suku / bangsa, pendidikan, pekerjaan, dan alamat.<b><o:p></o:p></b></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 31.5pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">2.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Identitas penanggung<b><o:p></o:p></b></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 31.5pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">3.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Keluhan utama dan riwayat kesehatan masa lalu<br />
Keluhan utama : pada keluhan utama akan nampak semua apa yang dirasakan klien pada saat itu seperti kelemahan, nafsu makan menurun dan pucat.<br />
Riwayat kesehatan masa lalu : riwayat kesehatan masa lalu akan memberikan informasi kesehatan atau penyakit masa lalu yang pernah diderita,<br />
Pemerisaan fisik<b><o:p></o:p></b></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 31.5pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">4.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Aktivitas / istirahat<br />
Gejala : Keletihan / kelemahan terus-menerus sepanjang hari.<br />
Kebutuhan tidur lebih besar dan istirahat.<br />
Tanda : Gangguan gaya berjalan<b><o:p></o:p></b></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 31.5pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">5.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Sirkulasi<br />
Gejala : Palpitasi atau nyeri.<br />
Tanda : Tekanan darah menurun, nadi lemah, pernafasan lambat, warna kulit pucat atai sianosis, konjungtiva pucat.<b><o:p></o:p></b></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 31.5pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">6.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Eliminasi<br />
Gejala : Sering berkemih, nokturia (berkemih malam hari.<b><o:p></o:p></b></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 31.5pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">7.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Integritas ego<br />
Gejala : Kuatir, takut.<br />
Tanda : Ansietas, gelisah.<b><o:p></o:p></b></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 31.5pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">8.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Makanan / cairan<br />
Gejala : Nafsu makan menurun.<br />
Tanda : Penurunan berat badan, turgor kulit buruk dengan bekas gigitan, tampak kulit dan membran mukosa kering.<b><o:p></o:p></b></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 31.5pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">9.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Hygiene<br />
Gejala : Keletihan / kelemahan<br />
Tanda : Penampilan tidak rapi.<b><o:p></o:p></b></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 31.5pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">10.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Neurosensori<br />
Gejala : Sakit kepala / pusing, gangguan penglihatan.<br />
Tanda : Kelemahan otot, penurunan kekuatan otot.<b><o:p></o:p></b></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 31.5pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">11.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Nyeri / kenyamanan<br />
Gejala : Nyeri pada punggung, sakit kepala.<br />
Tanda : Penurunan rentang gerak, gelisah.<b><o:p></o:p></b></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 31.5pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">12.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Pernafasan<br />
Gejala : Dispnea saat bekerja.<br />
Tanda : Mengi<b><o:p></o:p></b></span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 31.5pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">13.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Keamanan<br />
Gejala : Riwayat transfusi.<br />
Tanda : Demam ringan, gangguan penglihatan.<b><o:p></o:p></b></span></span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 31.5pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;">14.<span style="line-height: normal;"> </span></span><!--[endif]--><span lang="EN-US" style="line-height: 115%;">Seksualitas<br />
Gejala : Kehilangan libido.<br />
(Doenges, E, Marilynn, 2000, hal : 582 – 585).<b><o:p></o:p></b></span></span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 31.5pt; text-indent: -18pt;"><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US" style="line-height: 115%;"><br />
</span></span></div><div style="margin-left: 36pt; text-indent: -18pt;"><span lang="EN-US" style="font-family: Times, 'Times New Roman', serif; text-indent: -18pt;">B. </span><span lang="EN-US" style="font-family: Times, 'Times New Roman', serif; text-indent: -18pt;">Diagnosa Keperawatan</span><br />
<!--[if !supportLists]--></div><div style="margin-left: 54pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US">1. </span><!--[endif]--><span lang="EN-US">Intoleransi aktivitas berhubungan dengan ketidakseimbangan antara suplai oksigen (pengiriman) dan kebutuhan.<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></span></div><div style="margin-left: 135pt; text-indent: -81pt;"><span style="font-family: Times, 'Times New Roman', serif;"><b><span lang="EN-US">Tujuan</span></b><span lang="EN-US"> : dapat mempertahankan/meningkatkan ambulasi/aktivitas.<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></span></div><div style="margin-left: 135pt; text-indent: -81pt;"><span style="font-family: Times, 'Times New Roman', serif;"><b><span lang="EN-US">Kriteria hasil</span></b><span lang="EN-US"> : -melaporkan peningkatan toleransi aktivitas (termasuk aktivitas sehari-hari)<br />
- menunjukkan penurunan tanda intolerasi fisiologis, misalnya nadi, pernapasan, dan tekanan darah masih dalam rentang normal.<br />
<o:p></o:p></span></span></div><div style="margin-left: 135pt; text-indent: -81pt;"><span style="font-family: Times, 'Times New Roman', serif;"><b><span lang="EN-US">Intervensi :</span></b><span lang="EN-US"><o:p></o:p></span></span></div><div style="margin-left: 72pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US">1. </span><!--[endif]--><span lang="EN-US">Kaji kehilangan atau gangguan keseimbangan, gaya jalan dan kelemahan otot.<o:p></o:p></span></span></div><div style="margin-left: 72pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;">Rasional : menunjukkan perubahan neurology karena defisiensi vitamin B12 mempengaruhi keamanan pasien/risiko cedera.<o:p></o:p></span></span></div><div style="margin-left: 72pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US">2. </span><!--[endif]--><span lang="EN-US">Observasi tanda-tanda vital sebelum dan sesudah aktivitas.<o:p></o:p></span></span></div><div style="margin-left: 72pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;">Rasional : manifestasi kardiopulmonal dari upaya jantung dan paru untuk membawa jumlah oksigen adekuat ke jaringan.<o:p></o:p></span></span></div><div style="margin-left: 72pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US">3. </span><!--[endif]--><span lang="EN-US">Berikan lingkungan tenang, batasi pengunjung, dan kurangi suara bising, pertahankan tirah baring bila di indikasikan.<o:p></o:p></span></span></div><div style="margin-left: 72pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;">Rasional : meningkatkan istirahat untuk menurunkan kebutuhan oksigen tubuh dan menurunkan regangan jantung dan paru.<o:p></o:p></span></span></div><div style="margin-left: 72pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US">4. </span><!--[endif]--><span lang="EN-US">Gunakan teknik menghemat energi, anjurkan pasien istirahat bila terjadi kelelahan dan kelemahan, anjurkan pasien melakukan aktivitas semampunya (tanpa memaksakan diri).<o:p></o:p></span></span></div><div style="margin-left: 72pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;">Rasional : meningkatkan aktivitas secara bertahap sampai normal dan memperbaiki tonus otot/stamina tanpa kelemahan. Meingkatkan harga diri dan rasa terkontrol.<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></span></div><div style="margin-left: 54pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US">2. </span><!--[endif]--><span lang="EN-US">Perubahan perfusi jaringan berhubungan dengan penurunan komponen seluler yang diperlukan untuk pengiriman oksigen/nutrient ke sel.<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></span></div><div style="margin-left: 36pt; text-indent: 18pt;"><span style="font-family: Times, 'Times New Roman', serif;"><b><span lang="EN-US">Tujuan</span></b><span lang="EN-US"> : peningkatan perfusi jaringan<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></span></div><div style="margin-left: 36pt; text-indent: 18pt;"><span style="font-family: Times, 'Times New Roman', serif;"><b><span lang="EN-US">Kriteria hasil</span></b><span lang="EN-US"> : - menunjukkan perfusi adekuat, misalnya tanda vital stabil.<o:p></o:p></span></span></div><div style="margin-left: 36pt; text-indent: 18pt;"><span style="font-family: Times, 'Times New Roman', serif;"><b><span lang="EN-US">Intervensi </span></b><span lang="EN-US">:<o:p></o:p></span></span></div><div style="margin-left: 72pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><b><span lang="EN-US">1.<span style="font-weight: normal;"> </span></span></b><!--[endif]--><span lang="EN-US">Awasi tanda vital kaji pengisian kapiler, warna kulit/membrane mukosa, dasar kuku.<o:p></o:p></span></span></div><div style="margin-left: 72pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;">Rasional : memberikan informasi tentang derajat/keadekuatan perfusi jaringan dan membantu menetukan kebutuhan intervensi.<o:p></o:p></span></span></div><div style="margin-left: 72pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><b><span lang="EN-US">2.<span style="font-weight: normal;"> </span></span></b><!--[endif]--><span lang="EN-US">Tinggikan kepala tempat tidur sesuai toleransi.<o:p></o:p></span></span></div><div style="margin-left: 72pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;">Rasional : meningkatkan ekspansi paru dan memaksimalkan oksigenasi untuk kebutuhan seluler.<o:p></o:p></span></span></div><div style="margin-left: 72pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><b><span lang="EN-US">3.<span style="font-weight: normal;"> </span></span></b><!--[endif]--><span lang="EN-US">Awasi upaya pernapasan ; auskultasi bunyi napas perhatikan bunyi adventisius.<o:p></o:p></span></span></div><div style="margin-left: 72pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;">Rasional : dispnea, gemericik menununjukkan gangguan jajntung karena regangan jantung lama/peningkatan kompensasi curah jantung.<o:p></o:p></span></span></div><div style="margin-left: 72pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><b><span lang="EN-US">4.<span style="font-weight: normal;"> </span></span></b><!--[endif]--><span lang="EN-US">Selidiki keluhan nyeri dada/palpitasi.<o:p></o:p></span></span></div><div style="margin-left: 72pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;">Rasional : iskemia seluler mempengaruhi jaringan miokardial/ potensial risiko infark.<o:p></o:p></span></span></div><div style="margin-left: 72pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><b><span lang="EN-US">5.<span style="font-weight: normal;"> </span></span></b><!--[endif]--><span lang="EN-US">Berikan oksigen tambahan sesuai indikasi.<o:p></o:p></span></span></div><div style="margin-left: 72pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;">Rasional : memaksimalkan transport oksigen ke jaringan.<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></span></div><div style="margin-left: 54pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US">3. </span><!--[endif]--><span lang="EN-US">Risiko tinggi terhadap kerusakan integritas kulit berhubungan dengan perubahan sirkulasi dan neurologist.<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></span></div><div style="margin-left: 36pt; text-indent: 18pt;"><span style="font-family: Times, 'Times New Roman', serif;"><b><span lang="EN-US">Tujuan</span></b><span lang="EN-US"> : dapat mempertahankan integritas kulit.<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></span></div><div style="margin-left: 54pt;"><span style="font-family: Times, 'Times New Roman', serif;"><b><span lang="EN-US">Kriteria hasil</span></b><span lang="EN-US"> : - mengidentifikasi factor risiko/perilaku individu untuk mencegah cedera dermal.<o:p></o:p></span></span></div><div style="margin-left: 54pt;"><b><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;">Intervensi:<o:p></o:p></span></span></b></div><div style="margin-left: 72pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US">1. </span><!--[endif]--><span lang="EN-US">Kaji integritas kulit, catat perubahan pada turgor, gangguan warna, hangat local, eritema, ekskoriasi.<b><o:p></o:p></b></span></span></div><div style="margin-left: 72pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;">Rasional : kondisi kulit dipengaruhi oleh sirkulasi, nutrisi dan imobilisasi. Jaringan dapat menjadi rapuh dan cenderung untuk infeksi dan rusak.<o:p></o:p></span></span></div><div style="margin-left: 72pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US">2. </span><!--[endif]--><span lang="EN-US">Reposisi secara periodic dan pijat permukaan tulang apabila pasien tidak bergerak atau ditempat tidur.<b><o:p></o:p></b></span></span></div><div style="margin-left: 72pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;">Rasional : meningkatkan sirkulasi kesemua kulit, membatasi iskemia jaringan/mempengaruhi hipoksia seluler.<o:p></o:p></span></span></div><div style="margin-left: 72pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US">3. </span><!--[endif]--><span lang="EN-US">Anjurkan pemukaan kulit kering dan bersih. Batasi penggunaan sabun.<b><o:p></o:p></b></span></span></div><div style="margin-left: 72pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;">Rasional : area lembab, terkontaminasi, memberikan media yang sangat baik untuk pertumbuhan organisme patogenik. Sabun dapat mengeringkan kulit secara berlebihan.<o:p></o:p></span></span></div><div style="margin-left: 72pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US">4. </span><!--[endif]--><span lang="EN-US">Bantu untuk latihan rentang gerak.<b><o:p></o:p></b></span></span></div><div style="margin-left: 72pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;">Rasional : meningkatkan sirkulasi jaringan, mencegah stasis.<o:p></o:p></span></span></div><div style="margin-left: 72pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US">5. </span><!--[endif]--><span lang="EN-US">Gunakan alat pelindung, misalnya kulit domba, keranjang, kasur tekanan udara/air. Pelindung tumit/siku dan bantal sesuai indikasi. (kolaborasi)<b><o:p></o:p></b></span></span></div><div style="margin-left: 72pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;">Rasional : menghindari kerusakan kulit dengan mencegah /menurunkan tekanan terhadap permukaan kulit.<o:p></o:p></span></span></div><div style="margin-left: 54pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US">4. </span><!--[endif]--><span lang="EN-US">Kurang pengetahuan sehubungan dengan kurang terpajan/mengingat ; salah interpretasi informasi ; tidak mengenal sumber informasi.<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></span></div><div style="margin-left: 54pt;"><span style="font-family: Times, 'Times New Roman', serif;"><b><span lang="EN-US">Tujuan</span></b><span lang="EN-US"> : pasien mengerti dan memahami tentang penyakit, prosedur diagnostic dan rencana pengobatan.<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></span></div><div style="margin-left: 54pt;"><span style="font-family: Times, 'Times New Roman', serif;"><b><span lang="EN-US">Kriteria hasil</span></b><span lang="EN-US"> : - pasien menyatakan pemahamannya proses penyakit dan penatalaksanaan penyakit.<br />
- mengidentifikasi factor penyebab.<br />
- Melakukan tiindakan yang perlu/perubahan pola hidup.<o:p></o:p></span></span></div><div style="margin-left: 54pt;"><span style="font-family: Times, 'Times New Roman', serif;"><b><span lang="EN-US">Intervensi</span></b><span lang="EN-US"><o:p></o:p></span></span></div><div style="margin-left: 72pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US">1. </span><!--[endif]--><span lang="EN-US">Berikan informasi tentang anemia spesifik. Diskusikan kenyataan bahwa terapi tergantung pada tipe dan beratnya anemia.<br />
Rasional : memberikan dasar pengetahuan sehingga pasien dapat membuat pilihan yang tepat. Menurunkan ansietas dan dapat meningkatkan kerjasama dalam program terapi.<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></span></div><div style="margin-left: 72pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US">2. </span><!--[endif]--><span lang="EN-US">Tinjau tujuan dan persiapan untuk pemeriksaan diagnostic.<br />
Rasional : ansietas/ketakutan tentang ketidaktahuan meningkatkan stress, selanjutnya meningkatkan beban jantung. Pengetahuan menurunkan ansietas<o:p></o:p></span></span></div><div style="margin-left: 72pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US">3. </span><!--[endif]--><span lang="EN-US">Berikan penjelasan pada klien tentang penyakitnya dan kondisinya sekarang.<br />
Rasional : dengan mengetahui penyakit dan kondisinya sekarang, klien dan keluarganya akan merasa tenang dan mengurangi rasa cemas.<o:p></o:p></span></span></div><div class="MsoListParagraphCxSpFirst" style="margin-left: 72pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US">4. </span><!--[endif]--><span lang="EN-US" style="line-height: 115%;"> Anjurkan klien dan keluarga untuk memperhatikan diet makanan nya.<br />
Rasional : diet dan pola makan yang tepat membantu proses penyembuhan.<br />
Minta klien dan keluarga mengulangi kembali tentang materi yang telah diberikan.<br />
Rasional : mengetahui seberapa jauh pemahaman klien dan keluarga serta menilai keberhasilan dari tindakan yang dilakukan.</span></span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 72pt;"><br />
</div><div style="margin-left: 18pt; text-indent: -18pt;"><span style="font-family: Times, 'Times New Roman', serif;"><b><span lang="EN-US">I.<span style="font-weight: normal;"> </span></span></b><!--[endif]--><span lang="EN-US"><b>Hasil-hasil Riset mengenai Anemia</b><o:p></o:p></span></span></div><div style="margin-left: 18pt; text-indent: -18pt;"><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US"><b><br />
</b></span></span></div><div style="margin-left: 31.5pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US">1. </span><!--[endif]--><span lang="EN-US">Penelitian halterman yang berjudul <i>Iron Deficiency and Cognitive Achievement Among School-Aged Children and Adolescents in the United States </i>meneliti tentang hubungan antara Anemia defisiensi besi (ADB) terhadap skor tes kognitif dengan sampel penelitian anak-anak usia sekolah dan remaja. Dari 5398 sampel pada anak-anak didapatkan prevalensi 3% menderita anemia defisiensi besi. Prevalensi ADB lebih tinggi didapatkan pada remaja putri sebanyak 8,7%. Hasil penelitian menunjukan nilai matematika pada penderita ADB lebih rendah (Halterman, 2001).<o:p></o:p></span></span></div><div style="margin-left: 31.5pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US">2. </span><!--[endif]--><span lang="EN-US">Penelitian A. Sen dan S.J. Kanani yang berjudul <i>Deleterious Functional Impact of Anemia on Young Adolescent School Girls </i>meneliti tentang hubungan ADB dengan pertumbuhan fisik dan fungsi kognitif di Gujarat-India. Sampel penelitian adalah siswi umur 9-14 tahun. Variabel bebas adalah kadar hemoglobin dan variabel terikat adalah tes IQ yang dimodifikasi dari tes <i>Wechsler Intelligence Scale for Children </i>(WISC). Pada anak yang tidak anemia didapatkan skor IQ lebih tinggi dari pada anak yang anemia (Sen, 2006).<o:p></o:p></span></span></div><div style="margin-left: 31.5pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US">3. </span><!--[endif]--><span lang="EN-US">Penelitian di Amerika Serikat, mendapatkan nilai rata-rata matematika pada anak yang menderita anemia defisiensi besi lebih rendah dibanding anak tanpa anemia defisiensi besi (Halterman, 2001). Penelitian Bidasari di daerah perkebunan Aek Nabara bekerjasama dengan Fakultas Psikologi USU (2006) pada anak usia 7–14 tahun yang menderita anemia defisiensi besi diperoleh <i>Full IQ </i>tidak melebihi rata-rata dengan gangguan pemusatan perhatian dan fungsi kognitif terutama dalam bidang aritmatika (Lubis, 2008).<o:p></o:p></span></span></div><div style="margin-left: 31.5pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US">4. </span><!--[endif]--><span lang="EN-US">Penelitian di Gujarat-India menunjukan prevalensi anemia mencapai 67% dari sampel. Hasil penelitian menunjukan bahwa secara signifikan pada penderita anemia mempunyai skor IQ yang lebih rendah daripada yang tidak anemia (Sen, 2006).<o:p></o:p></span></span></div><div style="margin-left: 31.5pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Times, 'Times New Roman', serif;"><span lang="EN-US">5. </span><!--[endif]--></span><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;">Di Indonesia prevalensi anemia pada remaja putri tahun 2006, yaitu 28% (Depkes RI, 2007). Data Survei Kesehatan Rumah Tangga (SKRT) tahun 2004 menyatakan bahwa prevalensi anemia gizi pada balita 40,5%, ibu hamil 50,5%, ibu nifas 45,1%, remaja putri usia 10-18 tahun 57,1% dan usia 19-45 tahun 39,5%. Dari semua kelompok umur tersebut, wanita mempunyai resiko paling tinggi untuk menderita anemia terutama remaja putri ( Isniati, 2007)</span><span style="font-family: Calibri, sans-serif; font-size: small;"><o:p></o:p></span></span></div><div style="margin-left: 31.5pt; text-indent: -18pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"><br />
</span></span></div><div style="margin-left: 31.5pt; text-indent: -18pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;">REFERENSI :</span></span></div><div style="margin-left: 31.5pt; text-indent: -18pt;"><span lang="EN-US" style="text-indent: -18pt;">1.<span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="text-indent: -18pt;">Doenges, Marilynn E. 1999. Rencana Asuhan Keperawatan pedoman untuk perencanaan dan pendokumentasian pasien. ed.3. EGC : Jakarta</span></div><div style="margin-left: 31.5pt; text-indent: -18pt;"><span lang="EN-US" style="text-indent: -18pt;">2. <span style="font-size: 7pt;"> </span></span><span lang="EN-US" style="text-indent: -18pt;">Handayani, Wiwik.2008.Asuhan Keperawatan pada Klien dengan Gangguan Sistem Hematologi.Salemba Medika : Jakarta </span></div><div style="margin-left: 31.5pt; text-indent: -18pt;"><span lang="EN-US" style="text-indent: -18pt;"><br />
</span></div><div style="margin-left: 31.5pt; text-indent: -18pt;"><span lang="EN-US"><span style="font-family: Times, 'Times New Roman', serif;"><br />
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</span></span></div>salnihttp://www.blogger.com/profile/00126668517852477742noreply@blogger.com0Universitas Sam Ratulangi, Jalan Kampus Selatan, Manado, Indonesia1.455717 124.827162999999931.2841114999999999 124.59370349999993 1.6273225 125.06062249999992tag:blogger.com,1999:blog-8321145958076225978.post-47956182164233712882011-10-27T08:12:00.001-07:002011-10-27T08:12:14.832-07:00ELIMINASI URINE<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span class="Apple-style-span" style="font-family: Arial, sans-serif;"><b><br />
</b></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l24 level1 lfo2; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span>Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Anatomi Fisiologi Sistem urinaria<o:p></o:p></span></b></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Sistem perkemihan melibatkan 6 organ, yaitu:<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">- Ginjal<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">- ureter<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">- Kandung Kemih<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">- Saluran Kencing (Uretra)<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Organ yang paling berperan dalam hal ini adalah Ginjal (Renal; <i>Kidney</i>).<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l28 level1 lfo30; text-indent: -21.25pt;"><!--[if !supportLists]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial; mso-fareast-language: IN;"><span>1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><!--[endif]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Ginjal<o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span> </span>Ginjal merupakan organ berbentuk seperti kacang yang terletak di kedua sisi<i>columna vertebralis</i>, di bawah liver dan limphe. Di bagian <i>superior</i> ginjal terdapat <i>adrenal gland</i>(juga disebut <i>kelenjar suprarenal</i>). Ginjal bersifat retroperitoneal, yang berarti terletak di belakang<i>peritonium</i> yang melapisi rongga <i>abdomen</i>. Kedua ginjal terletak di sekitar vertebra T12 hingga L3. Ginjal kanan biasanya terletak sedikit di bawah ginjal kiri untuk memberi tempat untuk hati. Sebagian dari bagian atas ginjal terlindungi oleh iga ke sebelas dan duabelas. Kedua ginjal dibungkus oleh dua lapisan lemak (lemak perirenal dan lemak pararenal) yang membantu meredam goncangan.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span class="Apple-style-span" style="font-family: Arial, sans-serif;"><br />
</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span> </span>Ginjal kanan sedikit lebih rendah dibandingkan dengan ginjal kiri karena tertekan ke bawah oleh hati. Kutub atas ginjal kanan terletak setinggi iga keduabelas, sedangkan ginjal kiri terletak setinggi iga kesebelas. Pada orang dewasa, panjang ginjal sekitar 12-13 cm, lebarnya 6 cm, tebal 2,5 cm dan beratnya ± 140 gram ( pria=150 – 170 gram, wanita = 115-155 gram).<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span> </span>Potongan longitudinal ginjal memperlihatkan dua daerah yang berbeda yaitu Korteks dan medula.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l16 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial; mso-fareast-language: IN;"><span>a)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Korteks : bagian luar dari ginjal<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l16 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial; mso-fareast-language: IN;"><span>b)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Medula : Bagian dalam dari ginjal<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l16 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial; mso-fareast-language: IN;"><span>c)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Piramid : Medula yang terbagi-bagi menjadi baji segitiga<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l16 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial; mso-fareast-language: IN;"><span>d)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Kolumna Bertini ; Bagian korteks yang mengelilingi piramid.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l16 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial; mso-fareast-language: IN;"><span>e)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Papilaris berlini : Papila dari tiap piramid yang terbentuk dari persatuan bagian terminal dari banyak duktus pengumpul.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l16 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial; mso-fareast-language: IN;"><span>f)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pelvis: Reservoar utama sistem pengumpulan ginjal.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l16 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial; mso-fareast-language: IN;"><span>g)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Kaliks minor: bagian ujung pelvis berbentuk seperti cawan yang mengalami penyempitan karena adanya duktus papilaris yang masuk ke bagian pelvis ginjal.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l16 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial; mso-fareast-language: IN;"><span>h)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Kaliks mayor: Kumpulan dari beberapa kaliks minor.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.4pt; margin-right: 0cm; margin-top: 0cm;"><span style="font-family: "Arial","sans-serif";">Ginjal berfungsi :<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l12 level1 lfo1; tab-stops: list 36.0pt; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Mengeluarkan zat sisa organik.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l12 level1 lfo1; tab-stops: list 36.0pt; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Mengeluarkan konsentrasi ion penting<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l12 level1 lfo1; tab-stops: list 36.0pt; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Pengaturan keseimbangan asam basa tubuh<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l12 level1 lfo1; tab-stops: list 36.0pt; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Produksi sel darah merah<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l12 level1 lfo1; tab-stops: list 36.0pt; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Pengaturan tekanan darah<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l12 level1 lfo1; tab-stops: list 36.0pt; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Pengendalian terbatas terhadap konsentrasi glukosa darah atau asam amino darah<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l12 level1 lfo1; tab-stops: list 36.0pt; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Pengeluaran zat beracun.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Mekanisme Homeostasis Ginjal</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
<span> </span>Mekanisme ini diatur oleh otak terutama hipotalamus, yang bila terangsang akan merangsang koordinasi tubuh. Proses ini akan terjadi terus menerus hingga lingkungan dinamis dalam tubuh akan berada pada jumlah yang normal (Guyton, 1996 ).<br />
Sekresi Ion<br />
<span> </span>Ginjal juga mengatur pH, konsentrasi ion mineral, dan komposisi air dalam darah. Selain itu, ginjal mempertahankan pH plasma darah pada kisaran 7,4 melalui pertukaran ion hidronium dan hidroksil. Akibatnya, urine yang dihasilkan dapat bersifat asam pada pH 5 atau alkalis pada pH 8. Kadar ion natrium dikendalikan melalui sebuah proses homeostasis yang melibatkan aldosteron untuk meningkatkan penyerapan ion natrium pada tubulus konvulasi.Kenaikan atau penurunan tekanan osmotik darah karena kelebihan atau kekurangan air akan segera dideteksi oleh hipotalamus yang akan memberi sinyal pada kelenjar pituitari dengan umpan balik negatif. Kelenjar pituitari mensekresi hormon antidiuretik vasopresin, untuk menekan sekresi air, sehingga terjadi perubahan tingkat absorpsi air pada tubulus ginjal. Akibatnya, konsentrasi cairan jaringan akan kembali menjadi 98 persen (Taslim, 2008).<br />
<span> </span>Fungsi pemindahan ini terdapat dalam tubulus proksimal yaitu mengambil dan memindahkan ion organic dan disekresikan ke cairan tubulus. Ion organic ini termasuk endogenous produk sisa dan exogenous drugs dan racun. Ion organic seperti garam, oxalate, urate, creatinine, prostaglandin, epinephrine dan hipurates merupakan sisa produk endogen yang disekresikan ke cairan tubulus proksimal (Guyton, 1996).<br />
<span> </span>Urine terbentuk dalam ginjal dan membuangnya dari tubuh lewat saluran. Urine terdiri dari 98% air dan yang lainnya terdiri dari pembentukan metabolisme nitrogen (urea, uric acis, creatinin dan juga produk lain dari metabolisme protein (Bykov, 1960). Urine biasanya bersifat kurang asam dengan pH antara 5 - 7 (Kimber, 1949). Urine yang sehat gaya beratnya berkisar 1.010 - 1.030, tergantung perbandingan larutan dengan air. Banyaknya urine yang dikeluarkan dalam 1 hari dari 1.200 - 1.500 cc (40 - 50 oz). (Ganong, 2001)<br />
<span> </span>Umpan Balik Penyeimbangan Cairan Dalam Tubuh<br />
Diantara kemungkinannya ialah:<br />
1. Apabila banyak garam dalam badan dan kurang air<br />
2. Apabila kurang garam dalam badan dan banyak air<br />
<span> </span>Apabila kadar garam lebih dari julat normal dan kurang air dalam badan, tekanan osmosis darah akan meningkat, osmoreseptor pada hipotalamus akan terangsang kemudian kelenjar hipofisis akan dirangsang lebih aktif untuk mensekresikan hormon ADH (antidiuretik) untuk meningkatkan permeabilitas tubulus ginjal terhadap air, kelenjar (hormon aldosteron) akan kurang dirangsang, maka lebih banyak air diserap dan kurang ion natrium dan ion kalsium diserap kembali masuk dalam tubuh, tekanan osmosis darah akan turun, proses ini akan berulang sehingga tekanan osmosis darah pada jumlah normal ( Wikipedia, 2008 ).<br />
<span> </span>Apabila kadar garam lebih rendah dari jumlah normal dalam tubuh dan lebih banyak air dalam tubuh, tekanan osmosis darah akan menurun, osmoreseptor pada hipotalamus akan terangsang kemudian kelenjar pituitari akan kurang dirangsang untuk mensekresikan hormon ADH (antidiuresis) untuk mengurangi permeabilitas tubulus ginjal terhadap air, kelenjar adrenal (hormon aldosteron) akan dirangsang dengan lebih aktif, maka lebih sedikit air diserap dan lebih sedikit juga natrium dan kalsium diserap kembali masuk dalam tubuh, tekanan osmosis darah akan naik, proses ini akan berulang sehingga tekanan osmosis darah berada pada jumlah normal ( Wikipedia, 2008 ).<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-outline-level: 2;"><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Nefron<o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span> </span>Unit fungsional ginjal adalah nefron. Pada manusia setiap ginjal mengandung 1-1,5 juta nefron yang pada dasarnya mempunyai struktur dan fungsi yang sama.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pada manusia setiap ginjal mengandung 1-1,5 juta nefron yang pada dasarnya mempunyai struktur dan fungsi yang sama.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Dapat dibedakan dua jenis nefron:<o:p></o:p></span></div><ol start="1" type="1"><li class="MsoNormal" style="line-height: 150%; mso-list: l7 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Nefron kortikalis yaitu nefron yang glomerulinya terletak pada bagian luar dari korteks dengan lingkungan henle yang pendek dan tetap berada pada korteks atau mengadakan penetrasi hanya sampai ke zona luar dari medula.<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l7 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Nefron juxtamedullaris yaitu nefron yang glomerulinya terletak pada bagian dalam dari korteks dekat dengan cortex-medulla dengan lengkung henle yang panjang dan turun jauh ke dalam zona dalam dari medula, sebelum berbalik dan kembali ke cortex.<o:p></o:p></span></li>
</ol><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><a href="http://biofarmasiumi.files.wordpress.com/2010/11/ginjal3.jpg"><span style="font-family: Arial, sans-serif; font-size: 12pt; line-height: 150%; text-decoration: none;"><!--[if gte vml 1]><v:shape
id="Picture_x0020_3" o:spid="_x0000_i1026" type="#_x0000_t75" alt="http://biofarmasiumi.files.wordpress.com/2010/11/ginjal3.jpg?w=370&h=480"
href="http://biofarmasiumi.files.wordpress.com/2010/11/ginjal3.jpg" style='width:276.75pt;
height:207pt;visibility:visible;mso-wrap-style:square' o:button="t"> <v:fill o:detectmouseclick="t"/> <v:imagedata src="file:///C:\Users\USER\AppData\Local\Temp\msohtmlclip1\01\clip_image003.jpg"
o:title="ginjal3"/> </v:shape><![endif]--><!--[if !vml]--><span><img alt="http://biofarmasiumi.files.wordpress.com/2010/11/ginjal3.jpg?w=370&h=480" border="0" height="276" src="file:///C:/Users/USER/AppData/Local/Temp/msohtmlclip1/01/clip_image004.jpg" v:shapes="Picture_x0020_3" width="369" /></span><!--[endif]--></span></a><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Bagian-bagian nefron:<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">a. Glomerolus</span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Suatu jaringan kapiler berbentuk bola yang berasal dari arteriol afferent yang kemudian bersatu menuju arteriol efferent, Berfungsi sebagai tempat filtrasi sebagian air dan zat yang terlarut dari darah yang melewatinya.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">b. Kapsula Bowman</span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Bagian dari tubulus yang melingkupi glomerolus untuk mengumpulkan cairan yang difiltrasi oleh kapiler glomerolus.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">c. Tubulus, terbagi menjadi 3 yaitu:</span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">1.Tubulus proksimal</span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Tubulus proksimal berfungsi mengadakan reabsorbsi bahan-bahan dari cairan tubuli dan mensekresikan bahan-bahan ke dalam cairan tubuli.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">2.Lengkung Henle</span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Lengkung henle membentuk lengkungan tajam berbentuk U. Terdiri dari pars descendens yaitu bagian yang menurun terbenam dari korteks ke medula, dan pars ascendens yaitu bagian yang naik kembali ke korteks. Bagian bawah dari lengkung henle mempunyai dinding yang sangat tipis sehingga disebut segmen tipis, sedangkan bagian atas yang lebih tebal disebut segmen tebal.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Lengkung henle berfungsi reabsorbsi bahan-bahan dari cairan tubulus dan sekresi bahan-bahan ke dalam cairan tubulus. Selain itu, berperan penting dalam mekanisme konsentrasi dan dilusi urin.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">3.Tubulus distal</span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Berfungsi dalam reabsorbsi dan sekresi zat-zat tertentu.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">d. Duktus pengumpul (duktus kolektifus)</span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Satu duktus pengumpul mungkin menerima cairan dari delapan nefron yang berlainan. Setiap duktus pengumpul terbenam ke dalam medula untuk mengosongkan cairan isinya (urin) ke dalam pelvis ginjal.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l28 level1 lfo30; text-indent: -18.0pt;"><!--[if !supportLists]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial; mso-fareast-language: IN;"><span>2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><!--[endif]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Ureter<o:p></o:p></span></b></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif"; mso-fareast-language: IN;"><span> </span>Kedua ureter merupakan saluran yang panjangnya sekitar 10-12 inci (25 ningga 30 cm), terbentang dari ginjal sampai vesica urinaria. Fungsi ureter menyalurkan urine ke vesica urinaria.</span><span style="font-family: "Arial","sans-serif";"> Ureter menyempit pada tiga titik; dititik asal ureter, di titik saat melewati pinggiran pelvis, dan di titik saat pertemuannya dengan kandung kemih. Batu ginjal dapat tersangkut ditempat ini, dan mengakibatkan nyeri dan disebut kolik ginjal. Ureter<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";">Menghubungnkan ginjal dan kandung kemih.. Otot ureter memiliki aktifitas peristaltik intrinsik, yang berfungsi untuk mengalirkan urine ke kandung kemih.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l28 level1 lfo30; text-indent: -18.0pt;"><!--[if !supportLists]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial; mso-fareast-language: IN;"><span>3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><!--[endif]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Kandung kemih ( vesica urinaria)<o:p></o:p></span></b></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";"><span> </span>Kandung kemih (<em><span style="font-family: "Arial","sans-serif";">Buli-buli/bladder</span></em>) merupakan sebuah kantong yang terdiri atas otot halus, berfungsi menampung urine. Dalam kandung kemih terdapat beberapa lapisan jaringan otot yang paling dalam, memanjang ditengah, dan melingkar yang disebut sebagai<span class="apple-converted-space"> </span><em><span style="font-family: "Arial","sans-serif";">destrusor,</span></em><span class="apple-converted-space"><i> </i></span>berfungsi untuk mengeluarkan urine bila terjadi kontraksi.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";">Pada dasar kandung kemih terdapat lapisan tengan jaringan otot berbentuk lingkaran bagian dalam atau disebut sebagai otot lingkar yang berfungsi menjaga saluran antara kandung kemih dan uretra, sehingga uretra dapat menyalurkan urine dari kandung kemih keluar tubuh.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";">Penyaluran ransangan kekandung kemih dan ransangan motoris ke otot lingkar bagian dalam diatur oleh sistem simpatis. Akibat dari ransangan ini, otot lingkar menjadi kendur dan terjadi kokntraksi sfingter bagian dalam sehingga urine tetap tinggal dalam kandung kemih. Sistem para simpatis menyalurkan ransangan motoris kandung kemih dan ransangan penghalang ke bagian dalam otot lingkar. Rangansang aini dapat menyebabkan terjadinya kontraksi otot destrusor dan kendurnya sfingter.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l28 level1 lfo30; text-indent: -18.0pt;"><!--[if !supportLists]--><b><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><!--[endif]--><b><span style="font-family: "Arial","sans-serif";">Uretra<o:p></o:p></span></b></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";">Uretra merupakan organ yang berfungsi menyelurkan urine ke bagian luar. Fungsi uretra pada wanita berbeda dengan yang terdapat pada laki-laki. Pada laki-laki, uretra digunakan sebagai tempat pengaliran urine dan sistem reproduksi, berukuran panjang 13,7-16,2 cm, dan terdiri dari tiga bagian; yaitu prostat, selaput (membran) dan bagian yang berongga (ruang). Pada wanita panjang 3,7-6,2 cm dan hanya berfungsi sebagai tempat penyaluran urine kebagian luar tubuh.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: 12.25pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm;"><span style="font-family: "Arial","sans-serif";">Saluran berkemih dilapisi oleh membran mukosa, dimulai dari meatus uretra hingga ginjal. Meskipun mikroorganisme sercara normal tidak ada yang bisa melewati uretra bagian bawah, membran mukosa ini pada keadaan patologis yang terus menerus akan menjadikannya media yang baik untuk pertumbuhan beberapa patogen.<o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; mso-add-space: auto; mso-list: l24 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;"><span>Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Mekanisme Pembentukan Urine<o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">1.Penyaringan ( Filtrasi )<br />
</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span> </span>Filtrasi darah terjadi di glomerulus, dimana jaringan kapiler dengan struktur spesifik dibuat untuk menahan komonen selular dan medium-molekular-protein besar kedalam vascular system, menekan cairan yang identik dengan plasma di elektrolitnya dan komposisi air. Cairan ini disebut filtrate glomerular. Tumpukan glomerulus tersusun dari jaringan kapiler. Di mamalia, arteri renal terkirim dari arteriol afferent dan melanjut sebagai arteriol eferen yang meninggalkan glomrerulus. Tumpukan glomerulus dibungkus didalam lapisan sel epithelium yang disebut kapsula bowman. Area antara glomerulus dan kapsula bowman disebut bowman space dan merupakan bagian yang mengumpulkan filtrate glomerular, yang menyalurkan ke segmen pertama dari tubulus proksimal. Struktur kapiler glomerular terdiri atas 3 lapisan yaitu : endothelium capiler, membrane dasar, epiutelium visceral. Endothelium kapiler terdiri satu lapisan sel yang perpanjangan sitoplasmik yang ditembus oleh jendela atau fenestrate (Guyton.1996).<br />
<span> </span>Dinding kapiler glomerular membuat rintangan untuk pergerakan air dan solute menyebrangi kapiler glomerular. Tekanan hidrostatik darah didalam kapiler dan tekanan oncotik dari cairan di dalam bowman space merupakan kekuatn untuk proses filtrasi. Normalnya tekanan oncotik di bowman space tidak ada karena molekul protein yang medium-besar tidak tersaring. Rintangan untuk filtrasi ( filtration barrier ) bersifat selektiv permeable. Normalnya komponen seluler dan protein plasmatetap didalam darah, sedangkan air dan larutan akan bebas tersaring (Guyton.1996).<br />
<span> </span>Pada umumnya molekul dengan raidus 4nm atau lebih tidak tersaring, sebaliknya molekul 2 nm atau kurang akan tersaring tanpa batasan. Bagaimanapun karakteristik juga mempengaruhi kemampuan dari komponen darah untuk menyebrangi filtrasi. Selain itu beban listirk (electric charged ) dari sretiap molekul juga mempengaruhi filtrasi. Kation ( positive ) lebih mudah tersaring dari pada anionBahan-bahan kecil yang dapat terlarut dalam plasma, seperti glukosa, asam amino, natrium, kalium, klorida, bikarbonat, garam lain, dan urea melewati saringan dan menjadi bagian dari endapan.Hasil penyaringan di glomerulus berupa filtrat glomerulus (urin primer) yang komposisinya serupa dengan darah tetapi tidak mengandung protein (Guyton.1996).<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
<b>2. Penyerapan ( Absorsorbsi)<br />
</b><span> </span>Tubulus proksimal bertanggung jawab terhadap reabsorbsi bagian terbesar dari filtered solute. Kecepatan dan kemampuan reabsorbsi dan sekresi dari tubulus renal tiak sama. Pada umumnya pada tubulus proksimal bertanggung jawab untuk mereabsorbsi ultrafiltrate lebih luas dari tubulus yang lain. Paling tidak 60% kandungan yang tersaring di reabsorbsi sebelum cairan meninggalkan tubulus proksimal. Tubulus proksimal tersusun dan mempunyai hubungan dengan kapiler peritubular yang memfasilitasi pergherakan dari komponen cairan tubulus melalui 2 jalur : jalur transeluler dan jalur paraseluler. Jalur transeluler, kandungan ( substance ) dibawa oleh sel dari cairn tubulus melewati epical membrane plasma dan dilepaskan ke cairan interstisial dibagian darah dari sel, melewati basolateral membrane plasma (Sherwood, 2001).<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Jalur paraseluler, kandungan yang tereabsorbsi melewati jalur paraseluler bergerakdari vcairan tubulus menuju zonula ocludens yang merupakan struktur permeable yang mendempet sel tubulus proksimal satu daln lainnya. Paraselluler transport terjadi dari difusi pasif. Di tubulus proksimal terjadi transport Na melalui Na, K pump. Di kondisi optimal, Na, K, ATPase pump manekan tiga ion Na kedalam cairan interstisial dan mengeluarkan 2 ion K ke sel, sehingga konsentrasi Na di sel berkurang dan konsentrasi K di sel bertambah. Selanjutnya disebelah luar difusi K melalui canal K membuat sel polar. Jadi interior sel bersifat negative . pergerakan Na melewati sel apical difasilitasi spesifik transporters yang berada di membrane. Pergerakan Na melewati transporter ini berpasangan dengan larutan lainnya dalam satu pimpinan sebagai Na ( contransport ) atau berlawanan pimpinan ( countertransport ) (Sherwood, 2001).<br />
<span> </span>Substansi diangkut dari tubulus proksimal ke sel melalui mekanisme ini ( secondary active transport ) termasuk gluukosa, asam amino, fosfat, sulfat, dan organic anion. Pengambilan active substansi ini menambah konsentrasi intraseluler dan membuat substansi melewati membrane plasma basolateral dan kedarah melalui pasif atau difusi terfasilitasi. Reabsorbsi dari bikarbonat oleh tubulus proksimal juga di pengaruhi gradient Na (Sherwood, 2001)<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">3<b>. Penyerapan Kembali ( Reabsorbsi )</b><br />
<span> </span>Volume urin manusia hanya 1% dari filtrat glomerulus. Oleh karena itu, 99% filtrat glomerulus akan direabsorbsi secara aktif pada tubulus kontortus proksimal dan terjadi penambahan zat-zat sisa serta urea pada tubulus kontortus distal. Substansi yang masih berguna seperti glukosa dan asam amino dikembalikan ke darah. Sisa sampah kelebihan garam, dan bahan lain pada filtrate dikeluarkan dalam urin. Tiap hari tabung ginjal mereabsorbsi lebih dari 178 liter air, 1200 g garam, dan 150 g glukosa. Sebagian besar dari zat-zat ini direabsorbsi beberapa kali (Sherwood.2001).<br />
<span> </span>Setelah terjadi reabsorbsi maka tubulus akan menghasilkan urin sekunder yang komposisinya sangat berbeda dengan urin primer. Pada urin sekunder, zat-zat yang masih diperlukan tidak akan ditemukan lagi. Sebaliknya, konsentrasi zat-zat sisa metabolisme yang bersifat racun bertambah, misalnya ureum dari 0,03′, dalam urin primer dapat mencapai 2% dalam urin sekunder. Meresapnya zat pada tubulus ini melalui dua cara. Gula dan asam mino meresap melalui peristiwa difusi, sedangkan air melalui peristiwa osn osis. Reabsorbsi air terjadi pada tubulus proksimal dan tubulus distal (Sherwood.2001).<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">4. Augmentasi<br />
</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span> </span>Augmentasi adalah proses penambahan zat sisa dan urea yang mulai terjadi di tubulus kontortus distal. Komposisi urin yang dikeluarkan lewat ureter adalah 96% air, 1,5% garam, 2,5% urea, dan sisa substansi lain, misalnya pigmen empedu yang berfungsi memberi warm dan bau pada urin. Zat sisa metabolisme adalah hasil pembongkaran zat makanan yang bermolekul kompleks. Zat sisa ini sudah tidak berguna lagi bagi tubuh. Sisa metabolisme antara lain, CO2, H20, NHS, zat warna empedu, dan asam urat (Cuningham, 2002).<br />
<span> </span>Karbon dioksida dan air merupakan sisa oksidasi atau sisa pembakaran zat makanan yang berasal dari karbohidrat, lemak dan protein. Kedua senyawa tersebut tidak berbahaya bila kadarnya tidak berlebihan. Walaupun CO2 berupa zat sisa namun sebagian masih dapat dipakai sebagai dapar (penjaga kestabilan PH) dalam darah. Demikian juga H2O dapat digunakan untuk berbagai kebutuhan, misalnya sebagai pelarut (Sherwood.2001).<br />
<span> </span>Amonia (NH3), hasil pembongkaran/pemecahan protein, merupakan zat yang beracun bagi sel. Oleh karena itu, zat ini harus dikeluarkan dari tubuh. Namun demikian, jika untuk sementara disimpan dalam tubuh zat tersebut akan dirombak menjadi zat yang kurang beracun, yaitu dalam bentuk urea. Zat warna empedu adalah sisa hasil perombakan sel darah merah yang dilaksanakan oleh hati dan disimpan pada kantong empedu. Zat inilah yang akan dioksidasi jadi urobilinogen yang berguna memberi warna pada tinja dan urin.Asam urat merupakan sisa metabolisme yang mengandung nitrogen (sama dengan amonia) dan mempunyai daya racun lebih rendah dibandingkan amonia, karena daya larutnya di dalam air rendah (Sherwood.2001).<o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; mso-add-space: auto; mso-list: l20 level1 lfo7; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;"><span>Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Faktor - Faktor yang Mempengaruhi Pembentukan Urine<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-add-space: auto; mso-list: l6 level1 lfo8; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -18.0pt;"><!--[if !supportLists]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial; mso-fareast-language: IN;"><span>1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><!--[endif]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hormon<o:p></o:p></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 21.3pt; mso-add-space: auto; mso-list: l21 level1 lfo9; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial; mso-fareast-language: IN;"><span>a)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">ADH<br />
<span> </span>Hormon ini memiliki peran dalam meningkatkan reabsorpsi air sehingga dapat mengendalikan keseimbangan air dalam tubuh. Hormon ini dibentuk oleh hipotalamus yang ada di hipofisis posterior yang mensekresi ADH dengan meningkatkan osmolaritas dan menurunkan cairan ekstrasel ( Frandson,2003 )<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 21.3pt; mso-add-space: auto; mso-list: l21 level1 lfo9; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial; mso-fareast-language: IN;"><span>b)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Aldosteron<br />
<span> </span>Hormon ini berfungsi pada absorbsi natrium yang disekresi oleh kelenjar adrenal di tubulus ginjal. Proses pengeluaran aldosteron ini diatur oleh adanya perubahan konsentrasi kalium, natrium, dan sistem angiotensin rennin ( Frandson, 2003).<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 21.3pt; mso-add-space: auto; mso-list: l21 level1 lfo9; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial; mso-fareast-language: IN;"><span>c)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Prostaglandin<br />
<span> </span>Prostagladin merupakan asam lemak yang ada pada jaringan yang berlungsi merespons radang, pengendalian tekanan darah, kontraksi uterus, dan pengaturan pergerakan gastrointestinal. Pada ginjal, asam lemak ini berperan dalam mengatur sirkulasi ginjal ( Frandson, 2003)<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 21.3pt; mso-add-space: auto; mso-list: l21 level1 lfo9; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial; mso-fareast-language: IN;"><span>d)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Gukokortikoid<br />
Hormon ini berfungsi mengatur peningkatan reabsorpsi natrium dan air yang menyebabkan volume darah meningkat sehingga terjadi retensi natrium ( Frandson, 2003)<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 21.3pt; mso-add-space: auto; mso-list: l21 level1 lfo9; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial; mso-fareast-language: IN;"><span>e)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Renin<br />
Selain itu ginjal menghasilkan Renin; yang dihasilkan oleh sel-sel apparatus jukstaglomerularis pada :<br />
1. Konstriksi arteria renalis ( iskhemia ginjal )<br />
2. Terdapat perdarahan ( iskhemia ginjal )<br />
3.Uncapsulated ren (ginjal dibungkus dengan karet atau sutra )<br />
4. Innervasi ginjal dihilangkan<br />
5. Transplantasi ginjal ( iskhemia ginjal )<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 3.3pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Sel aparatus juxtaglomerularis merupakan regangan yang apabila regangannya turun akan mengeluarkan renin. Renin mengakibatkan hipertensi ginjal, sebab renin mengakibatkan aktifnya angiotensinogen menjadi angiotensin I, yg oleh enzim lain diubah menjadi angiotensin II; dan ini efeknya menaikkan tekanan darah (sherwood, 2001).<o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; mso-add-space: auto; mso-list: l6 level1 lfo8; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -18.0pt;"><!--[if !supportLists]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial; mso-fareast-language: IN;"><span>2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><!--[endif]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Zat - zat diuretik<o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Banyak terdapat pada kopi, teh, alkohol. Akibatnya jika banyak mengkonsumsi zat diuretik ini maka akan menghambat proses reabsorpsi, sehingga volume urin bertambah.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><br />
</div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; mso-add-space: auto; mso-list: l6 level1 lfo8; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -18.0pt;"><!--[if !supportLists]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial; mso-fareast-language: IN;"><span>3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><!--[endif]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Suhu internal atau eksternal<o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span> </span>Jika suhu naik di atas normal, maka kecepatan respirasi meningkat dan mengurangi volume urin.<o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; mso-add-space: auto; mso-list: l6 level1 lfo8; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial; mso-fareast-language: IN;"><span>4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Konsentrasi Darah</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
<span> </span>Jika kita tidak minum air seharian, maka konsentrasi air dalam darah rendah.Reabsorpsi air di ginjal mengingkat, volume urin menurun.E<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; mso-add-space: auto; mso-list: l6 level1 lfo8; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -18.0pt;"><!--[if !supportLists]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial; mso-fareast-language: IN;"><span>5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><!--[endif]--><b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Emosi</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
Emosi tertentu dapat merangsang peningkatan dan penurunan volume urin.<b><o:p></o:p></b></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l24 level1 lfo2; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span>Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b><span style="font-family: "Arial","sans-serif";">KONSEP DASAR PEMENUHAN KEBUTUHAN ELIMINASI URINE<o:p></o:p></span></b></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><b><span style="font-family: "Arial","sans-serif";">Miksi (berkemih)<o:p></o:p></span></b></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";"><span> </span>Miksi adalah proses pengosongan kandung kemih bila kandung kemih terisi.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";">Proses ini terjadi dari dua langkah utama yaitu :<br />
<span> </span>Kandung kemih secara progresif terisi sampai tegangan di dindingnya meningkat diatas nilai ambang, yang kemudian mencetuskan langkah kedua<br />
Timbul refleks saraf yang disebut refleks miksi (refleks berkemih) yang berusaha mengosongkan kandung kemih atau jika ini gagal, setidak-tidaknya menimbulkan kesadaran akan keinginan untuk berkemih. Meskipun refleks miksi adalah refleks autonomik medula spinalis, refleks ini bisa juga dihambat atau ditimbulkan oleh pusat korteks serebri atau batang otak.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l16 level2 lfo3; text-indent: -21.3pt;"><!--[if !supportLists]--><b><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><!--[endif]--><b><span style="font-family: "Arial","sans-serif";">Anatomi Fisiologik & Hubungan Saraf pada Kandung Kemih<o:p></o:p></span></b></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm;"><br />
</div><div align="center" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; text-align: center;"><span style="font-family: "Arial","sans-serif"; mso-fareast-language: IN; mso-no-proof: yes;"><!--[if gte vml 1]><v:shape id="Picture_x0020_7" o:spid="_x0000_i1025"
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o:title="images"/> </v:shape><![endif]--><!--[if !vml]--><img border="0" height="166" src="file:///C:/Users/USER/AppData/Local/Temp/msohtmlclip1/01/clip_image006.jpg" v:shapes="Picture_x0020_7" width="236" /><!--[endif]--></span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";"><span> </span>Kandung kemih<span> </span>adalah ruangan berdinding otot polos yang terdiri dari dua bagian besar :<br />
Badan (corpus), merupakan bagian utama kandung kemih dimana urin berkumpul dan<br />
Leher (kollum), merupakan lanjutan dari badan yang berbentuk corong, berjalan secara inferior dan anterior ke dalam daerah segitiga urogenital dan berhubungan dengan uretra. Bagian yang lebih rendah dari leher kandung kemih disebut uretra posterior karena hubungannya dengan uretra.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";"><span> </span>Otot polos kandung kemih disebut otot detrusor. Serat-serat ototnya meluas ke segala arah dan bila berkontraksi, dapat meningkatkan tekanan dalam kandung kemih menjadi 40 sampai 60 mmHg. Dengan demikian, kontraksi otot detrusor adalah langkah terpenting untuk mengosongkan kandung kemih. Sel-sel otot polos dari otot detrusor terangkai satu sama lain sehingga timbul aliran listrik berhambatan rendah dari satu sel otot ke sel otot lainnya. Oleh karena itu, potensial aksi dapat menyebar ke seluruh otot detrusor, dari satu sel otot ke sel otot berikutnya, sehingga terjadi kontraksi seluruh kandung kemih dengan segera.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";"><span> </span>Pada dinding posterior kandung kemih, tepat diatas bagian leher dari kandung kemih, terdapat daerah segitiga kecil yang disebut Trigonum. Bagian terendah dari apeks trigonum adalah bagaian kandung kemih yang membuka menuju leher masuk kedalam uretra posterior, dan kedua ureter memasuki kandung kemih pada sudut tertinggi trigonum. Trigonum dapat dikenali dengan melihat mukosa kandung kemih bagian lainnya, yang berlipat-lipat membentuk rugae. Masing-masing ureter, pada saat memasuki kandung kemih, berjalan secara oblique melalui otot detrusor dan kemudian melewati 1 sampai 2 cm lagi dibawah mukosa kandung kemih sebelum mengosongkan diri ke dalam kandung kemih.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";"><span> </span>Leher kandung kemih (uretra posterior) panjangnya 2 – 3 cm, dan dindingnya terdiri dari otot detrusor yang bersilangan dengan sejumlah besar jaringan elastik. Otot pada daerah ini disebut sfinter internal. Sifat tonusnya secara normal mempertahankan leher kandung kemih dan uretra posterior agar kosong dari urin dan oleh karena itu, mencegah pengosongan kandung kemih sampai tekanan pada daerah utama kandung kemih meningkat di atas ambang kritis.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";">Setelah uretra posterior, uretra berjalan melewati diafragma urogenital, yang mengandung lapisan otot yang disebut sfingter eksterna kandung kemih. Otot ini merupakan otot lurik yang berbeda otot pada badan dan leher kandung kemih, yang hanya terdiri dari otot polos. Otot sfingter eksterna bekerja di bawah kendali sistem saraf volunter dan dapat digunakan secara sadar untuk menahan miksi bahkan bila kendali involunter berusaha untuk mengosongkan kandung kemih.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l16 level2 lfo3; text-indent: -21.3pt;"><!--[if !supportLists]--><b><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><!--[endif]--><b><span style="font-family: "Arial","sans-serif";">Persarafan Kandung Kemih<o:p></o:p></span></b></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";"><span> </span>Persarafan utama kandung kemih ialah nervus pelvikus, yang berhubungan dengan medula spinalis melalui pleksus sakralis, terutama berhubungan dengan medula spinalis segmen S-2 dan S-3. Berjalan melalui nervus pelvikus ini adalah serat saraf sensorik dan serat saraf motorik. Serat sensorik mendeteksi derajat regangan pada dinding kandung kemih. Tanda-tanda regangan dari uretra posterior bersifat sangat kuat dan terutama bertanggung jawab untuk mencetuskan refleks yang menyebabkan pengosongan kandung kemih.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";"><span> </span>Saraf motorik yang menjalar dalam nervus pelvikus adalah serat parasimpatis. Serat ini berakhir pada sel ganglion yang terletak pada dinding kandung kemih. Saraf psot ganglion pendek kemudian mempersarafi otot detrusor.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";">Selain nervus pelvikus, terdapat dua tipe persarafan lain yang penting untuk fungsi kandung kemih. Yang terpenting adalah serat otot lurik yang berjalan melalui nervus pudendal menuju sfingter eksternus kandung kemih. Ini adalah serat saraf somatik yang mempersarafi dan mengontrol otot lurik pada sfingter. Juga, kandung kemih menerima saraf simpatis dari rangkaian simpatis melalui nervus hipogastrikus, terutama berhubungan dengan segmen L-2 medula spinalis. Serat simpatis ini mungkin terutama merangsang pembuluh darah dan sedikit mempengaruhi kontraksi kandung kemih. Beberapa serat saraf sensorik juga berjalan melalui saraf simpatis dan mungkin penting dalam menimbulkan sensasi rasa penuh dan pada beberapa keadaan, rasa nyeri.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";"><span> </span>Transpor Urin dari Ginjal melalui Ureter dan masuk ke dalam Kandung Kemih<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";">Urin yang keluar dari kandung kemih mempunyai komposisi utama yang sama dengan cairan yang keluar dari duktus koligentes, tidak ada perubahan yang berarti pada komposisi urin tersebut sejak mengalir melalui kaliks renalis dan ureter sampai kandung kemih.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";"><span> </span>Urin mengalir dari duktus koligentes masuk ke kaliks renalis, meregangkan kaliks renalis dan meningkatkan pacemakernya, yang kemudian mencetuskan kontraksi peristaltik yang menyebar ke pelvis renalis dan kemudian turun sepanjang ureter, dengan demikian mendorong urin dari pelvis renalis ke arah kandung kemih. Dinding ureter terdiri dari otot polos dan dipersarafi oleh saraf simpatis dan parasimpatis seperi juga neuron-neuron pada pleksus intramural dan serat saraf yang meluas diseluruh panjang ureter.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";">Seperti halnya otot polos pada organ viscera yang lain, kontraksi peristaltik pada ureter ditingkatkan oleh perangsangan parasimpatis dan dihambat oleh perangsangan simpatis.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";"><span> </span>Ureter memasuki kandung kemih menembus otot detrusor di daerah trigonum kandung kemih. Normalnya, ureter berjalan secara oblique sepanjang beberapa cm menembus dinding kandung kemih. Tonus normal dari otot detrusor pada dinding kandung kemih cenderung menekan ureter, dengan demikian mencegah aliran balik urin dari kandung kemih waktu tekanan di kandung kemih meningkat selama berkemih atau sewaktu terjadi kompresi kandung kemih. Setiap gelombang peristaltik yang terjadi di sepanjang ureter akan meningkatkan tekanan dalam ureter sehingga bagian yang menembus dinding kandung kemih membuka dan memberi kesempatan urin mengalir ke dalam kandung kemih.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";">Pada beberapa orang, panjang ureter yang menembus dinding kandung kemih kurang dari normal, sehingga kontraksi kandung kemih selama berkemih tidak selalu menimbulkan penutupan ureter secara sempurna. Akibatnya, sejumlah urin dalam kandung kemih terdorong kembali kedalam ureter, keadaan ini disebut refluks vesikoureteral. Refluks semacam ini dapat menyebabkan pembesaran ureter dan, jika parah, dapat meningkatkan tekanan di kaliks renalis dan struktur-struktur di medula renalis, mengakibatkan kerusakan daerah ini.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l16 level2 lfo3; text-indent: -21.3pt;"><!--[if !supportLists]--><b><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><!--[endif]--><b><span style="font-family: "Arial","sans-serif";">Sensasi rasa nyeri pada Ureter dan Refleks Ureterorenal.<o:p></o:p></span></b></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";"><span> </span>Ureter dipersarafi secara sempurna oleh serat saraf nyeri. Bila ureter tersumbat (contoh : oleh batu ureter), timbul refleks konstriksi yang kuat sehubungan dengan rasa nyeri yang hebat. Impuls rasa nyeri juga menyebabkan refleks simpatis kembali ke ginjal untuk mengkontriksikan arteriol-arteriol ginjal, dengan demikian menurunkan pengeluaran urin dari ginjal. Efek ini disebut refleks ureterorenal dan bersifat penting untuk mencegah aliran cairan yang berlebihan kedalam pelvis ginjal yang ureternya tersumbat.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l16 level2 lfo3; text-indent: -18.0pt;"><!--[if !supportLists]--><b><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><!--[endif]--><b><span style="font-family: "Arial","sans-serif";">Refleks Berkemih<o:p></o:p></span></b></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";"><span> </span>selama kandung kemih terisi, banyak yang menyertai kontraksi berkemih mulai tampak, seperti diperlihatkan oleh gelombang tajam dengan garis putus-putus. Keadaan ini disebabkan oleh refleks peregangan yang dimulai oleh reseptor regang sensorik pada dinding kandung kemih, khususnya oleh reseptor pada uretra posterior ketika daerah ini mulai terisi urin pada tekanan kandung kemih yang lebih tinggi. Sinyal sensorik dari reseptor regang kandung kemih dihantarkan ke segmen sakral medula spinalis melalui nervus pelvikus dan kemudian secara refleks kembali lagi ke kandung kemih melalui serat saraf parasimpatis melalui saraf yang sama ini.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";">Ketika kandung kemih hanya terisi sebagian, kontraksi berkemih ini biasanya secara spontan berelaksasi setelah beberapa detik, otot detrusor berhenti berkontraksi, dan tekanan turun kembali ke garis basal. Karena kandung kemih terus terisi, refleks berkemih menjadi bertambah sering dan menyebabkan kontraksi otot detrusor lebih kuat.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";"><span> </span>Sekali refleks berkemih mulai timbul, refleks ini akan “ menghilang sendiri. “ Artinya, kontraksi awal kandung kemih selanjutnya akan mengaktifkan reseptor regang untuk menyebabkan peningkatan selanjutnya pada impuls sensorik ke kandung kemih dan uretra posterior, yang menimbulkan peningkatan refleks kontraksi kandung kemih lebih lanjut, jadi siklus ini berulang dan berulang lagi sampai kandung kemih mencapai kontraksi yang kuat. Kemudian, setelah beberapa detik sampai lebih dari semenit, refleks yang menghilang sendiri ini mulai melemah dan siklus regeneratif dari refleks miksi ini berhenti, menyebabkan kandung kemih berelaksasi.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm;"><span style="font-family: "Arial","sans-serif";">Jadi refleks berkemih adalah suatu siklus tunggal lengkap dari :<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l10 level1 lfo5; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Peningkatan tekanan yang cepat dan progresif<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l10 level1 lfo5; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Periode tekanan dipertahankan dan<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l10 level1 lfo5; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Kembalinya tekanan ke tonus basal kandung kemih.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";"><span> </span>Sekali refleks berkemih terjadi tetapi tidak berhasil mengosongkan kandung kemih, elemen saraf dari refleks ini biasanya tetap dalam keadaan terinhibisi selama beberapa menit sampai satu jam atau lebih sebelum refleks berkemih lainnya terjadi. Karena kandung kemih menjadi semakin terisi, refleks berkemih menjadi semakin sering dan semakin kuat.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";">Sekali refleks berkemih menjadi cukup kuat, hal ini juga menimbulkan refleks lain, yang berjalan melalui nervus pudendal ke sfingter eksternus untuk menghambatnya. Jika inhibisi ini lebih kuat dalam otak daripada sinyal konstriktor volunter ke sfingter eksterna, berkemih pun akan terjadi. Jika tidak, berkemih tidak akan terjadi sampai kandung kemih terisi lagi dan refleks berkemih menjadi makin kuat.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l16 level2 lfo3; text-indent: -21.3pt;"><!--[if !supportLists]--><b><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><!--[endif]--><b><span style="font-family: "Arial","sans-serif";">Perangsangan atau Penghambatan Berkemih oleh Otak<o:p></o:p></span></b></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";"><span> </span>Refleks berkemih adalah refleks medula spinalis yang seluruhnya bersifat autonomik, tetapi dapat dihambat atau dirangsang oleh pusat dalam otak.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";">Pusat-pusat ini antara lain :<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l27 level1 lfo6; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Pusat perangsang dan penghambat kuat dalam batang otak, terutama terletak di pons dan Beberapa pusat yang terletak di korteks serebral yang terutama bekerja sebagai penghambat tetapi dapat juga menjadi perangsang.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l27 level1 lfo6; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Refleks berkemih merupakan dasar penyebab terjadinya berkemih, tetapi pusat yang lebih tinggi normalnya memegang peranan sebagai pengendali akhir dari berkemih seperti berikut :<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l27 level1 lfo6; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Pusat yang lebih tinggi menjaga secara parsial penghambatan refleks berkemih kecuali jika persitiwa berkemih dikehendaki.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l27 level1 lfo6; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Pusat yang lebih tinggi dapat mencegah berkemih, bahkan jika refleks berkemih timbul, dengan membuat kontraksi tonik terus menerus pada sfingter eksternus kandung kemih sampai mendapatkan waktu yang baik untuk berkemih.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l27 level1 lfo6; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Jika tiba waktu untuk berkemih, pusat kortikal dapat merangsang pusat berkemih sakral untuk membantu mencetuskan refleks berkeih dan dalam waktu bersamaam menghambat sfingter eksternus kandung kemih sehingga peristiwa berkemih dapat terjadi.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";"><span> </span>Berkemih di bawah keinginan biasanya tercetus dengan cara berikut : Pertama, seseorang secara sadar mengkontraksikan otot-otot abdomennya, yang meningkatkan tekanan dalam kandung kemih dan mengakibatkan urin ekstra memasuki leher kandung kemih dan uretra posterior di bawah tekanan, sehingga meregangkan dindingnya. Hal ini menstimulasi reseptor regang, yang merangsang refleks berkemih dan menghambat sfingter eksternus uretra secara simultan. Biasanya, seluruh urin akan keluar, terkadang lebih dari 5 sampai 10 ml urin tertinggal di kandung kemih.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l24 level1 lfo2; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span>Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b><span style="font-family: "Arial","sans-serif";">Proses Keperawatan<o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><b><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pengkajian<o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span> </span>Riwayat keperawatan eliminasi urin membantu perawat menentukan pola eliminasi normal klien. Perawat mendapatkan suatu gambaran urine normal dan beberapa perubahan yang terjadi danmengumpulkan informasi tentang beberapa masalah yang pernah terjadi berhubungan dengan eliminasi, adanya ostomy dan faktor-faktor yang mempengaruhi pola eliminasi.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l14 level1 lfo10; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>a)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Pola berkemih<br />
Pada orang-orang untuk berkemih sangat individual<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l14 level1 lfo10; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>b)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Frekuensi<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm;"><span style="font-family: "Arial","sans-serif";">Frekuensi untuk berkemih tergantung kebiasaan dan kesempatan.Banyak orang-orang berkemih kira-kira 70 % dari urine setiap hari pada waktu bangun tidur dan tidak memerlukan waktu untuk berkemih pada malam hari.<br />
Orang-orang biasanya berkemih : pertama kali pada waktu bangun tidur, sebelum tidur dan berkisar waktu makan.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l14 level1 lfo10; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>c)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Volume<br />
Volume urine yang dikeluarkan sangat bervariasi.<br />
Usia Jumlah / hari :<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 59.7pt; margin-right: 0cm; margin-top: 0cm; mso-list: l2 level1 lfo11; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Hari pertama & kedua dari kehidupan 15 – 60 ml<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 59.7pt; margin-right: 0cm; margin-top: 0cm; mso-list: l2 level1 lfo11; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Hari ketiga – kesepuluh dari kehidupan 100 – 300 ml<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 59.7pt; margin-right: 0cm; margin-top: 0cm; mso-list: l2 level1 lfo11; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";"><span> </span>Hari kesepuluh – 2 bulan kehidupan 250 – 400 ml<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 59.7pt; margin-right: 0cm; margin-top: 0cm; mso-list: l2 level1 lfo11; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Dua bulan – 1 tahun kehidupan 400 – 500 ml<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 59.7pt; margin-right: 0cm; margin-top: 0cm; mso-list: l2 level1 lfo11; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">1 – 3 tahun 500 – 600 ml<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 59.7pt; margin-right: 0cm; margin-top: 0cm; mso-list: l2 level1 lfo11; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">3 – 5 tahun 600 – 700 ml<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 59.7pt; margin-right: 0cm; margin-top: 0cm; mso-list: l2 level1 lfo11; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">5 – 8 tahun 700 – 1000 ml<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 59.7pt; margin-right: 0cm; margin-top: 0cm; mso-list: l2 level1 lfo11; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">8 – 14 tahun 800 – 1400 ml<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 59.7pt; margin-right: 0cm; margin-top: 0cm; mso-list: l2 level1 lfo11; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">14 tahun – dewasa 1500 ml<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 59.7pt; margin-right: 0cm; margin-top: 0cm; mso-list: l2 level1 lfo11; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Dewasa tua 1500 ml / kurang<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";"><span> </span>Jika volume dibawah 500 ml atau diatas 300 ml dalam periode 24 jam pada <span> </span>orang dewasa, maka perlu lapor.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><b><span style="font-family: "Arial","sans-serif";">Faktor yang mempengaruhi kebiasaan berkemih<o:p></o:p></span></b></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l22 level1 lfo12; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Diet dan intake<br />
Jumlah dan type makanan merupakan faktor utama yang mempengaruhi output urine, seperti protein dan sodium mempengaruhi jumlah urine yang keluar, kopi meningkatkan pembentukan urine intake cairan dari kebutuhan, akibatnya output urine lebih banyak.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l22 level1 lfo12; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; letter-spacing: .6pt;">Kondisi Prenalis</span><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; letter-spacing: .6pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">-penurunan vol intravaskuler dehidrasi, perdarahan, luka bakar syok<span> </span>hipovolemi.<o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; letter-spacing: .6pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">-Perubahan resistensi vaskuler seperti sepsisn dan reaksi anafilatik<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; letter-spacing: .6pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">-Kegagalan pompa jantung : gagal jantung hipertensi, penyakit pada katup<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; letter-spacing: .6pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kondisi renalis : Obat nefrotoksik(gentamicin) reaksi tranfusi penyakit pada glomerulud(GNA/K) neoplasma ginjal.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; letter-spacing: .6pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Penyakit sistemik : Diabetes M, herediter : ginjal polikistik infeksi.<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; letter-spacing: .6pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kondisi pascarenalis : Obstruksi ureter, kandung kemih, Uretra: kalkulus, bekuan darah, tumor, striktur. Hipertrofi Prostat kandung kemih neorogenik tumor pelvis.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l22 level1 lfo12; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Respon keinginan awal untuk berkemih<br />
Beberapa masyarakat mempunyai kebiasaan mengabaikan respon awal untuk berkemih dan hanya pada akhir keinginan berkemih menjadi lebih kuat. Akibatnya urine banyak tertahan di kandung kemih. Masyarakat ini mempunyai kapasitas kandung kemih yang lebih daripada normal<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l22 level1 lfo12; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Gaya hidup<br />
Banyak segi gaya hidup mempengaruhi seseorang dalam hal eliminasi urine. Tersedianya fasilitas toilet atau kamar mandi dapat mempengaruhi frekuensi eliminasi. Praktek eliminasi keluarga dapat mempengaruhi tingkah laku.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l22 level1 lfo12; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Stress psikologi<br />
Meningkatnya stress seseorang dapat mengakibatkan meningkatnya frekuensi keinginan berkemih, hal ini karena meningkatnya sensitive untuk keinginan berkemih dan atau meningkatnya jumlah urine yang diproduksi.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l22 level1 lfo12; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>6.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Tingkat aktifitas<br />
Aktifitas sangat dibutuhkan untuk mempertahankan tonus otot. Eliminasi urine membutuhkan tonus otot kandung kemih yang baik untuk tonus sfingter internal dan eksternal. Hilangnya tonus otot kandung kemih terjadi pada masyarakat yang menggunakan kateter untuk periode waktu yang lama. Karena urine secara terus menerus dialirkan keluar kandung kemih, otot-otot itu tidak pernah merenggang dan dapat menjadi tidak berfungsi.<br />
Aktifitas yang lebih berat akan mempengaruhi jumlah urine yang diproduksi, hal ini disebabkan karena lebih besar metabolisme tubuh.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l22 level1 lfo12; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>7.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Tingkat perkembangan<br />
Tingkat pertumbuhan dan perkembangan juga akan mempengaruhi pola berkemih. Pada wanita hamil kapasitas kandung kemihnya menurun karena adanya tekanan dari fetus atau adanya lebih sering berkemih.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l22 level1 lfo12; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>8.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Kondisi Patologis.<br />
Demam dapat menurunkan produksi urine (jumlah & karakter)<br />
Obat diuretiik dapat meningkatkan output urine.Analgetik dapat terjadi retensi urine.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 57.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l18 level1 lfo13; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Warna :<br />
Þ Normal urine berwarna kekuning-kuningan<br />
Þ Obat-obatan dapat mengubah warna urine seperti orange gelap<br />
Þ Warna urine merah, kuning, coklat merupakan indikasi adanya penyakit<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 57.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l18 level1 lfo13; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Bau :<br />
Þ Normal urine berbau aromatik yang memusingkan<br />
Þ Bau yang merupakan indikasi adanya masalah seperti infeksi atau mencerna obat-obatan tertentu<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 57.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l18 level1 lfo13; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Berat jenis :<br />
Þ Adalah berat atau derajat konsentrasi bahan (zat) dibandingkan dengan suatu volume yang sama dari yang lain seperti air yang disuling sebagai standar.<br />
Berat jenis air suling adalah 1, 009 ml<br />
Þ Normal berat jenis : 1010 – 1025<br />
Kejernihan :<br />
Þ Normal urine terang dan transparan<br />
Þ Urine dapat menjadi keruh karena ada mukus atau pus.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo14; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>8.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">pH :<br />
Normal pH urine sedikit asam (4,5 – 7,5).Urine yang telah melewati temperatur ruangan untuk beberapa jam dapat menjadi alkali karena aktifitas bakteri Vegetarian urinennya sedikit alkali.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo14; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>9.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Protein :<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm;"><span style="font-family: "Arial","sans-serif";">Normal : molekul-molekul protein yang besar seperti : albumin, fibrinogen, globulin, tidak tersaring melalui ginjal —- urine<br />
Pada keadaan kerusakan ginjal, molekul-molekul tersebut dapat tersaring —- urine.Adanya protein didalam urine —- proteinuria, adanya albumin dalam urine albuminuria.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo14; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>10.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Darah :<br />
Darah dalam urine dapat tampak jelas atau dapat tidak tampak jelas.Adanya darah dalam urine — hematuria.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo14; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>11.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Glukosa :<br />
Normal : adanya sejumlah glukosa dalam urine tidak berarti bila hanya bersifat sementara, misalnya pada seseorang yang makan gula banyak —- menetap pada pasien DM.Adanya gula dalam urine —- glukosa.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo14; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>12.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Keton :<br />
Hasil oksidasi lemak yang berlebihan.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><b><span style="font-family: "Arial","sans-serif";">Masalah-masalah dalam Eliminasi<o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 35.9pt;"><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Gangguan eliminasi urin adalah keadaan dimana seorang individu mengalami atau berisiko mengalami disfungsi eliminasi urine. Biasanyaorang yang mengalami gangguan eliminasi urin akan dilakukan kateterisasiurine, yaitu tindakan memasukan selang kateter ke dalam kandung kemihmelalui uretra dengan tujuan mengeluarkan urine.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";"><span> </span>Masalah-masalahnya adalah : retensi, inkontinensia urine, enuresis, perubahan pola urine (frekuensi, keinginan (urgensi), poliurine dan urine suppression).<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";">Penyebab umum masalah ini adalah :<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l9 level1 lfo15; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Obstruksi<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l9 level1 lfo15; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Pertumbuhan jaringan abnormal<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l9 level1 lfo15; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Batu<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l9 level1 lfo15; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Infeksi<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm;"><span style="font-family: "Arial","sans-serif";">.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l19 level1 lfo16; text-indent: -21.3pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Retensi<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";"><span> </span>Adanya penumpukan urine didalam kandung kemih dan ketidak sanggupan kandung kemih untuk mengosongkan diri.Menyebabkan distensi kandung kemih.Normal urine berada di kandung kemih 250 – 450 ml.Urine ini merangsang refleks untuk berkemih.Dalam keadaan distensi, kandung kemih dapat menampung urine sebanyak 3000 – 4000 ml urine<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";">Tanda-tanda klinis retensi<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l17 level1 lfo17; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Ketidaknyamanan daerah pubis.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l17 level1 lfo17; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Distensi kandung kemih<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l17 level1 lfo17; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Ketidak sanggupan unutk berkemih.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l17 level1 lfo17; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Sering berkeih dalam kandung kemih yang sedikit (25 – 50 ml<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l17 level1 lfo17; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Ketidak seimbangan jumlah urine yang dikelurakan dengan intakenya<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l17 level1 lfo17; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Meningkatnya keresahan dan keinginan berkemih.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l17 level1 lfo17; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Penyebab<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l17 level1 lfo17; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Operasi pada daerah abdomen bawah, pelviks, kandung kemih, urethra<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l17 level1 lfo17; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Pembesaran kelenjar prostat<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l17 level1 lfo17; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Strikture urethra.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l17 level1 lfo17; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Trauma sumsum tulang belakang.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l19 level1 lfo16; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Inkontinensi urine<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";"><span> </span>Ketidaksanggupan sementara atau permanen otot sfingter eksterna untuk mengontrol keluarnya urine dari kandung kemih.Jika kandung kemih dikosongkan secara total selama inkontinensi —- inkontinensi komplit.Jika kandung kemih tidak secara total dikosongkan selama inkontinensia —- inkontinensi sebagian<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";">Penyebab Inkontinensi<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l25 level1 lfo18; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Proses ketuaan<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l25 level1 lfo18; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Pembesaran kelenjar prostat<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l25 level1 lfo18; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Spasme kandung kemih<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l25 level1 lfo18; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Menurunnya kesadaran<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l25 level1 lfo18; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Menggunakan obat narkotik sedative<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";">Ada beberapa jenis inkontinensi yang dapat dibedakan :<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; mso-list: l13 level1 lfo19; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Total inkontinensi<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 17.45pt; margin-right: 0cm; margin-top: 0cm;"><span style="font-family: "Arial","sans-serif";">Adalah kelanjutan dan tidak dapat diprediksikan keluarnya urine. Penyebabnya biasanya adalah injury sfinter eksternal pada laki-laki, injury otot perinela atau adanya fistula antara kandung kemih dan vagina pada wanita dan kongenital atau kelainan neurologis<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; mso-list: l13 level1 lfo19; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Stress inkontinensia<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm;"><span style="font-family: "Arial","sans-serif";">Ketidaksanggupan mengontrol keluarnya urine pada waktu tekanan abdomen meningkat contohnya batuk, tertawa —– karena ketidaksanggupan sfingter eksternal menutup.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; mso-list: l13 level1 lfo19; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Urge inkontinensi<br />
Terjadi pada waktu kebutuhan berkemih yang baik, tetapi tidak dapat ketoilet tepat pada waktunya. Disebabkan infeksi saluran kemih bagian bawah atau spasme kandung kemih.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; mso-list: l13 level1 lfo19; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Fungisonal inkontinensi<br />
Adalah involunter yang tidak dapat diprediksi keluarnya urine. Biasa didefinisikan sebagai inkontinensi persists karena secara fisik dan mental mengalami gangguan atau beberapa faktor lingkungan dalam persiapan untuk buang air kecil di kamar mandi.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.45pt; margin-right: 0cm; margin-top: 0cm; mso-list: l13 level1 lfo19; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Refleks inkontinensi<br />
Adalah involunter keluarnya urine yang diprediksi intervalnya ketika ada reaksi volume kandung kemih penuh. Klien tidak dapat merasakan pengosongan kandung kemihnya penuh.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l19 level1 lfo16; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Enuresis<br />
Sering terjadi pada anak-anak.Umumnya terjadi pada malam hari — nocturnal<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.3pt; margin-right: 0cm; margin-top: 0cm;"><span style="font-family: "Arial","sans-serif";">enuresis Dapat terjadi satu kali atau lebih dalam semalam.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 3.3pt; margin-right: 0cm; margin-top: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";">Penyebab Enuresis<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l11 level1 lfo20; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Kapasitas kandung kemih lebih besar dari normalnya<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l11 level1 lfo20; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Anak-anak yang tidurnya bersuara dan tanda-tanda dari indikasi dari keinginan berkemih tidak diketahui, yang mengakibatkan terlambatnya bagun tidur untuk kekamar mandi.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l11 level1 lfo20; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Kandung kemih irritable dan seterusnya tidak dapat menampung urine dalam jumlah besar.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l11 level1 lfo20; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Suasana emosional yang tidak menyenangkan di rumah (misalnya persaingan dengan saudara kandung, ceksok dengan orang tua). Orang tua yang mempunyai pendapat bahwa anaknya akan mengatasi kebiasaannya tanpa dibantu untuk mendidiknya.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l11 level1 lfo20; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Infeksi saluran kemih atau perubahan fisik atau neurologi sistem perkemihan.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l11 level1 lfo20; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Makanan yang banyak mengandung garam dan mineral atau makanan pemedas<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l11 level1 lfo20; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Anak yang takut jalan pada gang gelap untuk kekamar mandi.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l19 level1 lfo16; text-indent: -21.3pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Perubahan pola berkemih<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l15 level1 lfo21; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Frekuensi<br />
o Normal, meningkatnya frekuensi berkemih, karena meningkatnya cairan<br />
o Frekuensi tinggi tanpa suatu tekanan intake cairan dapat diakibatkan karena cystitis<br />
o Frekuensi tinggi pada orang stress dan orang hamil<br />
o Canture / nokturia — meningkatnya frekuensi berkemih pada malam hari, tetapi ini tidak akibat meningkatnya intake cairan.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l15 level1 lfo21; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Urgency<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm;"><span style="font-family: "Arial","sans-serif";">Adalah perasaan seseorang untuk berkemih.Sering seseorang tergesa-gesa ke toilet takut mengalami inkontinensi jika tidak berkemih.Pada umumnya anak kecil masih buruk kemampuan mengontrol sfingter eksternal.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 38.55pt; margin-right: 0cm; margin-top: 0cm; mso-list: l1 level1 lfo22; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Dysuria<br />
o Adanya rasa sakit atau kesulitan dalam berkemih<br />
o Dapat terjadi karena : striktura urethra, infeksi perkemihan, trauma pada kandung kemih dan urethra.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 38.55pt; margin-right: 0cm; margin-top: 0cm; mso-list: l1 level1 lfo22; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Polyuria<br />
o Produksi urine abnormal dalam jumlah besar oleh ginjal, seperti 2.500 ml/hari, tanpa adanya peningkatan intake cairan<br />
o Dapat terjadi karena : DM, defisiensi ADH, penyakit ginjal kronik<br />
o Tanda-tanda lain adalah : polydipsi, dehidrasi dan hilangnya berat badan.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 38.55pt; margin-right: 0cm; margin-top: 0cm; mso-list: l1 level1 lfo22; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Urinari suppresi<br />
o Adalah berhenti mendadak produksi urine<br />
o Secara normnal urine diproduksi oleh ginjal secara terus menerus pada kecepatan 60 – 120 ml/jam (720 – 1440 ml/hari) dewasa<br />
o Keadaan dimana ginjal tidak memproduksi urine kurang dari 100 ml/hari disanuria<br />
o Produksi urine abnormal dalam jumlah sedikit oleh ginjal disebut oliguria misalnya 100 – 500 ml/hari<br />
o Penyebab anuria dan oliguria : penyakit ginjal, kegagalan jantung, luka bakar dan shock.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><b><span style="color: black; font-family: "Arial","sans-serif"; mso-fareast-language: IN;">Patofisiologi </span></b><b><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span> </span>Gangguan pada eliminasi sangat beragam seperti yang telah dijelaskandi atas. Masing-masing gangguan tersebut disebabkan oleh etiologi yang berbeda. Pada pasien dengan usia tua, trauma yang menyebabkan cederamedulla spinal, akan menyebabkan gangguan dalam mengkontrol urin/inkontinensia urin. Gangguan traumatik pada tulang belakang bisamengakibatkan kerusakan pada medulla spinalis. Lesi traumatik padam medulla spinalis tidak selalu terjadi bersama-sama dengan adanya fraktur atau dislokasi.Tanpa kerusakan yang nyata pada tulang belakang, efektraumatiknya bisa mengakibatkan efek yang nyata di medulla spinallis.Cedera medulla spinalis (CMS) merupakan salah satu penyebab gangguanfungsi saraf termasuk pada persyarafan berkemih dan defekasi.Komplikasi cedera spinal dapat menyebabkan syok neurogenikdikaitkan dengan cedera medulla spinalis yang umumnya dikaitkan sebagaisyok spinal. Syok spinal merupakan depresi tiba-tiba aktivitas reflex padamedulla spinalis (areflexia) di bawah tingkat cedera. Dalam kondisi ini, otot-otot yang dipersyarafi oleh bagian segmen medulla yang ada di bawah tingkatlesi menjadi paralisis komplet dan fleksid, dan refleks-refleksnya tidak ada.Hal ini mempengaruhi refleks yang merangsang fungsi berkemih dan defekasi.Distensi usus dan ileus paralitik disebabkan oleh depresi refleks yang dapatdiatasi dengan dekompresi usus (Brunner & Suddarth, 2002). Hal senadadisampaikan Sjamsuhidajat (2004), pada komplikasi syok spinal terdapattanda gangguan fungsi autonom berupa kulit kering karena tidak berkeringatdan hipotensi ortostatik serta gangguan fungsi kandung kemih dan gangguandefekasi.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span> </span></span><span class="nw"><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Proses berkemih melibatkan 2 proses yang berbeda yaitu pengisian danpenyimpanan urine dan pengosongan kandung kemih. Hal ini salingberlawanan dan bergantian secara normal. Aktivitas otot-otot kandung kemihdalam hal penyimpanan dan pengeluaran urin dikontrol oleh sistem sarafotonom dan somatik. Selama fase pengisian, pengaruh sistem saraf simpatisterhadap kandung kemih menjadi bertekanan rendah dengan meningkatkanresistensi saluran kemih. Penyimpanan urin dikoordinasikan oleh hambatansistem simpatis dari aktivitas kontraktil otot detrusor yang dikaitkan denganpeningkatan tekanan otot dari leher kandung kemih dan proksimal uretra.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span class="nw"><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;"><span> </span>Pengeluaran urine secara normal timbul akibat dari kontraksi yangsimultan otot detrusor dan relaksasi saluran kemih. Hal ini dipengaruhi olehsistem saraf parasimpatis yang mempunyai neurotransmiter utama yaituasetilkholin, suatu agen kolinergik. Selama fase pengisian, impuls afferenditransmisikan ke saraf sensoris pada ujung ganglion dorsal spinal sakralsegmen 2-4 dan informasikan ke batang otak. Impuls saraf dari batang otakmenghambat aliran parasimpatis dari pusat kemih sakral spinal. Selama fasepengosongan kandung kemih, hambatan pada aliran parasimpatis sakraldihentikan dan timbul kontraksi otot detrusor.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span class="nw"><span style="color: black; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;"><span> </span>Hambatan aliran simpatis pada kandung kemih menimbulkan relaksasipada otot uretra trigonal dan proksimal. Impuls berjalan sepanjang nervuspudendus untuk merelaksasikan otot halus dan skelet dari sphincter eksterna.Hasilnya keluarnya urine dengan resistensi saluran yang minimal. Pasien postoperasi dan post partum merupakan bagian yang terbanyak menyebabkanretensi urine akut. Fenomena ini terjadi akibat dari trauma kandung kemih danedema sekunder akibat tindakan pembedahan atau obstetri, epidural anestesi,obat-obat narkotik, peregangan atau trauma saraf pelvik, hematoma pelvik,nyeri insisi episiotomi atau abdominal, khususnya pada pasien yangmengosongkan kandung kemihnya dengan manuver Valsalva. Retensi urinepos operasi biasanya membaik sejalan dengan waktu dan drainase kandungkemih yang adekuat.<o:p></o:p></span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><b><span style="font-family: "Arial","sans-serif";">Diagnosa Keperawatan<o:p></o:p></span></b></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l26 level1 lfo23; text-indent: -21.3pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Perubahan dalam eliminasi urine berhubungan dengan retensi urine<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l26 level1 lfo23; text-indent: -21.3pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">inkontinensi dan enuresis.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l26 level1 lfo23; text-indent: -21.3pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Gangguan integritas kulit berhubungan dengan adanya inkontinensi urine.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l26 level1 lfo23; text-indent: -21.3pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Perubahan dalam rasa nyaman berhubungan dengan dysuria<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l26 level1 lfo23; text-indent: -21.3pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Resiko infeksi berhubungan dengan retensi urine, pemasangan kateter<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l26 level1 lfo23; text-indent: -21.3pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>6.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Perubahan konsep diri berhubungan dengan inkontinensi<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l26 level1 lfo23; text-indent: -21.3pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>7.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Isolasi sosial berhubungan dengan inkontensi<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l26 level1 lfo23; text-indent: -21.3pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>8.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Self care defisit : toileting jika klien inkontinesi<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l26 level1 lfo23; text-indent: -21.3pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>9.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Potensial defisit volume cairan berhubungan dengan gangguan fungsi saluran<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm;"><span style="font-family: "Arial","sans-serif";">urinary akibat proses penyakit<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l26 level1 lfo23; text-indent: -21.3pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>10.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Gangguan body image berhubungan dengan pemasangan urinary diversi ostomy<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l26 level1 lfo23; text-indent: -21.3pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>11.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Kurang pengetahuan berhubungan dengan keterampilan pemasangan diversi urinary ostomy<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><b><span style="font-family: "Arial","sans-serif";">Perencanaan & Intervensi</span></b><span style="font-family: "Arial","sans-serif";"><br />
Tujuan :<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l8 level1 lfo24; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Memberikan intake cairan secara tepat<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l8 level1 lfo24; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Memastikan keseimbangan intake dan output cairan<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l8 level1 lfo24; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Mencegah ketidakseimbangan cairan dan elektrolit<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l8 level1 lfo24; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Mencegah kerusakan kulit<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l8 level1 lfo24; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Mencegah infeksi saluran kemih<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l8 level1 lfo24; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Memulihkan self esteem atau mencegah tekanan emosiona<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l8 level1 lfo24; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Untuk anak kecil meningkatkan kontrol berkemih dan self esteem<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";">Tindakan secara umum<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l3 level1 lfo25; text-indent: -21.3pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Intake cairan secara tepat, pasien dengan masalah perkemihan yang sering intake jumlah cairan setiap hari ditentukan dokter. Pasien dengan infeksi perkemihan, cairannya sering ditingkatkan. Pasien dengan edema cairannya dibatasi.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l3 level1 lfo25; text-indent: -21.3pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Mengukur intake dan output cairan. Jumlah caiaran yang masuk dan keluar dalam setiap hari harus diukur, untuk mengetahui kesimbangan cairan.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l3 level1 lfo25; text-indent: -21.3pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Membantu mempertahankan secara normal berkemih.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l3 level1 lfo25; text-indent: -21.3pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Membantu pasien mempertahankan posisi normal untuk berkemih<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l3 level1 lfo25; text-indent: -21.3pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Memberikan kebebasan untuk pasien<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l3 level1 lfo25; text-indent: -21.3pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>6.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Memberikan bantuan pada saat pasien pertama kali merasa ingin buang air kecil<br />
Jika menggunakan bedpan atau urinal yakin itu dalam keadaan hangat.<br />
Bila pasien menggunakan bedpan, tinggikan bagian kepala tempat tidur dengan posisi fowler dan letakkan bantal kecil dibawah leher untuk meningkatkan<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l3 level1 lfo25; text-indent: -21.3pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>7.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">support dan kenyamanan fisik (prosedur membantu memberi pispot/urinal)<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l3 level1 lfo25; text-indent: -21.3pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>8.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Tuangkan air hangat dalam perineum<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l3 level1 lfo25; text-indent: -21.3pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>9.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Mengalirkan air keran dalam jarak yang kedengaran pasien<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l3 level1 lfo25; text-indent: -21.3pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>10.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Memberikan obat-obatan yang diperlukan untuk mengurangi nyeri dan membantu relaks otot<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l3 level1 lfo25; text-indent: -21.3pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>11.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Letakkan secara hati-hati tekan kebawah diatas kandung kemih pada waktu berkemih<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l3 level1 lfo25; text-indent: -21.3pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span>12.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Menenangkan pasien dan menghilangkan sesuatu yang dapat menimbulkan kecemasan.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><b><span style="font-family: "Arial","sans-serif";">Tindakan hygienis</span></b><span style="font-family: "Arial","sans-serif";"><br />
Tujuannya <o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l4 level1 lfo26; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">untuk memberikan rasa nyaman dan mencegah infeksi<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l4 level1 lfo26; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Untuk mempertahankan kebersihan di daerah genital<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><br />
</div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";">Tujuan Tindakan spesifik masalah-masalah perkemihan:<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";">Retensi urin<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l29 level1 lfo27; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Membantu dalam mempertahankan pola berkemih secara normal<br />
Jika tejadi pada post operasi —- berikan analgetik<br />
Kateterisasi urin<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";">Inkontinensi<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l5 level1 lfo28; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Menetapkan rencana berkemih secara teratur dan menolong pasien mempertahankan itu<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l5 level1 lfo28; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Mengatur intake cairan, khususnya sebelum pasien istirahat, mengurangi kebutuhan berkemih<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l5 level1 lfo28; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Meningkatkan aktifitas fisik untuk meningkatkan tonus otot dan sirkulasi darah, selanjutnya menolong pasien mengontrol berkemih<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l5 level1 lfo28; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Merasa yakin bahwa toilet dan bedpan dalam jangkauannya<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l5 level1 lfo28; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Tindakan melindungi dengan menggunakan alas untuk mempertahankan laken agar tetap kering<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l5 level1 lfo28; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Untuk pasien yang mengalami kelemahan kandung kemih pengeluaran manual dengan tekanan kandung kemih diperlukan untuk mengeluarkan urine<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l5 level1 lfo28; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Untuk pasien pria yang dapat berjalan/berbaring ditempat tidur, inkontinensi tidak dikontrol dapat menggunakan kondom atau kateter penis.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm;"><span style="font-family: "Arial","sans-serif";">Enuresis<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l23 level1 lfo29; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Untuk enuresis yang kompleks, maka perlu dikaji komprehensif riwayat fisik dan psikologi, selain itu juga urinalisis (fisik, kimia atau pemeriksaan mikroskopis) untuk mengetahui penyebabnya.<o:p></o:p></span></div><div style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l23 level1 lfo29; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Mencegah agar tidak terjadi konflik kedua orang tua dan anak-anaknya<br />
Membatasi cairan sebelum tidur dan mengosongkan kandung kemih sebelum tidur / secara teratur.<o:p></o:p></span></div><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: KO; mso-fareast-theme-font: minor-fareast;"><br clear="all" style="mso-special-character: line-break; page-break-before: always;" /> </span> <div class="MsoNormal" style="line-height: 150%;"><br />
</div>salnihttp://www.blogger.com/profile/00126668517852477742noreply@blogger.com0tag:blogger.com,1999:blog-8321145958076225978.post-73839360980641985492011-10-27T07:52:00.000-07:002011-10-27T07:52:15.631-07:00Inkontinensia feses<div align="center" class="MsoNormal" style="text-align: center;"><br />
</div><div align="center" class="MsoNormal" style="text-align: center;"><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;">BAB 1<br />
PENDAHULUAN<o:p></o:p></span></div><div align="center" class="MsoNormal" style="text-align: center;"><br />
</div><div align="left" class="MsoListParagraphCxSpFirst" style="mso-list: l3 level1 lfo8; text-align: left; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span>A.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;">Latar Belakang</span><span style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="text-indent: 36.0pt;"><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;">Puji syukur </span><span style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;">kami</span><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;"> panjatkan kehadirat Allah SWT, Tuhan Yang Maha Esa<span> </span>yang telah memberikan rahmat serta hidayah-Nya<span> </span>sehingga penyusunan tugas</span><span style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"> makalah</span><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;"> ini dapat diselesaikan.Tugas ini disusun untuk diajukan sebagai tugas mata kuliah </span><span style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;">Kebutuhan Dasar Manusia Fakultas Kedokteran Program Studi Keperawatan </span><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;">dengan judul “Inkontinensia feses</span><span style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;">”.<span> </span></span><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;"><br />
<span> </span>Manusia merupakan salah satu makhluk hidup. Dikatakan sebagai makhluk hidup karena manusia memiliki ciri-ciri diantaranya: dapat bernafas, berkembangbiak, tumbuh, beradaptasi, memerlukan makan, dan megeluarkan sisa metabolisme tubuh (eliminasi). Setiap kegiatan yang dilakukan tubuh dikarenakan peranan masing-masing organ.<br />
<span> </span>Membuang urine dan alvi (feses) merupakan salah satu aktivitas pokok yang harus dilakukan oleh setiap manusia. Karena apabila eliminasi tidak dilakukan setiap manusia akan menimbulkan berbagai macam gangguan<span> </span>atau masalah defekasi seperti konstipasi,impaksi, diare, inkontinensia feses, flatulen, hemoroid. Selain berbagai macam yang telah disebutkan diatas akan menimbulkan dampak pada system organ lainnya seperti: system pencernaan, ekskresi, dll.</span><span style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;">Adapun faktor-faktor yang dapat mempengaruhi proses defekasi manusia antara lain usia,diet,asupan cairan,aktivitas,pengobatan gaya hidup,penyakit,nyeri,kerusakan sensoris dan motoris.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="text-indent: 36.0pt;"><span style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;">Saya mengucapkan terima kasih kepada segala pihak sehingga makalah ini dapat rangkum,Lebih khusus lagi kepada dosen pembimbing, Ns.Sisfiani Sarimin.Skep.SSIT terima kasih atas bimbingan dan petunjuknya sehingga pembuatan makalah ini bisa terarah.<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="text-indent: 36.0pt;"><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;">Demikianlah </span><span style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;">makalah</span><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;"> ini disusun semoga bermanfaat, agar dapat memenuhi tugas mata </span><span style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;">kuliah kebutuhan dasar manusia.</span><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;"><o:p></o:p></span></div><div align="left" class="MsoNormal" style="text-align: left;"><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;"><span> </span></span><span style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"><o:p></o:p></span></div><div align="left" class="MsoNormal" style="text-align: left;"><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;">B. </span><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"><span> </span></span><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;">Tujuan Permasalahan<br />
1) Mengetahui pengertian inkontinensia<br />
2) Menjelaskan penyebab terjadinya masalah inkontinensia feses<o:p></o:p></span></div><div align="left" class="MsoNormal" style="text-align: left;"><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;">3) Menjelaskan gejala dari inkontinensia feses<o:p></o:p></span></div><div align="left" class="MsoNormal" style="text-align: left;"><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;">4) Menjelaskan diagnosis dan pengobatan dari akibat masalah inkontinensia feses<o:p></o:p></span></div><div align="left" class="MsoNormal" style="text-align: left;"><br />
</div><div class="MsoNormal"><br />
</div><div align="center" class="MsoNormal" style="text-align: center;"><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;">BAB II<o:p></o:p></span></div><div align="center" class="MsoNormal" style="text-align: center;"><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;">PEMBAHASAN<o:p></o:p></span></div><div align="center" class="MsoNormal" style="text-align: center;"><br />
</div><div align="left" class="MsoNormal" style="text-align: left;"><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;"><span> </span>Eliminasi adalah proses pembuangan sisa metabolisme tubuh baik berupa urine atau alvi (buangair besar). Kebutuhan eliminasi terdiri dari atas dua, yakni eliminasi urine (kebutuhan buang airkecil) dan eliminasi alvi (kebutuhan buang air besar).<o:p></o:p></span></div><div align="left" class="MsoNormal" style="text-align: left;"><br />
</div><div align="left" class="MsoNormal" style="text-align: left;"><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;">A. Pengertian<o:p></o:p></span></div><div class="MsoNormal"><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;"><span> </span>Inkontinensia feses (alvi) adalah hilangnya kemampuan otot untuk mengontrol pengeluaran feses dan gas melalui sfingter anus akibat kerusakan fungsi sfingter atau persarafan di daerah anus. <o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;">B. Penyebab Inkontinensia Feses<o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="mso-list: l2 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;">Penyebab utama timbulnya inkontinensia feses adalah masalah sembelit, penggunaan pencahar yang berlebihan, gangguan saraf seperti demensia dan strok serta gangguan kolorektum seperti diare, neuropati diabetik, dan kerusakan sfingter rektum.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="mso-list: l2 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;">Penyebab inkontinensia feses dapat dibagi dalam 4 kelompok ( Brocklehurst dkk,1987, kane dkk,1989 ) adalah<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l5 level1 lfo2; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span>Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;">Inkontinensia Feses Akibat Konstipasi<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 108.0pt; mso-add-space: auto; mso-list: l1 level1 lfo3; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span>v<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;">Obstipasi yang berlangsung lama dapat mengakibatkan sumbatan/impaksi dari masa feses yang keras (skibala). Masa fese yang tidak dapat keluar ini akan menyumbat lumen bawah dari anus dan menyebabkan perubahan dari besarnya sudut ano rektal. Kemampuan sensor menumpul dan tidak dapat membedakan antara flatus, cairan atau feses. Akibatnya feses yang cair akan merebes keluar. <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 108.0pt; mso-add-space: auto; mso-list: l1 level1 lfo3; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span>v<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;">Skibala yang terjadi dapat juga menyebabkan iritasi pada mukosa rektum dan terjadi produksi cairan dan mukus, yang selanjutnya melalui sela-sela dari feses yang impaksi akan keluar dan terjadi inkontinensia feses.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 108.0pt; mso-add-space: auto;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l5 level1 lfo2; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span>Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;">Inkontinensia Feses Simtomatik<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 108.0pt; mso-add-space: auto; mso-list: l0 level1 lfo4; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span>v<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;">inkontinensia feses simtomatik dapat merupakan penampilan klinis dari macam-macam kelainan patologis yang dapat menyebabkan diare. Keadaan ini mungkin dipermudah dengan adanya perubahan berkaitan dengan bertambahnya usia dari proses kontrol yang rumit pada fungsi sfingter terhadap feses yang cair, dan gangguan pada saluran anus bagian atas dalam membedakan flatus dan feses yang cair. <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 108.0pt; mso-add-space: auto; mso-list: l0 level1 lfo4; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span>v<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;">Penyebab yang paling umum dari diare pada usia lanjut adalah obat-obatan antara lain yang mengandung unsur besi atau memang akibat obat pencahar <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 108.0pt; mso-add-space: auto;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l5 level1 lfo2; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span>Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;">Inkontinensia Feses Akibat Gangguan Kontrol Persyarafan Dari Proses Defekasi (Inkontinensia Neurogenik)<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto;"><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;">inkontinensia neurogenik terjadi akibat gangguan fungsi menghambat dari korteks serebri saat terjadi regangan/distensi rektum. Proses normal dari defekasi melalui refleks gastro-kolon . Beberapa menit setelah makanan sampai di lambung,akan menyebabkan pergerakan feses dari kolon desenden ke arah rektum. Distensi rektum akan diikuti relaksasi sfingter interna. Dan seperti halnya kandung kemih, tidak terjadi kontraksi intrinsik dari rektum pada orang dewasa normal, karena adanya inhibisi atau hambatan dari pusat di korteks serebri.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l5 level1 lfo2; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span>Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;">Inkontinensia Feses Akibat Hilangnya Refleks Anal<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 108.0pt; mso-add-space: auto; mso-list: l6 level1 lfo5; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span>v<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;">inkontinensia feses terjadi akibat hilangnya refleks anal, disertai kelemahan otot-otot seran lintang.<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 108.0pt; mso-add-space: auto; mso-list: l6 level1 lfo5; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span>v<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;">Parks, Henry dan Swash dalam penelitiannya (seperti dikutip oleh Brocklehurst dkk,1987), menunjukkan berkurangnya unit-unit yang berfungsi motorik pada otot-otot daerah sfingter dan purbo rektal. Keadaan ini menyebabkan hilangnya refleksi anal, berkurangnya sensasi pada anus disertai menurunnya tonus anus. Hal ini dapat berakibat inkontinensia feses pada peningkatan tekanan intraabdomen dan prolaps dari rektum. Pengelolaan inkontinensia sebaliknya ini diserahkan pada ahli proktologi untuk pengobatannya. <o:p></o:p></span></div><div class="MsoNormal"><br />
</div><div align="left" class="MsoNormal" style="text-align: left;"><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-no-proof: no;">Inkontinensia feses yang menetap bisa terjadi pada : <br />
- Orang yang mengalami cedera anus atau urat saraf tulang belakang <br />
- Prolapsus rektum (penonjolan lapisan rektum melalui anus) <br />
- Pikun <br />
- Cedera neurologis pada kencing manis <br />
- Tumor anus <br />
- Cedera di panggul karena persalinan. <o:p></o:p></span></div><div align="left" class="MsoNormal" style="text-align: left;"><br />
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</div><div align="left" class="MsoNormal" style="text-align: left;"><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-no-proof: no;">C. Gejala<br />
<span> </span>Gejala bisa berupa merembesnya feses cair yang disertai dengan buang gas dari dubur atau penderita sama sekali tidak dapat mengendalikan keluarnya feses. Umumnya ,orang dewasa tidak mengalami “kecelakaan buang air besar” ini kecuali mungkin sesekali ketika terserang diare parah.Tapi itu tidak berlaku bagi orang yang mengalami inkontinensia tinja,kejadian BAB di celana itu berulang-ulang dan kronis.<o:p></o:p></span></div><div align="left" class="MsoNormal" style="text-align: left;"><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-no-proof: no;">Gejalanya antara lain :<o:p></o:p></span></div><div align="left" class="MsoListParagraphCxSpFirst" style="mso-list: l7 level1 lfo6; text-align: left; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-no-proof: no;">Tidak dapat mengendalikan gas atau feses yang mungkin cair atau padat dari perut</span><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;"><o:p></o:p></span></div><div align="left" class="MsoListParagraphCxSpLast" style="mso-list: l7 level1 lfo6; text-align: left; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-no-proof: no;">Mungkin tidak sempat ke toilet untuk BAB</span><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;"><o:p></o:p></span></div><div align="left" class="MsoNormal" style="text-align: left;"><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-no-proof: no;">Bagi beberapa orang termasuk anak-anak inkontinensia tinja adalah masalah yang relative kecil,terbatas pada sesekali mengotori pakaian mereka.bagi yang lain,kondisi bisa menghancurkan lengkap karena kurangnya control usus.<br />
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<!--[endif]--><o:p></o:p></span></div><div align="left" class="MsoNormal" style="text-align: left;"><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-no-proof: no;">D. Diagnosa dan Pengobatan<o:p></o:p></span></div><div align="left" class="MsoNormal" style="text-align: left;"><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;"><span> </span>1.Diagnosa<br />
<span> </span>Untuk menentukan diagnosis, dilakukan pemeriksaan terhadap kemungkinan adanya kelainan struktur maupun kelainan saraf yang bisa menyebabkan keadaan ini. <br />
Termasuk di dalamnya adalah : <br />
- Pemeriksaan anus dan rektum <br />
- Memeriksa tingkat sensasi di sekeliling lubang anus <br />
- Pemeriksaan sigmoidoiskopi. <br />
Mungkin juga diperlukan pemeriksaan fungsi saraf dan lapisan otot-otot pelvis. <o:p></o:p></span></div><div align="left" class="MsoListParagraph" style="text-align: left;"><br />
</div><div align="left" class="MsoNormal" style="text-align: left;"><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;"><span> </span>2.<span> </span>Pengobatan<br />
<span> </span>Langkah pertama untuk memperbaiki keadaan ini adalah berusaha untuk memiliki kebiasaan defekasi (buang air besar) yang teratur, yang akan menghasilkan bentuk tinja yang normal. <br />
<span> </span>Melakukan perubahan pola makan, berupa penambahan jumlah serat. Jika hal-hal tersebut diatas tidak membantu, diberikan obat yang memperlambat kontraksi usus, misalnya loperamid. <br />
<span> </span>Melatih otot-otot anus (sfingter) akan meningkatkan ketegangan dan kekuatannya dan membantu mencegah kekambuhan. <br />
<span> </span>Dengan biofeedback, penderita kembali melatih sfingternya dan meningkatkan kepekaan rektum terhadap keberadaan tinja. <br />
<span> </span>Jika keadaan ini menetap, pembedahan dapat membantu proses penyembuhan. Misalnya jika penyebabnya adalah cedera pada anus atau kelainan anatomi di anus. <br />
<span> </span>Pilihan terakhir adalah kolostomi, yaitu pembuatan lubang di dinding perut yang dihubungkan dengan usus besar. Anus ditutup (dijahit) dan penderita membuang tinjanya ke dalam kantong plastik yang ditempelkan pada lubang tersebut. <o:p></o:p></span></div><div align="left" class="MsoNormal" style="text-align: left;"><br />
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</div><div align="center" class="MsoNormal" style="text-align: center;"><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;">BAB III<o:p></o:p></span></div><div align="center" class="MsoNormal" style="text-align: center;"><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;">KESIMPULAN DAN SARAN</span><span style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"><o:p></o:p></span></div><div align="left" class="MsoNormal" style="text-align: left;"><br />
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</div><div align="left" class="MsoListParagraph" style="mso-list: l4 level1 lfo7; text-align: left; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span>a)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;">Kesimpulan<o:p></o:p></span></div><div align="left" class="MsoNormal" style="text-align: left;"><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;"><span> </span>Inkontinensia feses yang merupakan hilangnya kemampuan otot dalam mengontrol pengeluaran feses yang melalui sfinkter anus akibat kerusakan sfinkter. Berbagai penyebab inkontinensia feses kebanyakan dipicu karena kerusakan sfinkter<span> </span>dan obat-obatan yang mengandung unsur besi. Gejala yang dihasilkan umumnya berupa merembesnya feses cair disertai dengan buang gas dari dubur. Pemeriksaan dapat dilihat pada kelainan struktur dan kelainan saraf. Pengobatan tergantung penyebab inkontinensia, dapat mencakup perubahan pola makan, obat-obatan & latihan khusus yang membantu untuk lebih mengontrol perut atau pembedahan.</span><span style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"><o:p></o:p></span></div><div align="left" class="MsoNormal" style="text-align: left;"><br />
</div><div align="left" class="MsoListParagraph" style="mso-list: l4 level1 lfo7; text-align: left; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span>b)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;">Saran<span> </span><o:p></o:p></span></div><div class="MsoNormal" style="text-indent: 36.0pt;"><span lang="EN-US" style="font-size: 11.0pt; line-height: 150%;">Agar supaya terhindar dari masalah defekasi seperti inkontinensia feses, sebaiknya mengkonsumsi makanan yang banyak mengandung serat seperti buah-buahan dan sayuran. Selain itu tingkatkan pula pola hidup sehat dan olahraga yang teratur serta hindari penggunaan obat – obat pencahar.<o:p></o:p></span></div><div align="left" class="MsoNormal" style="text-align: left;"><br />
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</div>salnihttp://www.blogger.com/profile/00126668517852477742noreply@blogger.com0tag:blogger.com,1999:blog-8321145958076225978.post-52130577954865950952011-10-27T07:37:00.000-07:002011-10-27T07:37:19.154-07:00Nutritional Food Safety<div class="MsoTitle"><span lang="EN-US">Nutritional Food Safety</span></div><div class="MsoNormal"><br />
</div><h1><span lang="EN-US">Pendahuluan</span></h1><div class="MsoNormal"><br />
</div><div class="MsoBodyTextIndent" style="line-height: normal;"><span lang="EN-GB">Konsumsi zat gizi harus juga mempertimbangkan efek negatifnya jika dikonsumsi dalam jumlah yang berlebihan. Materi ini akan mengulas bagaimana efeknya jika kita mengkonsumsi zat gizi (karbohidrat, protein, lemak, vitamin, dan mineral) dalam jumlah yang berlebihan.</span></div><div class="MsoNormal" style="margin-right: 1.3pt; text-align: justify; text-indent: 27.0pt;"><br />
</div><div class="MsoHeading8" style="line-height: normal;"><span lang="EN-US">Nutritional Food Safety</span></div><ul style="margin-top: 0cm;" type="disc"><li class="MsoNormal"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 10.0pt;">Chronic Health Issues – Nutrient/Diet<o:p></o:p></span></li>
<li class="MsoNormal"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 10.0pt;">Composition<o:p></o:p></span></li>
<ul style="margin-top: 0cm;" type="circle"><li class="MsoNormal"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 8.5pt;">High fat<o:p></o:p></span></li>
<li class="MsoNormal"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 8.5pt;">High sugar<o:p></o:p></span></li>
<li class="MsoNormal"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 8.5pt;">Low fiber<o:p></o:p></span></li>
<li class="MsoNormal"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 8.5pt;">Nutritional deficiency<o:p></o:p></span></li>
<li class="MsoNormal"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 8.5pt;">Alcohol/Tobacco overconsumption<o:p></o:p></span></li>
</ul><li class="MsoNormal"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 10.0pt;">Is this a public policy concern?<o:p></o:p></span></li>
</ul><div class="MsoNormal"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 8.5pt;">Annual Costs Associated with the Unsafe Consumption of Food, U.S., 2000</span><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 10.0pt;">-2002<o:p></o:p></span></div><h3 style="line-height: normal;"><span lang="EN-GB"><!--[if gte vml 1]><v:shapetype
id="_x0000_t75" coordsize="21600,21600" o:spt="75" o:preferrelative="t"
path="m@4@5l@4@11@9@11@9@5xe" filled="f" stroked="f"> <v:stroke joinstyle="miter"/> <v:formulas> <v:f eqn="if lineDrawn pixelLineWidth 0"/> <v:f eqn="sum @0 1 0"/> <v:f eqn="sum 0 0 @1"/> <v:f eqn="prod @2 1 2"/> <v:f eqn="prod @3 21600 pixelWidth"/> <v:f eqn="prod @3 21600 pixelHeight"/> <v:f eqn="sum @0 0 1"/> <v:f eqn="prod @6 1 2"/> <v:f eqn="prod @7 21600 pixelWidth"/> <v:f eqn="sum @8 21600 0"/> <v:f eqn="prod @7 21600 pixelHeight"/> <v:f eqn="sum @10 21600 0"/> </v:formulas> <v:path o:extrusionok="f" gradientshapeok="t" o:connecttype="rect"/> <o:lock v:ext="edit" aspectratio="t"/> </v:shapetype><v:shape id="_x0000_i1025" type="#_x0000_t75" style='width:333pt;
height:99pt'> <v:imagedata src="file:///C:\Users\USER\AppData\Local\Temp\msohtmlclip1\01\clip_image001.wmz"
o:title=""/> </v:shape><![endif]--><!--[if !vml]--><img height="132" src="file:///C:/Users/USER/AppData/Local/Temp/msohtmlclip1/01/clip_image002.gif" v:shapes="_x0000_i1025" width="444" /><!--[endif]--><o:p></o:p></span></h3><div class="MsoNormal"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 6.0pt;">Ratio of Obesity costs to Microbial costs<o:p></o:p></span></div><div class="MsoNormal"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 6.0pt;">– 93/6.9 = 13.5<o:p></o:p></span></div><div class="MsoNormal"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 6.0pt;">– 125/33 = 3.0<o:p></o:p></span></div><div class="MsoNormal"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 6.0pt;">– 400/5 = 80<o:p></o:p></span></div><div class="MsoNormal"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 4.0pt;">*Estimated cost based on four types of microbes: Campylobactor , Salmonella, E.coli, Listeria <o:p></o:p></span></div><div class="MsoNormal"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 4.0pt;">**Todd, Ag.Outlook Forum, 2003<o:p></o:p></span></div><div class="MsoNormal"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 4.0pt;">*** Direct and Indirect Costs: www.cdc.gov/diabetes/pubs/estimates.htm</span><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 10.0pt;"><o:p></o:p></span></div><h3 align="left" style="line-height: normal; text-align: left;"><span lang="EN-GB"><o:p> </o:p></span></h3><h3 align="left" style="line-height: normal; text-align: left;"><span lang="EN-GB">Contoh kasus konsumsi </span><span lang="EN-US">French Fries berlebihan dan keamanannya <o:p></o:p></span></h3><div class="MsoNormal"><i><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 13.0pt;">McDonald’s Obesity Suit<o:p></o:p></span></i></div><ul style="margin-top: 0cm;" type="circle"><li class="MsoNormal"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 10.0pt;">Does Society:<o:p></o:p></span></li>
<ul style="margin-top: 0cm;" type="circle"><li class="MsoNormal"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 8.5pt;">Provide public information about the relationship between high levels of fat consumption and disease<o:p></o:p></span></li>
<li class="MsoNormal"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 8.5pt;">Put Label on French Fries stating that high levels of consumption are hazardous to your health<o:p></o:p></span></li>
<li class="MsoNormal"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 8.5pt;">Regulate the level of fat allowed in french fries</span><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 10.0pt;"><o:p></o:p></span></li>
</ul></ul><div class="MsoNormal"><br />
</div><div class="MsoNormal" style="mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 27.0pt;"><b><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 10.0pt;">Safe Food Consumption is a Public Good<o:p></o:p></span></b></div><ul style="margin-top: 0cm;" type="circle"><li class="MsoNormal"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 8.5pt;">Healthy People = healthy, productive economy<o:p></o:p></span></li>
<li class="MsoNormal"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 8.5pt;">Role of Government = right combination of policies and practices that deliver the optimum level of safe food<o:p></o:p></span></li>
<li class="MsoNormal"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 8.5pt;">Consumption - in their economy and culture.<o:p></o:p></span></li>
<li class="MsoNormal"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 8.5pt;">Policy Choice - depends on specific risks associated with specific food<o:p></o:p></span></li>
<li class="MsoNormal"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 8.5pt;">Role of economist – find optimum investment to ensure healthy & safe food consumption.</span><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 10.0pt;"><o:p></o:p></span></li>
</ul><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><h1><span lang="EN-US">Konsumsi Zat Gizi Secara Berlebihan<o:p></o:p></span></h1><div class="MsoNormal"><br />
</div><h1><span lang="EN-US">Pengaruh Karbohidrat bagi Kesehatan<o:p></o:p></span></h1><div class="MsoNormal"><br />
</div><div class="MsoBodyTextIndent2" style="line-height: normal;"><span lang="EN-US">Peranan utama karbohidrat di dalam tubuh adalah menyediakan glukosa bagi sel-sel tubuh, yang kemudian diubah menjadi energi. Glukosa memegang peranan sentral dalam metabolisme karbohidrat. Jaringan tertentu hanya memperoleh energi dari karbohidrat seperti sel darah merah serta sebagian besar otak dan system syaraf.</span></div><div class="MsoNormal" style="mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 27.0pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 10.0pt;">Salah satu fungsi utama hati adalah menyimpan dan mengeluarkan glukosa sesuai kebutuhan tubuh. Kelebihan glukosa akan disimpan di dalam hati dalam bentuk glikogen. Bila persediaan glukosa darah menurun, hati akan mengubah sebagian glikogen menjadi glukosa dan mengeluarkannya ke dalam aliran darah. Glukosa ini akan dibawa oleh darah ke seluruh bagian tubuh yang memerlukan seperti otak, system syaraf, jantung, dan organ tubuh lain.<o:p></o:p></span></div><div class="MsoNormal" style="mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 27.0pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 10.0pt;">Kelebihan karbohidrat di dalam tubuh akan diubah menjadi lemak. Perubahan ini terjadi di dalam hati. Lemak ini kemudian dibawa ke sel-sel lemak yang dapat menyimpan lemak dalam jumlah tidak terbatas. Bagi orang dengan gangguan metabolisme karbohidrat maka konsumsi karbohidrat harus dipertimbangkan secara benar sampai seberapa porsinya.<o:p></o:p></span></div><div class="MsoNormal" style="mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 27.0pt;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><b><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">GANGGUAN METABOLISME KARBOHIDRAT<o:p></o:p></span></b></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Hormon yang berkaitan dengan metabolisme karbohidrat<o:p></o:p></span></div><ol start="1" style="margin-top: 0cm;" type="a"><li class="MsoNormal" style="mso-list: l1 level1 lfo4; tab-stops: list 36.0pt; text-align: justify;"><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Insulin<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l1 level1 lfo4; tab-stops: list 36.0pt; text-align: justify;"><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Growth hormone (GH = somatotropin)<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l1 level1 lfo4; tab-stops: list 36.0pt; text-align: justify;"><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Epinephrine (adrenaline)<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l1 level1 lfo4; tab-stops: list 36.0pt; text-align: justify;"><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Glucagon<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l1 level1 lfo4; tab-stops: list 36.0pt; text-align: justify;"><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Cortisol<o:p></o:p></span></li>
<li class="MsoNormal" style="mso-list: l1 level1 lfo4; tab-stops: list 36.0pt; text-align: justify;"><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Tyroksin<o:p></o:p></span></li>
</ol><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Insulin<span> </span>→<span> </span>menurunkan glukosa darah dengan cara:<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 42.0pt; mso-list: l7 level1 lfo5; tab-stops: list 42.0pt 54.0pt; text-align: justify; text-indent: -24.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>(i)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">menaikkan pemakaian glukosa oleh otot/jaringan lemak<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 42.0pt; mso-list: l7 level1 lfo5; tab-stops: list 42.0pt 54.0pt; text-align: justify; text-indent: -24.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>(ii)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">mendorong glikogenesis<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 42.0pt; mso-list: l7 level1 lfo5; tab-stops: list 42.0pt 54.0pt; text-align: justify; text-indent: -24.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>(iii)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">mendorong glikosis → mempercepat penggunaan glukosa<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 42.0pt; mso-list: l7 level1 lfo5; tab-stops: list 42.0pt 54.0pt; text-align: justify; text-indent: -24.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>(iv)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">mendorong sintesis lipid dari glukosa di jaringan lemak<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 42.0pt; mso-list: l7 level1 lfo5; tab-stops: list 42.0pt 54.0pt; text-align: justify; text-indent: -24.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>(v)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">mendorong sinlisis asam amino dari glukosa<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; tab-stops: list 36.0pt 54.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Kecepatan sekresi insulin ke dalam aliran darah dipengaruhi oleh konsentrasi gula<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; tab-stops: list 36.0pt 54.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Bila konsentrasi gula plasma naik (sesudah makan) sel-sel terangsang untuk melepaskan insulin. Kecepatan tersebut kembali normal bila konsentrasi gula kembali normal<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; tab-stops: list 36.0pt 54.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Beberapa asam amino seperti liucine dan arginin menurunkan konsentrasi glukosa plasma dengan merangsang sekresi insulin.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Growth hormone<span> </span>→<span> </span>menaikkan konsentrasi gula plasma dengan cara:<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 42.0pt; mso-list: l6 level1 lfo7; tab-stops: list 54.0pt 72.0pt; text-align: justify; text-indent: -24.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>(i)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">penghambatan masuknya glukosa ke dalam otot<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 42.0pt; mso-list: l6 level1 lfo7; tab-stops: list 54.0pt 72.0pt; text-align: justify; text-indent: -24.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>(ii)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">menghambat glikolisis<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 42.0pt; mso-list: l6 level1 lfo7; tab-stops: list 54.0pt 72.0pt; text-align: justify; text-indent: -24.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>(iii)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">menghambat pembentukan trigliserida dari glukosa<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Epinephrine (adrenaline)<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; tab-stops: list 36.0pt 54.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Menaikkan konsentrasi gula darah dengan menaikkan kecepatan glikogenolisis di dalam liver<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; tab-stops: list 36.0pt 54.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Rangsangan sekresi epinephrine bisa berupa stres fisik atau emosional yang bersifat neurogenik<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Glucagon<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; tab-stops: list 36.0pt 54.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Menaikkan konsentrasi gula darah dengan mendorong glikogenolisis di dalam liver<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; tab-stops: list 36.0pt 54.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Sekresi glucagon juga dipengaruhi oleh konsentrasi gula darah, tetapi berlawanan dengan mekanisme pada insulin (gula darah turun → sekresi glucagon naik)<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 18.0pt; text-align: justify;"><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">atau: pengeluaran glucagon dirangsang oleh hypoglycemia dan ditekan oleh hyperglycemia<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Costisol (hidro cortisone)<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; tab-stops: list 36.0pt 54.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Menaikkan konsentrasi gula darah dengan mendorong glukoneogenesis dari pemecahan protein (asam amino → glukosa)<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; tab-stops: list 36.0pt 54.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Menaikkan konsentrasi gula darah dengan menurunkan/mencegah pemasukkan glukosa ke dalam sel-sel otot (insulin dan coretisal antagonis)<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Tyroksin<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; tab-stops: list 36.0pt 54.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Memacu konversi glikogen menjadi glukosa di dalam liver<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; tab-stops: list 36.0pt 54.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Mempercepat absorpsi glukosa di dalam usus<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><b><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Gangguan Metabolisme Karbohidrat: Hyperglycemia<o:p></o:p></span></b></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Bahaya hyperglycemia<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; tab-stops: list 36.0pt 54.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Konsentrasi gula darah tinggi → tekanan osmotik ekstraseluler tinggi → dehidrasi<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; tab-stops: list 36.0pt 54.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Bila sel otak mengalami dehidrasi → koma<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; tab-stops: list 36.0pt 54.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Bila konsentrasi >600 mg/dL biasanya akan terjadi koma dan ketidakseimbangan elektrolit<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; tab-stops: list 36.0pt 54.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Gula darah yang tinggi dalam waktu lama bisa mengakibatkan ”glikosilasi hemoglobin A” (HB Ac 1), yaitu terjadinya ikatan kovalen antara glukosa dan terminal valine dari hemoglobin A, oleh karena itu kandungan HB Ac 1 dipakai sebagai parameter penderita diabetes (normal: 4-6%; tidak normal: 7-11%)<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 18.0pt; mso-list: l0 level1 lfo6; tab-stops: list 36.0pt 54.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Diabet merupakan gangguan metabolisme karbohidrat, tetapi juga mempengaruhi<span> </span>metabolisme protein dan lemak:<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l6 level2 lfo7; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>(1)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">protein – washing → memaksa konversi asam amino menjadi glukosa<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l6 level2 lfo7; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>(2)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">menaikkan metabolisme trigliserida diikuti dengan over-produksi ketone bodies dan kolesterol<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 54.0pt; text-align: justify;"><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Hal-hal tersebut ditandai dengan:<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l3 level1 lfo8; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>(a)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">poly urea (volume urine berlebihan)<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 72.0pt; text-align: justify;"><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Bila kadar gula darah naik di atas 180 mg/dL, ginjal tidak dapat lagi menahan → sebagian gula ke urine → kadar gula urine tinggi → menarik air banyak (osmolitas gula) → poly urea<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l3 level1 lfo8; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>(b)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">poly dipsia (haus)<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 72.0pt; text-align: justify;"><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Keadaan tersebut akan mengganggu neraca air dalam tubuh → poly dipsia = rasa haus terus<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l3 level1 lfo8; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>(c)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">poly phagia (lapar)<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 72.0pt; text-align: justify;"><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Pada waktu bersamaan, meskipun kadar gula darah berlebihan, tetapi tidak dapat dimanfaatkan sebagai sumber energi sel → <i>glucose stored state</i> → kelaparan<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 72.0pt; mso-list: l3 level1 lfo8; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>(d)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">penurunan berat badan<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 72.0pt; text-align: justify;"><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Karena tubuh harus memecah protein/lemak untuk keperluan energinya → penurunan berat badan<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Diabetes dibagi menjadi 4:<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l8 level1 lfo9; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>(1)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Prediabetes<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo6; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">normal, tetapi secara genetis punya sifat/kemungkinan diabetes<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l8 level1 lfo9; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>(2)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Suspected (sub clinical) diabetes<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo6; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">gula darah puasa: normal<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo6; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">tidak glukosuria/ketosuria<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo6; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">GTT (Glucose Tolerence Test) normal, kecuali bila stress/hamil<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l8 level1 lfo9; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>(3)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Chemical/Latent diabetes<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo6; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">gula darah puasa normal atau sedikit lebih tinggi<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo6; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">tidak ada glukosuria/ketosuria<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo6; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">GTT abnormal<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo6; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Gula darah 2 jam mencapai 120 mg/dL<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l8 level1 lfo9; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>(4)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Overt diabetes<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo6; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">jelas positif diabetes<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo6; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">gula darah dapat mencapai 180 mg/dL atau lebih<o:p></o:p></span></div><div class="MsoNormal" style="margin-left: 36.0pt; mso-list: l0 level1 lfo6; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV; mso-fareast-font-family: Arial;"><span>-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">glukosuria/ketosuria<o:p></o:p></span></div><div class="MsoNormal" style="mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 27.0pt;"><br />
</div><h2 style="text-indent: 0cm;"><span lang="EN-US">Pengaruh Lipida Bagi Kesehatan</span></h2><div class="MsoNormal" style="mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 27.0pt;"><br />
</div><div class="MsoNormal" style="mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 27.0pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 10.0pt;">Kolesterol darah yang meningkat berpengaruh tidak baik untuk jantung dan pembuluh darah. Faktor makanan yang paling berpengaruh terhadap kadar kolesterol darah, dalam hal ini LDL (Low Density Lipoprotein), adalah lemak total, lemak jenuh dan energi total. Dengan mengurangi lemak total dalam makanan, jumlah energi total akan ikut berkurang. Jenis lemak yang dikurangi ini hendaknya lemak jenuh. Kolesterol makanan sebetulnya hanya sedikit meningkatkan kolesterol darah, tergantung jumlah kolesterol yang dimakan dan kemampuan tubuh untuk mengimbanginya dengan mensitesis kolesterol dengan jumlah lebih sedikit. <o:p></o:p></span></div><div class="MsoNormal" style="mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 27.0pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 10.0pt;">Kenaikan trigliserida dalam plasma (hipertrigliserida) juga dikaitkan dengan terjadinya penyakit jantung koroner. Kadar trigliserida plasma bnyak dipengaruhi oleh kandungan karbohidrat makanan dan obesitas.<o:p></o:p></span></div><div class="MsoNormal" style="mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 27.0pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 10.0pt;">Konsumsi lemak akhir-akhir ini juga dikaitkan dengan penyakit kanker. Hal yang berpengaruh adalah jumlah lemak dan mungkin asam lemak tidak jenuh ganda tertentu.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: IN;">Ada beberapa penyebab penyakit jantung. Penyebab yang dianggap penting yaitu tekanan darah tinggi atau hipertensi. Tekanan darah tinggi merupakan suatu penyakit yang diderita manusia tanpa disadari. Akibat yang ditimbulkan oleh tekanan darah tinggi adalah tersumbatnya pembuluh darah pada jantung, kelumpuhan pada jaringan otak, kerusakan jaringan mata, dan penyakit ginjal. Tingginya tekanan darah pada saat dilakukan pengukuran disebabkan karena menciutnya pembuluh darah. Menciutnya pembuluh darah disebabkan karena tertimbunnya lemak dalam pembuluh darah sehingga memperkecil diameter pembuluh darah. Penimbunan lemak dalam pembuluh darah sering disebut pengapuran pembuluh darah atau arteriosklerosis. Mengapurnya pembuluh darah di sekitar jantung akan menambah resiko terjadinya penyumbatan pembuluh darah pada jantung atau disebut <i>infark </i>jantung. Jantung yang selalu bekerja keras untuk dapat mengalirkan darah melalui pembuluh yang mengapur tersebut akan cepat mengalami kerusakan dibandingkan dengan jantung normal. Apabila terjadi penyumbatan pada pembuluh darah di otak, maka sel-sel otak tidak mendapatkan nutrien maupun oksigen, akibatnya terjadi kelumpuhan atau disebut <i>brain attack, </i>sedangkan bila terjadi pada jantung disebut <i>heart attack</i> dan menyebabkan kematian yang mendadak. Kerusakan pembuluh selaput mata dapat mengganggu penglihatan mata. Akibat kerusakan pada pembuluh darah yang halus mengakibatkan kerja ginjal kurang baik.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: IN;">Arteriosklerosis dan penyakit jantung koroner nampaknya lebih mudah diderita oleh orang yang termasuk dalam tipe A daripada tipe B. Manusia tipe A adalah yang bersifat kompetitif, <span>memaksakan diri</span><i>, </i><span>dan </span>mudah stress sedangkan manusia tipe B adalah manusia yang tenang, santai, dan tidak mudah stress. Resiko terkena hipertensi dan penyakit jantung koroner juga lebih besar terjadi pada perokok.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: IN;">Usaha untuk mengurangi arteriosklerosis dan penyakit jantung koroner adalah dengan pengaturan diet. Diet rendah lemak, rendah garam, tinggi serat, diet rendah kalori bagi yang kegemukan serta melakukan olah raga dengan teratur. Garam berfungsi untuk mengatur keseimbangan caiaran dalam tubuh. Makin tinggi garam makin besar pula kadar cairan dalam tubuh, akibatnya makin banyak darah yang harus melewati pembuluh dan mengakibatkan tekanan pada urat nadi semakin besar, jantung bekerja dengan keras untuk mengalirkan jumlah darah yang bertambah tersebut yang mengakibatkan naiknya tekanan darah. Diet rendah lemak termasuk rendah kolesterol dan asam lemak jenuh, rendah kalori, dan olah raga yang teratur dapat mengurangi kandungan lemak dalam tubuh sehingga pengapuran pembuluh menjadi berkurang. Diet tinggi serat dapat menghambat sintesis <i>endogenous cholesterol</i>. Tidur secukupnya dan mengurangi ketegangan serta emosi merupakan usaha untuk menurunkan tekanan darah tinggi. Penggunaan obat-obatan untuk menurunkan tekanan darah tinggi banyak dilakukan. Obat-obatan tersebut ada yang yang bersifat diuretik yaitu memperlancar pengeluaran air seni. Garam tubuh ikut keluar bersama air seni sehingga kadar garam menurun. Menurunnya kadar garam mengakibatkan jumlah zat cair yang dapat diikatnya menurun, sehingga jantung tidak harus bekerja keras untuk memompa. Ada pula obat-obatan yang dapat memperlebar pembuluh darah. Pemeriksaan secara teratur tekanan darah merupakan usaha yang sangat baik untuk mengurangi terjadinya resiko yang kurang baik.<o:p></o:p></span></div><div class="MsoNormal" style="mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 27.0pt;"><br />
</div><h2 style="text-indent: 0cm;"><span lang="EN-US">Pengaruh Protein Bagi Kesehatan</span></h2><div class="MsoNormal" style="mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 27.0pt;"><br />
</div><div class="MsoNormal" style="mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 27.0pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 10.0pt;">Protein secara berlebihan tidak menguntungkan tubuh. Makanan yang tinggi protein biasanya tinggi lemak sehingga menyebabkan obesitas. Diet protein tinggi yang sering dianjurkan untuk menurunkan berat badan kurang beralasan. Kelebihan protein dapat menimbulkan masalah lain, terutama pada bayi. Kelebihan asam amino memberatkan ginjal dan hati yang harus memetabolisme dan mengeluarkan kelebihan nitrogen. Kelebihan protein akan menimbulkan asidosis, dehidrasi, diare, kenaikan ammonia darah, kenaikan ureum darah, dan demam. Ini dilihat pada bayi yang diberi susu skim atau formula dengan konsentrasi tinggi, sehingga konsumsi protein mencapai 6 g/kg berat badan. Batas yang dianjurkan untuk konsumsi protein adalah 2 kali AKG untuk protein. <o:p></o:p></span></div><div class="MsoNormal" style="mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 27.0pt;"><br />
</div><h2 style="text-indent: 0cm;"><span lang="EN-US">Pengaruh Vitamin Bagi Kesehatan</span></h2><div class="MsoNormal" style="mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 27.0pt;"><br />
</div><h4><span lang="EN-US">Vitamin A</span></h4><div class="MsoNormal" style="mso-layout-grid-align: none; text-align: justify; text-autospace: none;"><br />
</div><div class="MsoNormal" style="mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 27.0pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 10.0pt;">Kelebihan vitamin A hanya bisa terjadi bila memakan vitamin A sebagai suplemen dalam takaran tinggi yang berlebihan misalnya takaran 16.000 RE untuk jangka waktu lama atau 40.000-55.000 RE/hari.<o:p></o:p></span></div><div class="MsoNormal" style="mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 27.0pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 10.0pt;">Gejala pada orang dewasa antara lain sakit kepala, pusing, rasa nek, rambut rontok, kulit mongering, tidak ada nafsu makan atau anoreksia, dan sakit pada tulang. Pada wanita menstruasi berhenti. Pada bayi terjadi pembesaran kepala, hidrosephalus, dan mudah tersinggung, yang dapat terjadi pada konsumsi 8.000 RE/hari selama<span> </span>30 hari.<o:p></o:p></span></div><div class="MsoNormal" style="mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 27.0pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 10.0pt;">Gejala kelebihan ini hanya terjadi bila dimakan dalam bentuk vitamin A. Karoten tidak dapat menimbulkan gejala kelebihan karena absorpsi karoten menurun bila konsumsi tinggi. Di samping itu sebagian dari karoten yang diserap tidak diubah menjadi vitamin A, akan tetapi disimpan di dalam lemak. Bila lemak di bawah kulit mengandung banyak karoten, warna kulit akan terlihat kekuningan.<o:p></o:p></span></div><div class="MsoBodyText" style="text-indent: 27.0pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-bidi-font-size: 10.0pt;"><span> </span></span><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Kelebihan vitamin A kurang baik karena akan mengakibatkan terjadinya penimbunan vitamin A dalam organ tubuh yang akan mengakibatkan nafsu makan menjadi menurun, rambut rontok, kulit menjadi gatal, tulang pada tangan dan kaki berasa sakit.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;"><span lang="SV" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: SV;">Pemakaian beta karoten yang berlebihan dapat mengakibatkan kulit menjadi kuning, telapak tangan banyak mengeluarkan keringat.<o:p></o:p></span></div><div class="MsoNormal" style="mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 27.0pt;"><br />
</div><h4><span lang="EN-US">Vitamin D</span></h4><div class="MsoNormal" style="text-indent: 27.0pt;"><br />
</div><div class="MsoBodyTextIndent2" style="line-height: normal; mso-layout-grid-align: auto; text-autospace: ideograph-numeric ideograph-other;"><span lang="EN-US">Konsumsi vitamin D dalam jumlah berlebihan mencapai lima kali AKG yaitu lebih dari 25 mikrogram (1000 SI) sehari, akan menyebabkan keracunan. Gejalanya adalah kelebihan absorpsi vitamin D yang pada akhirnya menyebabkan kalsifikasi berlebihan pada tulang dan jaringan tubuh, seperti ginjal, paru-paru, dan organ tubuh lain. Tanda-tanda khas adalah akibat hiperkalsemia seperti lemah, sakit kepala, kurang nafsu makan, diare, muntah-muntah, gangguan mental dan pengeluaran urin berlebihan. Bayi yang diberi vitamin D berlebihan menunjukkan gangguan saluran cerna, rapuh tulang, gangguan pertumbuhan, dan kelambatan perkembangan mental.</span></div><div class="MsoBodyTextIndent3" style="margin-left: 0cm; text-indent: 27.0pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt;">Di masa bayi seringkali diberi tambahan vitamin D sebanyak satu tetes setiap hari. Pemberian vitamin D yang terlalu banyak, misalnya satu sendok teh setiap hari akan mengakibatkan timbulnya keracunan. Gejala keracunan vitamin D yaitu nafsu makan hilang, muntah-muntah, berasa sangat haus, mengalami sembelit, dapat mengalami diare, kehilangan berat dan bersifat mudah marah. Apabila overdosis berlangsung terus menerus, anak dapat mengalami koma dan akhirnya mati.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><br />
</div><h4><span lang="EN-US">Vitamin E</span></h4><div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;"><br />
</div><div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 10.0pt;">Menggunakan vitamin E secara berlebihan dapat menimbulkan keracunan. Namun akibatnya tidak terlalu merugikan seperti halnya dengan kelebihan vitamin A. Gangguan pada saluran cerna terjadi bila memakan lebih dari 600 mg sehari (60-75 kali AKG). Dosis tinggi juga dapat meningkatkan efek obat antikoagulan yang digunakan untuk mencegah penggumpalan darah.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;"><br />
</div><h4><span lang="EN-US">Vitamin K</span></h4><div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;"><br />
</div><div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 10.0pt;">Kelebihan vitamin K hanya bisa terjadi bila vitamin K diberikan dalam bentuk berlebihan berupa vitamin K sintetik menadion. Gejala kelebihan vitamin K adalah hemolisis sel darah merah, sakit kuning dan kerusakan pada otak.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;"><br />
</div><h4><span lang="EN-US">Vitamin C</span></h4><div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;"><br />
</div><div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 10.0pt;">Kelebihan vitamin C berasal dari makanan tidak menimbulkan gejala. Tetapi konsumsi vitamin C berupa suplemen secara berlebihan tiap hari dapat menimbulkan hiperoksaluria dan resiko lebih tinggi terhadap batu ginjal. Dengan konsumsi 5-10 gr vitamin C baru sedikit asam askorbat dikeluarkan melalui urin. Resiko batu oksalat dengan suplemen vitamin C dosis tinggi dengan demikian rendah, akan tetapi hal ini dapat menjadi berarti pada seseorang yang mempunyai kecenderungan untuk pembentukan batu ginjal.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;"><br />
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</div><h4><span lang="EN-US">Vitamin B<sub>6</sub></span></h4><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 10.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br clear="all" style="page-break-before: always;" /> </span> <div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><span> </span>Konsumsi vitamin B6 dalam jumlah berlebihan selama berbulan-bulan akan menyebabkan kerusakan saraf yang tidak dapat diperbaiki, dimulai dengan semutan pada kaki, kemudian mati rasa pada tangan dan akhirnya tubuh tidak mampu bekerja. Gejala kelebihan vitamin B6 ini sudah dapat dilihat pada konsumsi sebanyak 25 mg sehari. Hal ini perlu diperhatikan bila menggunakan suplemen vitamin B6 dalam jumlah berlebihan.<o:p></o:p></span></div><div class="MsoNormal"><br />
</div><h2 style="text-indent: 0cm;"><span lang="EN-US">Pengaruh Mineral Bagi Kesehatan</span></h2><div class="MsoNormal"><br />
</div><div class="MsoBodyTextIndent2" style="line-height: normal; mso-layout-grid-align: auto; text-autospace: ideograph-numeric ideograph-other;"><span lang="EN-US">Mineral dalam jumlah berlebihan dapat menyebabkan keracunan (toksik). Pekerja tambang jika tidak berhati-hati dapat mengalami keracunan mineral, terutama managn. Sifat toksik ini perlu mendapat perhatian dalam penggunaan suplemen mineral.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Kelebihan natrium dapat menimbulkan keracunan yang dalam keadaan akut menyebabkan edema dan hipertensi. Hal ini dapat diatasi dengan banyak minum. Kelebihan konsumsi natrium secara terus menerus terutama dalam bentuk garam dapur dapat menimbulkan hipertensi.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Kelebihan kalium akut dapat terjadi bila konsumsi melalui saluran cerna (enteral) atau tidak melalui saluran cerna (parenteral) melebihi 12 g/m2 permukaan tubuh sehari (18 g untuk orang dewasa) tanpa diimbangi oleh kenaikan ekskresi. Hiperkalemia akut dapat menyebabkan gagal jantung yang berakibat kematian. Kelebihan kalium juga dapat terjadi bila ada gangguan fungsi ginjal.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Konsumsi kalsium hendaknya tidak melebihi 2500 mg sehari. Kelebihan kalsium dapat menimbulkan batu ginjal atau gangguan ginjal. Di samping itu dapat menyebabkan konstipasi. Kelebihan kalsium bisa terjadi bila menggunakan suplemen kalsium berupa tablet atau bentuk lain.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Kelebihan fosfor karena makanan jarang terjadi. Bila kadar fosfor darah terlalu tinggi, ion fosfat akan mengikat kalsium sehingga dapat menimbulkan kejang.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Akibat kelebihan magnesium belum diketahui dengan pasti. Kelebihan magnesium biasanya terjadi pada penyakit gagal ginjal.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Kelebihan besi jarang terjadi karena makanan, tetapi dapat disebabkan oleh suplemen besi. Gejalanya adalah rasa nek, muntah, diare, denyut jantung meningkat, sakit kepala, mengigau, dan pingsan.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Kelebihan Zn hingga 2-3 kali AKG menurunkan absorpsi tembaga. Pada hewan dapat menyebabkan degenerasi otot jantung. Kelebihan sampai 10 kali AKG mempengaruhi metabolisme kolesterol, mengubah nilai lipoprotein, dan dapat mempercepat timbulnya aterosklerosis. Dosis sebanyak 2 g atau lebih dapat menyebabkan muntah, diare, demam, kelelahan yang sangat, anemia, dan gangguan reproduksi. Suplemen Zn bisa menyebabkan keracunan begitu pula dengan makanan yang asam dan disimpan dalam kaleng yang dilapisi seng.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Suplemen iodium dalam dosis terlalu tinggi dapat menyebabkan perbesaran kelenjar tiroid, seperti halnya kekurangan iodium. Dalam keadaan berat dapat menutup jalan pernafasan sehingga meimbulkan sesak nafas.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Kelebihan tembaga secara kronis menyebabkan penumpukan tembaga di dalam hati yang dapat menyebabkan nekrosis hati atau serosis hati. Kelebihan tempaga dapat terjadi karena memakan suplemen tembaga, atau menggunakan alat pemasak terbuat dari tembaga, terutama bila digunakan untuk memasak cairan yang bersifat asam. Konsumsi sebanyak 10-15 mg tembaga sehari dapat menimbulkan muntah-muntah dan diare. Berbagai tahap perdarahan intravaskular dapat terjadi, begitupun nekrosis sel-sel hati dan gagal ginjal. Konsumsi dosis tinggi dapat menyebabkan kematian.<o:p></o:p></span></div><div class="MsoNormal" style="text-align: justify; text-indent: 27.0pt;"><br />
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</div><div class="MsoNormal"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 14.0pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Demikian materi <i>Nutritional Food Safety. </i>Semoga bermanfaat dan selamat mempelajari lebih jauh dengan menambah materi-materi terkait yang dapat di-download di internet.<o:p></o:p></span></div><div class="MsoNormal"><br />
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</div>salnihttp://www.blogger.com/profile/00126668517852477742noreply@blogger.com0tag:blogger.com,1999:blog-8321145958076225978.post-31182615358922684192011-10-16T05:48:00.000-07:002011-10-16T05:48:59.797-07:00Refleks<div align="left" class="MsoNormal" style="text-align: left;"><br />
</div><div align="center" class="MsoNormal" style="text-align: center;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">“REFLEKS”<o:p></o:p></span></div><div align="left" class="MsoNormal" style="text-align: left;"><br />
</div><div align="left" class="MsoListParagraph" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l1 level1 lfo1; text-align: left; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span>Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Definis</span><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;">i</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;"><o:p></o:p></span></div><div align="left" class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: left;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;"><span> </span>Refleks adalah respon yang terjadi secara otomatis tanpa usaha secara sadar. Atau, dapat dikatakan sebagai suatu respon motorik yang involunter, timbul karena adanya rangsangan sensorik.</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-no-proof: no;"> </span><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman"; mso-no-proof: no;"><span> </span>Refleks adalah jawaban terhadap suatu penrangsangan. Berakan yang timbul dinamakan gerakan refleksitorik. Semua gerakan reflektorik merupakan gerakanyang bangkit untuk penyesuaian diri, baik untuk menjamin ketangkasan gerakan voluntar, maupun untuk membela diri. Gerakan reflektorik tidak saja dilaksanakan oleh anggota gerak akan tetapi setiap otot lurik dapt melakukan gerakan reflektorik. Lagi pula perangsangnya tidak saja terdapat di permukaan tubuh,<span> </span>akan tetapi semua impuls perseptif dapat merangsang gerakan reflektorik, termasuk impuls pancaindera. <o:p></o:p></span></div><div align="left" class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: left;"><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman"; mso-no-proof: no;"><span> </span>Bahwasannya suatu perangsangan dijawab dengan bangkitnya suatu gerakan, menandakan bahwa daerah yang dirangsang dan otot yang bergerak secara reflektorik itu terdapat hubungan. Lintasan yang menghubungkan reseptor dan efektor itu dikenal sebagai busur refleks. <o:p></o:p></span></div><div align="left" class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: left;"><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman"; mso-no-proof: no;"><span> </span>Reseptor di kulit mendapat perangsangan. Suatu impuls dicetuskan dan dikirim melalui radiks dorsalis ke sebuah neuron di substansia grisea medula spinalis. Atas kedatangan impuls tersebut neuron menrangsang motoneuron di kornu anterior, yang pada gilirannya menggalakkan seabut otot untuk berkontraksi. Reseptor, serabut aferen, interneuron di arafinya merupakan busur refleks yang segmenta. Sebagian besar refleks pancaindera dan kebanyakan refleks superfisial terjadi dengan perantaraan busur refleks segmental yang di lengkapi juga dengan lintasan suprasegmental.<o:p></o:p></span></div><div align="left" class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: left;"><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman"; mso-no-proof: no;"><span> </span>Refleks-refleks yang dibangkitkan dalam rangka pemeriksaan klinis dapat bersifat refleks dalam dan refleks superfisial.<span> </span>Refleks dalam berarti refleks yang bangkit sebagai jawaban atas perangsangan terhadap otot, sedangkan refleks superfisial adalah refleks yang bangkit perangsang permukaan kulit atau mukosa.<o:p></o:p></span></div><div align="left" class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: left;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-no-proof: no;">Pada manusia gerak refleks terjadi melalui <i>reflex arc</i>.Gerak refleks dapat digunakan pada </span><span lang="EN-US"><a href="http://id.wikipedia.org/w/index.php?title=Pemeriksaan&action=edit&redlink=1" title="Pemeriksaan (halaman belum tersedia)"><span style="font-family: 'Comic Sans MS'; font-size: 11pt; line-height: 150%; text-decoration: none;">pemeriksaan</span></a></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-no-proof: no;"> </span><span lang="EN-US"><a href="http://id.wikipedia.org/w/index.php?title=Neurologis&action=edit&redlink=1" title="Neurologis (halaman belum tersedia)"><span style="font-family: 'Comic Sans MS'; font-size: 11pt; line-height: 150%; text-decoration: none;">neurologis</span></a></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-no-proof: no;"> untuk mengetahui kerusakan atau pemfungsian dari </span><span lang="EN-US"><a href="http://id.wikipedia.org/wiki/Sistem_saraf" title="Sistem saraf"><span style="font-family: 'Comic Sans MS'; font-size: 11pt; line-height: 150%; text-decoration: none;">sistem saraf</span></a></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-no-proof: no;"> pusat dan sistem saraf tepi.Gerak refleks dapat dilatih misalnya pengulangan dari </span><span lang="EN-US"><a href="http://id.wikipedia.org/wiki/Gerakan_motorik" title="Gerakan motorik"><span style="font-family: 'Comic Sans MS'; font-size: 11pt; line-height: 150%; text-decoration: none;">gerakan motorik</span></a></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-no-proof: no;"> pada latihan </span><span lang="EN-US"><a href="http://id.wikipedia.org/wiki/Olah_raga" title="Olah raga"><span style="font-family: 'Comic Sans MS'; font-size: 11pt; line-height: 150%; text-decoration: none;">olah raga</span></a></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-no-proof: no;"> atau pengaitan dari rangsang oleh reaksi otomatis selama </span><span lang="EN-US"><a href="http://id.wikipedia.org/w/index.php?title=Pengkkondisian&action=edit&redlink=1" title="Pengkkondisian (halaman belum tersedia)"><span style="font-family: 'Comic Sans MS'; font-size: 11pt; line-height: 150%; text-decoration: none;">pengkondisian klasikal</span></a></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-no-proof: no;">.</span><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman"; mso-no-proof: no;"><o:p></o:p></span></div><div align="left" class="MsoNormal" style="text-align: left;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;"><span> </span>Secara garis besar, refleks terbagi dalam 2 bagian, yaitu:<o:p></o:p></span></div><div align="left" class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo2; text-align: left; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";"><span>A.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Condition refleks,<o:p></o:p></span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="text-align: left;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Condition refleks merupakan gerakan tangkas, keadaan ini bisa dilatih.<o:p></o:p></span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo2; text-align: left; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";"><span>B.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Uncondition Refleks<o:p></o:p></span></div><div align="left" class="MsoListParagraphCxSpLast" style="text-align: left;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Uncondition refleks merupakan gerakan involunter yang tidak bisa dilatih. <o:p></o:p></span></div><div align="left" class="MsoNormal" style="text-align: left;"><br />
</div><div align="left" class="MsoListParagraphCxSpFirst" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l1 level1 lfo1; text-align: left; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span>Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Pembagian Refleks</span><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"> (undconditional refleks)</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;"><o:p></o:p></span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="mso-list: l2 level1 lfo3; text-align: left; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Refleks Fisiologis, terdiri dari:<o:p></o:p></span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l3 level1 lfo4; text-align: left; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";"><span>a)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Refleks Superfisial, contohnya: refleks kornea, refleks faring, refleks cahaya, refleks abdominal, refleks kremaster, refleks anal.<o:p></o:p></span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l3 level1 lfo4; text-align: left; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Comic Sans MS"; mso-fareast-font-family: "Comic Sans MS";"><span>b)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Refleks Tendo, contohnya:<span> </span>refleks biseps, refleks triseps, refleks brachioradialis, refleks quadriceps.<o:p></o:p></span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="mso-list: l2 level1 lfo3; text-align: left; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span>·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Refleks Patologis<o:p></o:p></span></div><div align="left" class="MsoListParagraphCxSpMiddle" style="text-align: left;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Contohnya: refleks hoffman tromer, refleks jaws, refleks babinski, refleks chaddock, refleks oppenheim, refleks regresi.</span><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"><o:p></o:p></span></div><div align="left" class="MsoListParagraphCxSpLast" style="text-align: left;"><br />
</div><div align="left" class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: left;"><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"><span> </span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Seluruh mekanisme gerak yang terjadi di tubuh kita tak lepas dari peranan system saraf. Sistem saraf ini tersusun atas jaringan saraf yang di dalamnya terdapat sel-sel saraf atau neuron. Meskipun system saraf tersusun dengan sangat kompleks,tetapi sebenarnya hanya tersusun atas 2 jenis sel,yaitu sel saraf dan sel neuroglia.<br />
Adapun berdasarkan fungsinya system saraf itu sendiri dapat dibedakan atas tiga jenis :</span><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"><o:p></o:p></span></div><div align="left" class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: left;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;"><br />
1. Sel saraf sensorik<br />
Sel saraf sensorik adalah sel yang membawa impuls berup rangsangan dari reseptor (penerima rangsangan), ke system saraf pusat (otak dan sumsum tulang belakang).SEl saraf sensorik disebut juga dengan sel saraf indera,karena berhubungan dengan alat indra.<br />
<br />
2. Sel saraf Motorik<br />
SEl saraf motorik berfungsi membawa impuls berupa tanggapan dari susunan saraf pusat (otak atau sumsum tulang belakang) menuju to atau kelenjar tubuh. Sel saraf motorik disebut juga dengan sel saraf penggerak,karena berhubungan erat dengan otot sebagai alat gerak.</span><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"><o:p></o:p></span></div><div align="left" class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: left;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;"><br />
3. Sel saraf penguhubung<br />
Sel saraf penguhubung disebut juga dengan sel saraf konektor,hal ini disebabkan karena fungsinya meneruskan rangsangan dari sel saraf sensorik ke sel saraf motorik.<br />
Namun pada hakikatnya sebenarnya system saraf terbagi menjadi du kelompok besar :<br />
</span><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"><span> </span>1) </span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Sistem saraf sadar<br />
Adalah system saraf yang mengatu tau mengkoordinasikan semua kegiatan yang dapat diatur menurut kemauan kita.Contohnya,melempar bola,berjalan,berfikir,menulis,berbicara dan lain-lain.<br />
Saraf sadar pun terbagi menjadi dua :<br />
a.Saraf pusat<br />
terdiri dari :<br />
- Otak<br />
Merupakan pusat kesadaran,yang letaknya di rongga tengkorak.<br />
- Sumsum tulang belakang<br />
</span><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"><span> </span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Sumsum tulang belakang berfungsi menghantarkan impuls (rangsangan) dari dan ke otak,serta mengkoordinasikan gerak refleks. Letaknya pada ruas-ruas tulang belakang,yakni dari ruas – ruas tulag leher hingga ke ruas-ruas tulang pinggang yang kedua. Dan dalam sumsum ini terdapat simpul – simpul gerak refleks.<br />
b. Saraf Tepi<br />
</span><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"><span> </span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Sistem saraf tepi terdiri dari sarfa-saraf yang berada di luar system saraf pusat (otak dan sumsum ulang belakang). Artinya system saraf tepi merupakan saraf yang menyebar pada seluruh bagian tubuh yang melayani organ-organ tubh tertentu,sepeti kulit,persendian,otot,kelenjar,saluran darah dan lain-lain.<br />
<br />
</span><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"><span> </span>2) </span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Susunan saraf tak sadar.<br />
- Susunan saraf simpatis<br />
- Susunan saraf parasimpatis<br />
</span><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"><span> </span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Gerak pada umumnya terjadi secara sadar, namun, ada pula gerak yang terjadi tanpa disadari yaitu gerak refleks. Impuls pada gerakan sadar melalui jalan panjang, yaitu dari reseptor, ke saraf sensori, dibawa ke otak untuk selanjutnya diolah oleh otak, kemudian hasil olahan oleh otak, berupa tanggapan, dibawa oleh saraf motor sebagai perintah yang harus dilaksanakan oleh efektor. <br />
</span><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"><span> </span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Gerak refleks berjalan sangat cepat dan tanggapan terjadi secara otomatis terhadap rangsangan, tanpa memerlukan kontrol dari otak. Jadi dapat dikatakan gerakan terjadi tanpa dipengaruhi kehendak atau tanpa disadari terlebih dahulu. Contoh gerak refleks misalnya berkedip, bersin, atau batuk. Dimana gerak refleks ini merupakan gerak yang dihasilkan oleh jalur saraf yang paling sederhana. Jalur saraf ini dibentuk oleh sekuen dari neuron sensorik ,interneuron, dan neuron motorik, yang mengalirkan impuls saraf untuk tipe refleks tertentu. Gerak refleks yang paling sederhanahanya memerlukandua tipe sel saraf, yaitu neuron sensorik dan neuron motorik. Gerak refleks bekerja bukanlah dibawah kesadaran dan kemauan seseorang.<br />
</span><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"><span> </span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Pada gerak refleks, impuls melalui jalan pendek atau jalan pintas, yaitu dimulai dari reseptor penerima rangsang, kemudian diteruskan oleh saraf sensori ke pusat saraf, diterima oleh set saraf penghubung (asosiasi) tanpa diolah di dalam otak langsung dikirim tanggapan ke saraf motor untuk disampaikan ke efektor, yaitu otot atau kelenjar. Jalan pintas ini disebut lengkung refleks. </span><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"><o:p></o:p></span></div><div align="left" class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: left;"><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"><span> </span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Gerak refleks dapat dibedakan atas refleks otak bila saraf penghubung (asosiasi) berada di dalam otak, misalnya, gerak mengedip atau mempersempit pupil bila ada sinar dan refleks sumsum tulang belakang bila set saraf penghubung berada di dalam sumsum tulang belakang misalnya refleks pada lutut</span><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;">.</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;"><br />
</span><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"><span> </span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Gerak refleks adalah gerak yang dihasilkan oleh jalur saraf yang paling sederhana. Jalur saraf ini dibentuk oleh sekuen neuron sensor,interneuron,dan neuron motor,yang mngalirkan impuls saraf untuk tipe reflek tertentu.Gerak refleks yang paling sederhana hanya memerlukan dua tipe sel sraf yaitu neuron sensor dan neuron motor.<br />
</span><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"><span> </span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Gerak refleks disebabkan oleh rangsangan tertentu yang biasanya mengejutkan dan menyakitkan. Misalnya bila kaki menginjak paku,secara otomatis kita akan menarik kaki dan akan berteriak. Refleks juga terjadi ketika kita membaui makanan enak , dengan keluarnya air liur tanpa disadari.</span><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"><o:p></o:p></span></div><div align="left" class="MsoNormal" style="margin-left: 108.0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: left; text-indent: 36.0pt;"><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-language: IN;"><v:shapetype coordsize="21600,21600" filled="f" id="_x0000_t75" o:preferrelative="t" o:spt="75" path="m@4@5l@4@11@9@11@9@5xe" stroked="f"> <v:stroke joinstyle="miter"> <v:formulas> <v:f eqn="if lineDrawn pixelLineWidth 0"> <v:f eqn="sum @0 1 0"> <v:f eqn="sum 0 0 @1"> <v:f eqn="prod @2 1 2"> <v:f eqn="prod @3 21600 pixelWidth"> <v:f eqn="prod @3 21600 pixelHeight"> <v:f eqn="sum @0 0 1"> <v:f eqn="prod @6 1 2"> <v:f eqn="prod @7 21600 pixelWidth"> <v:f eqn="sum @8 21600 0"> <v:f eqn="prod @7 21600 pixelHeight"> <v:f eqn="sum @10 21600 0"> </v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:formulas> <v:path gradientshapeok="t" o:connecttype="rect" o:extrusionok="f"> <o:lock aspectratio="t" v:ext="edit"> </o:lock></v:path></v:stroke></v:shapetype><v:shape alt="http://bebas.vlsm.org/v12/sponsor/Sponsor-Pendamping/Praweda/Biologi/Image/2-9c.jpg" id="Picture_x0020_2" o:spid="_x0000_i1025" style="height: 137.25pt; mso-wrap-style: square; visibility: visible; width: 225pt;" type="#_x0000_t75"> <v:imagedata o:title="2-9c" src="file:///C:\Users\USER\AppData\Local\Temp\msohtmlclip1\01\clip_image001.jpg"> </v:imagedata></v:shape></span><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"><o:p></o:p></span></div><div align="center" class="MsoNormal" style="margin-left: 108.0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: center; text-indent: 36.0pt;"><i><span lang="EN-US" style="color: black; font-family: "Verdana","sans-serif"; font-size: 7.5pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Gbr. Lengkung refleks yang menggambarkan mekanisme<br />
jalannya impuls pada lutut yang dipukul</span></i><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"><o:p></o:p></span></div><div class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: 23.4pt;"><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"><span> </span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pada gerak refleks, impuls melalui jalan pendek atau jalan pintas, yaitu dimulai dari reseptor penerima rangsang, kemudian diteruskan oleh saraf sensori ke pusat saraf, diterima oleh set saraf penghubung (asosiasi) tanpa diolah di dalam otak langsung dikirim tanggapan ke saraf motor untuk disampaikan ke efektor, yaitu otot atau kelenjar. Jalan pintas ini disebut lengkung refleks. Gerak refleks dapat dibedakan atas refleks otak bila saraf penghubung (asosiasi) berada di dalam otak, misalnya, gerak mengedip atau mempersempit pupil bila ada sinar dan refleks sumsum tulang belakang bila set saraf penghubung berada di dalam sumsum tulang belakang misalnya refleks pada lutut. [5] <o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span> </span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Unit dasar setiap kegiatan reflex terpadu adalah lengkung reflex. <span style="color: #4f81bd; mso-themecolor: accent1;">Lengkung reflex ini terdiri dari alat indra, serat saraf aferen, satu atau lebih sinaps yang terdapat di susunan saraf pusat atau di ganglion simpatis, serat saraf eferen, dan efektor</span>. Pada mamalia, hubungan (sinaps) antara neuron somatil aferen dan eferen biasanya terdapat di otak atau medulla spinalis. Serat neuron aferen masuk susunan saraf pusat melalui radiks dorsalis medulla spinalis atau melalui nervus kranialis, sedangkan badan selnya akan terdapat di ganglion-ganglion homolog nervi kranialis atau melalui nervus cranial yang sesuai. Kenyataan radiks dorsalis medulla spinalis bersifat sensorik dan radiks ventralis bersifat motorik dikenal sebagai hokum Bell- Magendie.<o:p></o:p></span></div><div class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: 23.4pt;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kegiatan pada lengkung reflex dimulai di reseptor sensorik, sebagai potensial reseptor yang besarnya sebanding dengan kuat rangsang. Potensial reseptor ini akan membangkitkan potensial aksi yang bersifat gagal atau tuntas, di saraf aferen. Frekuensi potensial aksi yang terbentuk akan sebanding dengan besarnya potensial generator. Di system saraf pusat (SSP), terjadi lagi respons yang besarnya sebanding dengan kuat rangsang, berupa potensial eksitasi pascasinaps (Excitatory Postsynaptic <o:p></o:p></span></div><div class="MsoNormal"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Potential=EPSP) dan potesial inhibisi postsinaps (Inhibitory Postsynaptic <o:p></o:p></span></div><div class="MsoNormal"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Potential=IPSP) di hubungan-hubungan saraf (sinaps). Respon yang timbul di serat <o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span> </span></span><span lang="EN-US" style="color: #4f81bd; font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-themecolor: accent1;">eferen</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> juga berupa repons yang bersifat gagal atau tuntas. Bila potensial aksi ini sampai di efektor, terjadi lagi respons yang besarnya sebanding dengan kuat rangsang. Bila efektornya berupa otot polos, akan terjadi sumasi respons sehingga dapat mencetuskan potensial aksi di otot polos. Akan tetapi, di efektor yang berupa otot rangka, respons bertahap tersebut selalu cukup besar untuk mencetuskan potensial aksi yang mampu menghasilkan kontraksi otot. Perlu ditekankan bahwa hubungan antara neuron aferen dan eferen biasanya terdapat di system saraf pusat, dan kegiatan di lengkung reflex ini dapat dimodifikasi oleh berbagai masukan dari neuron lain yang juga bersinaps pada neuron eferen tersebut. </span><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><o:p></o:p></span></div><div class="MsoNormal" style="text-indent: 36.0pt;"><span lang="EN-US" style="color: #4f81bd; font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-themecolor: accent1;">Lengkung reflex.</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Paling sederhana adalah <span style="color: #4f81bd; mso-themecolor: accent1;">lengkung reflex yang mempunyai satu <o:p></o:p></span></span></div><div class="MsoNormal"><span lang="EN-US" style="color: #4f81bd; font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-themecolor: accent1;">sinaps anatara neuron aferen dan eferen. Lengkung reflex semacam itu dinamakan <o:p></o:p></span></div><div class="MsoNormal"><span lang="EN-US" style="color: #4f81bd; font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-themecolor: accent1;">monosinaptik, dan reflex yang terjadi disebut reflex monosinaptik</span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">. Lengkung reflex yang <span style="color: #4f81bd; mso-themecolor: accent1;">mempunyai lebih dari satu interneuron antara neuron afern dan eferen dinamakanpolis anptik, dan jumlah sinapsnya antara 2 sampai beberapa ratus</span>. Pada kedua jenis lengkung reflex, terutama pada lengkung reflex polisinaptik. Kegiatan refleksnya dapat dimodifikasi oleh adanya fasilitas spasial dan temporal, oklusi, efek penggiatan bawah ambang (subliminal fringe), dan oleh berbagai efek lain. <o:p></o:p></span></div><div class="pj" style="line-height: 150%; text-indent: 23.4pt;"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Bila suatu otot rangka dengan persarafan yang utuh direnggangkan, akan timbul kontraksi<span style="color: #4f81bd; mso-themecolor: accent1;">. Respons ini disebut reflex renggang</span>. Rangsangannya adalah regangan pada otot, dan responnya berupa kontraksi otot yang direnggangkan. Reseptornya adalah kumparan otot (muscle spindle). Impuls yang timbul akibat peregangan <span class="nw">kumparan otot yang dihantarkan ke SSP melalui sera-serat sensorik cepat yang</span> <span class="nw">langsung bersinaps dengan neuron motorik otot yang teregang itu. Neurotransmitter</span> <span class="nw">di sinaps yang berada di SSP ini adalah glutamate. Reflex-refleks regang merupakan</span> <span class="nw">contoh reflex monosimpatik yang paling dikenal dan paling banyak diteliti.</span></span><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"><o:p></o:p></span></div><div class="pj" style="line-height: 150%; text-indent: 23.4pt;"><span class="nw"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Jika suatu otot keseluruhan diregangkan secara pasif, serat-serat intrafusal di</span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;"> <span class="nw">dalam gelendong-gelendong otot juga teregang, terjadi peningkatan pembentukan</span> <span class="nw">potensial aksi di serat saraf aferen yang ujung-ujung sensoriknya berakhir di serat-</span> <span class="nw">serat gelendong yang teregang tersebut. Neuron aferen secara langsung bersinaps</span> <span class="nw">dengan neuron motorik alfa yang mempersarafi serat-serat ekstrafusal otot yang</span> <span class="nw">sama, sehingga terjadi kontraksi otot itu.</span><span class="ff1"> Refleks regang</span><span class="nw"> (</span><span class="ff0">stretch reflex</span><span class="nw">) ini</span> <span class="nw">berfungsi sebagai mekanisme umpan balik negative untuk menahan setiap perubahan</span> <span class="nw">pasif panjang otot, sehingga panjang optimal dapat dipertahankan.</span></span><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"><o:p></o:p></span></div><div align="left" class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: left;"><span class="nw"><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"><span> </span></span></span><span class="nw"><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;">Contoh klasik reflex regang adalah</span></span><span class="nw"><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"> >>></span></span><span class="ff1"><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;"> <span lang="EN-US" style="color: #4f81bd; mso-themecolor: accent1;">reflex tendon patella</span></span></span><span class="nw"><span lang="EN-US" style="color: #4f81bd; font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-themecolor: accent1;"> atau</span></span><span class="ff3"><span lang="EN-US" style="color: #4f81bd; font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-themecolor: accent1;"> knee-jerk reflex</span></span><span class="nw"><span lang="EN-US" style="color: #4f81bd; font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-themecolor: accent1;">.</span></span><span lang="EN-US" style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%;"> <span class="nw">Otot- otot ekstenson lutut adalah</span><span class="ff0"> kuadriseps femoris</span><span class="nw">, yang membentuk anterior paha</span> <span class="nw">dan melekat ke tibia (tulang kering) tepat di bawah lutut melalui</span><span class="ff0"> tendon patella</span><span class="nw">.</span> <span class="nw">Pengetukan tendon ini dengan sebuah palu karet akan secara pasif meregangkan otot-</span> <span class="nw">otot kuadriseps dan mengaktifkan reseptor-reseptor gelendongnya. Reflex regang</span> <span class="nw">yang terjadi menimbulkan kontraksi otot ekstensor ini, sehingga lutut mengalami</span> <span class="nw">ekstensi dan mengangkat tungkai bawah dengan cara yang khas. Pemeriksaan ini</span> <span class="nw">dilakukan secara rutin sebagai penilain pendahuluan fungsi system saraf. Reflex</span> <span class="nw">patella yang normal mengindikasikan dokter bahwa sejumlah komponen saraf dan</span> <span class="nw">otot-gelendong otot, masukan aferen, neuron motorik, keluaran eferen taut</span> <span class="nw">neuromuskulus, dan otot itu sendiri-berfungsi normal. Reflex ini juga</span> <span class="nw">mengindikasikan adanya keseimbangan antara masukan eksitorik dan inhibitorik ke</span> <span class="nw">neuron motorik dari pusat-pusat yang lebih tinggi di otak</span></span><span class="nw"><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;">.<o:p></o:p></span></span></div><div align="left" class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: left;"><br />
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</span></span></div><div align="left" class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: left;"><span class="Apple-style-span" style="font-family: 'Comic Sans MS';"><span class="Apple-style-span" style="font-size: 15px; line-height: 22px;"></span></span></div><div align="center" class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: center;"><span class="Apple-style-span" style="font-family: 'Comic Sans MS';"><span class="nw"><span style="font-family: "Comic Sans MS"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;">Referensi</span></span><span style="border: none windowtext 1.0pt; color: #333333; font-family: "inherit","serif"; font-size: 8.0pt; line-height: 150%; mso-ansi-language: IN; mso-border-alt: none windowtext 0cm; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; padding: 0cm;"><o:p></o:p></span></span></div><span class="Apple-style-span" style="font-family: 'Comic Sans MS';"> <div class="MsoListParagraphCxSpFirst" style="line-height: 12.25pt; margin-bottom: 21.6pt; mso-add-space: auto; vertical-align: baseline;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span><span>1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="border: none windowtext 1.0pt; mso-border-alt: none windowtext 0cm; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; padding: 0cm;">Amien,M.1987.<i>Makhluk Hidup</i>.Jakarta:PN Balai Pustka</span><span lang="EN-US"> </span><span><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span><span>2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">G:/MEDISCH/UPI FPOK/STRETCH.htm</span><span><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; mso-add-space: auto; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -18.0pt;"><!--[if !supportLists]--><span><span>3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="border: none windowtext 1.0pt; mso-border-alt: none windowtext 0cm; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; padding: 0cm;">Hadisumarto,Suhargono.1997.<i>Biologi-2b</i>.Jakarta:Bumi Aksara.</span><span lang="EN-US"> Keeton,William T.1980.<i>Biology Science</i>.Library of Congress in Publication Krass</span><span><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; mso-add-space: auto; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -18.0pt;"><!--[if !supportLists]--><span><span>4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US"><a href="http://id.wikipedia.org/wiki/Refleks"><span style="text-decoration: none;">http://id.wikipedia.org/wiki/Refleks</span></a></span><span><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 12.25pt; margin-bottom: 21.6pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt; vertical-align: baseline;"><!--[if !supportLists]--><span><span>5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Kimbal,John W.1983.<i>Biology 3<sup>rd</sup> ed</i>.Addison Wesley.</span><span><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;"><!--[if !supportLists]--><span><span>6.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Sidharta priguma.2008. Tata Pemeriksaan Klinis Dalam Neurologi. Jakarta: Dian Rakyat</span><span><o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 12.25pt; margin-bottom: 21.6pt; mso-add-space: auto; mso-list: l0 level1 lfo1; text-indent: -18.0pt; vertical-align: baseline;"><!--[if !supportLists]--><span lang="EN-US"><span>7.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US">Syamsuri,Istamar.2004.<i>Biologi SMA kelas XI</i>.Jakarta : Erlangga.<o:p></o:p></span></div><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; mso-no-proof: yes;">Wilarso,joko.2001.<i>BIOLOGI PENDIDIKAN DASAR</i>.Jakarta:Erlangga</span></span><br />
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</div>salnihttp://www.blogger.com/profile/00126668517852477742noreply@blogger.com0tag:blogger.com,1999:blog-8321145958076225978.post-53028668339528260522011-10-16T05:28:00.000-07:002011-10-16T05:28:28.960-07:00Farmakologi<h2 align="center" style="margin-left: 0cm; text-align: center; text-indent: 0cm;"><b><span lang="EN-US" style="font-size: 12.0pt;">PENGERTIAN FARMAKOLOGI<o:p></o:p></span></b></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span><span class="Apple-style-span" style="font-size: 16px;">Berasal dari kata (Yunani)</span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><b><i><span lang="EN-US" style="font-size: 12.0pt;">pharmakon</span></i></b><i><span lang="EN-US" style="font-size: 12.0pt;"> </span></i><span lang="EN-US" style="font-size: 12.0pt;">: obat<o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><b><i><span lang="EN-US" style="font-size: 12.0pt;">Logia</span></i></b><span lang="EN-US" style="font-size: 12.0pt;"><span> </span><span> </span>: studi/ilmu<o:p></o:p></span></h2><h2 align="center" style="margin-left: 0cm; text-align: center; text-indent: 0cm;"><b><i><span lang="EN-US" style="font-size: 12.0pt;">“Ilmu tentang obat”<o:p></o:p></span></i></b></h2><div class="MsoNormal"><br />
</div><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Pada mulanya farmakologi mencakup berbagai pengetahuan tentang obat yang meliputi: sejarah, sumber, sifat-sifat fisika dan kimiawi, cara meracik, efek fisiologi dan biokimiawi, mekanisme kerja, absorpsi, distribusi, biotranformasi dan ekskresi, serta penggunaan obat untuk terapi dan tujuan lain.<o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span><o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Dewasa ini didefinisikan sebagai studi terintegrasi tentang sifat-sifat kimia dan organisme hidup serta segala aspek interaksi mereka.<o:p></o:p></span></h2><h2 align="center" style="margin-left: 0cm; text-align: center; text-indent: 0cm;"><i><span lang="EN-US" style="font-size: 12.0pt;">Atau<o:p></o:p></span></i></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Ilmu yang mempelajari interaksi obat dengan organisme hidup<o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><b><span lang="EN-US" style="font-size: 12.0pt;">FARMAKOKINETIKA<o:p></o:p></span></b></h2><div class="MsoNormal"><br />
</div><h2 align="center" style="margin-left: 0cm; text-align: center; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Studi tentang absorpsi, distribusi, dan biotransformasi serta eksresi (eliminasi)<o:p></o:p></span></h2><h2 align="center" style="margin-left: 0cm; text-align: center; text-indent: 0cm;"><i><span lang="EN-US" style="font-size: 12.0pt;">Atau<o:p></o:p></span></i></h2><h2 align="center" style="margin-left: 0cm; text-align: center; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Pengaruh organisme hidup terhadap obat<o:p></o:p></span></h2><h2 align="center" style="margin-left: 0cm; text-align: center; text-indent: 0cm;"><i><span lang="EN-US" style="font-size: 12.0pt;">Atau<o:p></o:p></span></i></h2><h2 align="center" style="margin-left: 0cm; text-align: center; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Penanganan obat oleh organisme hidup<o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><b><span lang="EN-US" style="font-size: 12.0pt;">FARMAKODINAMIKA<o:p></o:p></span></b></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 align="center" style="margin-left: 0cm; text-align: center; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Studi tentang tempat dan mekanisme kerja serta efek fisiologik dan biokimiawi obat pada organisme hidup<o:p></o:p></span></h2><h2 align="center" style="margin-left: 0cm; text-align: center; text-indent: 0cm;"><i><span lang="EN-US" style="font-size: 12.0pt;">Atau<o:p></o:p></span></i></h2><h2 align="center" style="margin-left: 0cm; text-align: center; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Pengaruh obat terhadap organisme hidup<o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><b><span lang="EN-US" style="font-size: 12.0pt;">FARMAKOTERAPI<o:p></o:p></span></b></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><b><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></b></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Merupakan cabang ilmu farmakologi yang mempelajari penggunaan obat untuk pencegahan dan menyembuhkan penyakit<o:p></o:p></span></h2><div class="MsoNormal"><br />
</div><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><b><span lang="EN-US" style="font-size: 12.0pt;">FARMAKOGNOSI<o:p></o:p></span></b></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Cabang ilmu farmakologi yang mempelajari sifat-sifat tumbuhan dan bahan lain yang merupakan sumber obat<o:p></o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><b><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></b></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><b><span lang="EN-US" style="font-size: 12.0pt;">KHEMOTERAPI<o:p></o:p></span></b></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Cabang ilmu farmakologi yang mempelajari pengobatan penyakit yang disebabkan oleh mikroba patogen termasuk pengobatan neoplasma<o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><b><span lang="EN-US" style="font-size: 12.0pt;">TOKSIKOLOGI<o:p></o:p></span></b></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Ilmu yang mempelajari keracunan zat kimia termasuk obat, zat yang digunakan dalam rumah tangga, industri, maupun lingkungan hidup lain. Dalam cabang ini juga dipelajari cara pencegahan, pengenalan dan penanggulangan kasus-kasus keracunan<o:p></o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><b><span lang="EN-US" style="font-size: 12.0pt;">FARMASI<o:p></o:p></span></b></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Suatu sistem yang memberikan pelayanan kesehatan dengan perhatian khusus pada pengetahuan tentang obat dan efeknya pada manusia dan hewan<o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h2 style="text-align: justify;"><b><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></b></h2><div class="MsoNormal"><br />
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</div><h2 align="center" style="text-align: center;"><b><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></b></h2><h2 align="center" style="text-align: center;"><b><span lang="EN-US" style="font-size: 14.0pt;">OBAT<o:p></o:p></span></b></h2><h2 style="text-align: justify;"><b><span lang="EN-US" style="font-size: 14.0pt;"><o:p> </o:p></span></b></h2><div class="MsoNormal"><br />
</div><h2 style="tab-stops: 120.75pt; text-align: justify;"><b><span lang="EN-US" style="font-size: 12.0pt;">Definisi obat<span> </span><o:p></o:p></span></b></h2><h2 style="mso-list: l0 level1 lfo1; text-align: justify;"><!--[if !supportLists]--><span lang="EN-US"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Obat adalah zat kimia yang mempengaruhi proses kehidupan (Benet,1991)<o:p></o:p></span></h2><h2 style="mso-list: l0 level1 lfo1; text-align: justify;"><!--[if !supportLists]--><span lang="EN-US"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Obat adalah substansi yang digunakan untuk merubah atau menyelidiki sistem fisiologi atau patologi untuk keuntungan si penerimanya (WHO,1966)<o:p></o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h2 style="mso-list: l0 level1 lfo1; text-align: justify;"><!--[if !supportLists]--><span lang="EN-US"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Obat dalam arti yang lebih spesifik setiap zat kimia selain makanan yang mempunyai pengaruh terhadap atau dapat menimbulkan efek pada organisme hidup<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="mso-list: l0 level1 lfo1; text-align: justify;"><!--[if !supportLists]--><span lang="EN-US"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b><span lang="EN-US" style="font-size: 12.0pt;">Obat Esensial</span></b><span lang="EN-US" style="font-size: 12.0pt;"> <o:p></o:p></span></h2><h2 style="text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">adalah obat yang paling dibutuhkan untuk pelayanan kesehatan bagi masyarakat terbanyak<o:p></o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h2 style="mso-list: l0 level1 lfo1; text-align: justify;"><!--[if !supportLists]--><span lang="EN-US"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b><span lang="EN-US" style="font-size: 12.0pt;">Obat Generik</span></b><span lang="EN-US" style="font-size: 12.0pt;"> <o:p></o:p></span></h2><h2 style="text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">adalah obat dengan nama resmi yang ditetapkan dalam Farmakope Indonesia (FI) untuk zat berkhasiat yang dikandungnya<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><div class="MsoNormal"><br />
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</div><h2 style="mso-list: l0 level1 lfo1; text-align: justify;"><!--[if !supportLists]--><span lang="EN-US"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b><span lang="EN-US" style="font-size: 12.0pt;">Obat Paten</span></b><span lang="EN-US" style="font-size: 12.0pt;"><o:p></o:p></span></h2><h2 style="text-align: justify; text-indent: 3.0pt;"><span lang="EN-US" style="font-size: 12.0pt;">adalah obat dengan nama yang merupakan milik produsen yang bersangkutan<o:p></o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h2 style="mso-list: l0 level1 lfo1; text-align: justify;"><!--[if !supportLists]--><span lang="EN-US"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b><span lang="EN-US" style="font-size: 12.0pt;">Obat Plasebo</span></b><span lang="EN-US" style="font-size: 12.0pt;"> <o:p></o:p></span></h2><h2 style="text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">adalah oabt buatan yang tidak mengandung zat berkhasiat atau obat yang tidak berkhasiat<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="mso-list: l0 level1 lfo1; text-align: justify;"><!--[if !supportLists]--><span lang="EN-US"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><b><span lang="EN-US" style="font-size: 12.0pt;">Obat tradisional</span></b><span lang="EN-US" style="font-size: 12.0pt;"> <o:p></o:p></span></h2><h2 style="text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">adalah obat yang berasal dari bahan-bahan tumbuhan, hewan maupun mineral dari alam secara murni, yang dibuat dan diolah secara sederhana berdasarkan turun temurun, dimana efek, dosis dan bentuknya sangat bervariasi dalam penggunaannya <o:p></o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><div class="MsoNormal"><br />
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</div><h2 align="center" style="margin-left: 0cm; text-align: center; text-indent: 0cm;"><b><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></b></h2><h2 align="center" style="margin-left: 0cm; text-align: center; text-indent: 0cm;"><b><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></b></h2><h2 align="center" style="margin-left: 0cm; text-align: center; text-indent: 0cm;"><b><span lang="EN-US" style="font-size: 12.0pt;">PENGGOLOGAN OABAT<o:p></o:p></span></b></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Golongan oabat adalah penggolongan yang dimaksud untuk meningkatkan keamanan dan ketepatan penggunaan serta pengamanan distribusi nya, <o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">terdiri dari:<o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="margin-left: 0cm; mso-list: l0 level1 lfo1; text-align: justify; text-indent: 0cm;"><!--[if !supportLists]--><span lang="EN-US"><span>•</span></span><!--[endif]--><b><span lang="EN-US" style="font-size: 12.0pt;">Obat bebas</span></b><span lang="EN-US" style="font-size: 12.0pt;"><o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Obat dijual bebas, tersebar diapotik sampai diwarung, mempunyai logo <i>berwarna Hijau</i> <o:p></o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h2 style="margin-left: 0cm; mso-list: l0 level1 lfo1; text-align: justify; text-indent: 0cm;"><!--[if !supportLists]--><span lang="EN-US"><span>•</span></span><!--[endif]--><b><span lang="EN-US" style="font-size: 12.0pt;">Obat Bebas Terbatas<o:p></o:p></span></b></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Obat keras dengan batasan jumlah dan kadar isi berkhasiat dan harus ada tanda peringatan (P)<o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Dijual bebas mempunyai logo <i>berwarna Biru<o:p></o:p></i></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><i><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></i></h2><h2 style="margin-left: 0cm; mso-list: l0 level1 lfo1; text-align: justify; text-indent: 0cm;"><!--[if !supportLists]--><span lang="EN-US"><span>•</span></span><!--[endif]--><b><span lang="EN-US" style="font-size: 12.0pt;">Obat Keras</span></b><i><span lang="EN-US" style="font-size: 12.0pt;"> (Daftar G = Gevaarijk = berbahaya)<o:p></o:p></span></i></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Obat berkhasiat keras yang untuk memperolehnya harus dengan resep dokter, mempunyai logo berwarna<i> Merah <o:p></o:p></i></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h2 style="margin-left: 0cm; mso-list: l0 level1 lfo1; text-align: justify; text-indent: 0cm;"><!--[if !supportLists]--><span lang="EN-US"><span>•</span></span><!--[endif]--><b><span lang="EN-US" style="font-size: 12.0pt;">Obat Narkotika</span></b><span lang="EN-US" style="font-size: 12.0pt;"> ( Daftar O = Opiat) <o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">yaitu obat yang termasuk golongan narkotik dengan turunannya, psikotropik dan anastesi lokal maupun umum, untuk memperolehnya harus denagan resep dokter dan apotik wajib melaporkannya.<o:p></o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><div class="MsoNormal"><br />
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</div><h2 style="text-align: justify;"><b><span lang="EN-US" style="font-size: 12.0pt;">Asal obat<o:p></o:p></span></b></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;">Obat diperoleh:<o:p></o:p></span></h2><h2 style="mso-list: l0 level1 lfo1; text-align: justify;"><!--[if !supportLists]--><span lang="EN-US"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Tumbuhan ……….………Kuinin<o:p></o:p></span></h2><h2 style="mso-list: l0 level1 lfo1; text-align: justify;"><!--[if !supportLists]--><span lang="EN-US"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Hewan ………………….. Insulin<o:p></o:p></span></h2><h2 style="mso-list: l0 level1 lfo1; text-align: justify;"><!--[if !supportLists]--><span lang="EN-US"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Mineral………………….. Koalin<o:p></o:p></span></h2><h2 style="mso-list: l0 level1 lfo1; text-align: justify;"><!--[if !supportLists]--><span lang="EN-US"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Mikroorganisme…………Penisilin<o:p></o:p></span></h2><h2 style="mso-list: l0 level1 lfo1; text-align: justify;"><!--[if !supportLists]--><span lang="EN-US"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Sintesa……………..........Sulfonamida<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><div class="MsoNormal"><br />
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</div><h1 style="text-align: justify;"><b><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></b></h1><h1><b><span lang="EN-US" style="font-size: 12.0pt;">RUTE PENGGUNAAN OBAT<o:p></o:p></span></b></h1><div class="MsoNormal"><br />
</div><h2 style="margin-left: 11.35pt; text-align: justify; text-indent: -11.35pt;"><span lang="EN-US" style="font-size: 12.0pt;">Obat dapat diberikan dengan berbagai macam cara :<o:p></o:p></span></h2><h2 style="margin-left: 11.35pt; text-align: justify; text-indent: -11.35pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>Jika dikaitkan dengan saluran cerna, maka:<o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 11.35pt;"><b><i><span lang="EN-US" style="font-size: 12.0pt;">1.Enteral<o:p></o:p></span></i></b></h2><h2 style="margin-left: 11.35pt; text-align: justify; text-indent: -11.35pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>cara pemberian obat melalui jalur saluran cerna atau saluran oral-gastrointestinal, dimulai dari mulut sampai poros usus (rektum)<o:p></o:p></span></h2><h2 style="margin-left: 11.35pt; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -11.35pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size: 14.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">P.O<o:p></o:p></span></h2><h2 style="margin-left: 11.35pt; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -11.35pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size: 14.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Sublingual<o:p></o:p></span></h2><h2 style="margin-left: 11.35pt; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -11.35pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size: 14.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Rektal<span> </span><o:p></o:p></span></h2><h2 style="margin-left: 11.35pt; text-align: justify; text-indent: -11.35pt;"><span lang="EN-US"><span> </span><span> </span></span><span lang="EN-US" style="font-size: 12.0pt;"><o:p></o:p></span></h2><h2 style="text-align: justify; text-indent: -2.15pt;"><b><i><span lang="EN-US" style="font-size: 12.0pt;">2. Parenteral<o:p></o:p></span></i></b></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>Cara pemberian dengan menempatkan obat diluar saluran cerna, meliputi:<o:p></o:p></span></h2><h2 style="mso-list: l0 level1 lfo1; text-align: justify;"><!--[if !supportLists]--><span lang="EN-US"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Topikal<o:p></o:p></span></h2><h2 style="mso-list: l0 level1 lfo1; text-align: justify;"><!--[if !supportLists]--><span lang="EN-US"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Injeksi (intrsdermsl, subkutan, intramuskular, i.v. dsb.<o:p></o:p></span></h2><h2 style="mso-list: l0 level1 lfo1; text-align: justify;"><!--[if !supportLists]--><span lang="EN-US"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Inhalasi<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US"><span> </span></span><span lang="EN-US" style="font-size: 12.0pt;"><o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -10.5pt;"><span lang="EN-US" style="font-size: 12.0pt;">Jika dikaitkan dengan sistem vaskuler, pemberian obat dapat diklasifikasikan menjadi:<o:p></o:p></span></h2><h2 style="margin-left: 36.0pt; mso-list: l2 level1 lfo3; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><b><i><span lang="EN-US" style="font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></i></b><!--[endif]--><b><i><span lang="EN-US" style="font-size: 12.0pt;">Intravaskuler<o:p></o:p></span></i></b></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>menempatkan obat langsung kedalam aliran darah (mis: i.v.)<o:p></o:p></span></h2><div class="MsoNormal"><br />
</div><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: 0cm;"><b><i><span lang="EN-US" style="font-size: 12.0pt;">2. <span> </span><span>Ekstra-vaskuler<o:p></o:p></span></span></i></b></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>pemberian atau penempatan obat diluar atau tidak langsung ke sistem aliran darah (mis: p.o.,i.m.,)<o:p></o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><div class="MsoNormal"><br />
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</div><h2 style="margin-left: 13.8pt; text-align: justify; text-indent: -13.8pt;"><b><span lang="EN-US" style="font-size: 12.0pt;">Sediaan obat melalui oral<o:p></o:p></span></b></h2><h2 style="margin-left: 13.8pt; text-align: justify; text-indent: -13.8pt;"><b><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></b></h2><h2 style="margin-left: 13.8pt; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -13.8pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size: 14.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Bentuk obat padat<o:p></o:p></span></h2><h2 style="margin-left: 13.8pt; text-align: justify; text-indent: -13.8pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>a.<span> </span>Tablet<o:p></o:p></span></h2><h2 style="margin-left: 13.8pt; text-align: justify; text-indent: -13.8pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- Tablet kempa, <o:p></o:p></span></h2><h2 style="margin-left: 13.8pt; text-align: justify; text-indent: -13.8pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- Tablet kunyah<o:p></o:p></span></h2><h2 style="margin-left: 13.8pt; text-align: justify; text-indent: -13.8pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- Tablet salut : <o:p></o:p></span></h2><h2 style="margin-left: 13.8pt; text-align: justify; text-indent: -13.8pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>salut gula,<span> </span>salut film polimer, salut enteric, salut yang tahan terhadap asam lambung, salut yang hanya hancur di usus.<o:p></o:p></span></h2><h2 style="margin-left: 13.8pt; text-align: justify; text-indent: -13.8pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- Tablet efervesen : dilarutkan dalam air<span> </span><o:p></o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>b. Kapsul<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- Kapsul gelatin keras : ada wadah dan tutup<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- Kapsul gelatin lunak : Buatan pabrik<span> </span><span> </span><o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>langsung<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>c. Serbuk<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- serbuk terbagi : satu bungkus untuk satu dosis<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- serbuk tak terbagi : serbuk banyak seperti bedak<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- serbuk efervesen : dilarutkan dalam air<o:p></o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h2 style="mso-list: l0 level1 lfo2; text-align: justify;"><!--[if !supportLists]--><span lang="EN-US" style="font-size: 14.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Bentuk obat cair<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>a. Larutan <span> </span>: jika tidak disebut lain pelarut adalah air<o:p></o:p></span></h2><h2><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>b. Sirup<span> </span>: larutan obat dalam larutan <span> </span>gula<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>c. Emulsi <span> </span>: campuran dua zat yang tidak saling campur ( tipe<span> </span><span> </span><span> </span><span> </span><o:p></o:p></span></h2><h2 style="margin-left: 72.0pt; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">o/w atau w/o)<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>d. Suspensi oral : campuran obat padat <span> </span><span> </span><span> </span><span> </span><span> </span>terbagi halus yang terdispersi<span> </span>dalam medium cairan<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;">Sediaan obat melalui parenteral<o:p></o:p></span></h1><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;">Wadah untuk larutan injeksi dapat berupa :<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -24.0pt;"><!--[if !supportLists]--><span lang="EN-US"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">ampul, 1ml, 2ml, 5ml, 10ml.<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -24.0pt;"><!--[if !supportLists]--><span lang="EN-US"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Vial atau Flakon, tertutup karet atau alumunium<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -24.0pt;"><!--[if !supportLists]--><span lang="EN-US"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Botol infus, 500ml. <o:p></o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;">Macam bentuk sediaan parenteral<o:p></o:p></span></h1><h2 style="margin-left: 24.0pt; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -24.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size: 14.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Berupa larutan dalam air<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -24.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size: 14.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Larutan dalam minyak<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -24.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size: 14.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Solutio petit (Mis: injeksi luminal)<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -24.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size: 14.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Suspensi obat padat dalam aqua<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -24.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size: 14.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Suspensi dalam minyak<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -24.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size: 14.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Emulsi<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -24.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size: 14.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Kristal steril yang dilarutkan dalam aqua steril<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -24.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size: 14.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Cairan invus intravena<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -24.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size: 14.0pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Cairan untuk diagnosa<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;">Macam rute parenteral:<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;">1. Injeksi intrakutan/intradermal:<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>disuntikan sedikit ke dalam kulit<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;">2. Injeksi subkutan/hipodermik :<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>disuntikan dibawah kulit<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;">3. Injeksi intramuskular :<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>disuntikan kedalam otot<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;">4. Injeksi intravena :<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>disuntikan kedalam pembuluh vena<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;">5. Injeksi intratekal/intraspinal/intradural :<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>disuntikan kedalam sumsum tulang belakang<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;">6. Injeksi intraperitonial:<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>disuntikan kedalam perut, sudah jarang dilakukan<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;">7. Injeksi peridural, ektradural, epidural:<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>disuntikan ke lapisan penutup otak<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;">8. Injeksi intrasisternal:<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>disuntikan ke sumsum tulang belakang dasar otak<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;">9. Injeksi intrakardial:<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>disuntikan langsung ke dalam jantung<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span><o:p></o:p></span></h2><div class="MsoNormal"><br />
</div><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;">Penggunaan obat melaui inhalasi<o:p></o:p></span></h1><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;">Obat bentuk gas atau uap diabsorpsi sangat cepat melaui Hidung, Trachea,<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;">Paru-paru, dan selaput lendir pada perjalanannya.<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Cara lama: anestesi dituangkan pada kain kasa sebagai tutup hidung, uap yang ada diisap.<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;">Cara medern : menggunakan tutup hidung dan dipasangkan ke mesin <o:p></o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;">Penggunaan obat melalui selaput lendir<o:p></o:p></span></h1><h2 style="margin-left: 24.0pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -24.0pt;"><!--[if !supportLists]--><span lang="EN-US"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Tablet bukal<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -24.0pt;"><!--[if !supportLists]--><span lang="EN-US"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Tablet sublingual<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -24.0pt;"><!--[if !supportLists]--><span lang="EN-US"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Permen larut dalam mulut<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -24.0pt;"><!--[if !supportLists]--><span lang="EN-US"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Tablet hipodermik<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -24.0pt;"><!--[if !supportLists]--><span lang="EN-US"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Tablet implantasi<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -24.0pt;"><!--[if !supportLists]--><span lang="EN-US"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Okulenta<span> </span>: salap mata<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -24.0pt;"><!--[if !supportLists]--><span lang="EN-US"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Larutan mata<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -24.0pt;"><!--[if !supportLists]--><span lang="EN-US"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Suspensi hidung<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;">*<span> </span><span> </span><span> </span>Tetes hidung<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;">*<span> </span>Tetes telinga<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;">*<span> </span>Supositoria<span> </span>: melalui dubur<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;">*<span> </span>Basila<span> </span>: melalui saluran kencing<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;">*<span> </span>Tablet oval vagina<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span><o:p></o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;">Penggunaan obat topical pada kulit<o:p></o:p></span></h1><h2 style="margin-left: 36.0pt; mso-list: l5 level1 lfo4; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Bentuk obat padat untuk penggunaan topikal adalah serbuk yang tujuannya menyerap lembab, mengurangi geseran antar dua lipatan kulit dan sebagai bahan pembawa obatnya.<o:p></o:p></span></h2><h2 style="margin-left: 36.0pt; mso-list: l5 level1 lfo4; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Bentuk obat cair untuk penggunan topical :<o:p></o:p></span></h2><h2 style="margin-left: 36.0pt; text-align: justify; text-indent: -12.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>sediaan basah seperti kompres, celupan dan<span> </span><span> </span>untuk mandi : larutan <span> </span>Rivanol, larutan P.K <span> </span>(Permanganas Kalicus)<span> </span><o:p></o:p></span></h2><h2 style="margin-left: 36.0pt; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Lotion, digunakan untuk efek menyejukan, tidak digunakan pada luka berair<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>Linimen, suatu larutan dalam alkohol atau minyak<o:p></o:p></span></h2><h2 style="text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">3. <span> </span>Bentuk obat semi/setengah padat pada penggunaan topical<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- salap, digunakan untuk kulit<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span><span> </span>- krim, mengandung banyak air<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span><span> </span>- pasta, <o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span><span> </span>- Jeli<o:p></o:p></span></h2><h2 style="text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">4. Bentuk obat aerosol untuk penggunaan topical<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span><span> </span>- Aerosol semprotan pembasah atau<span> </span>permukaaan<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span><span> </span>- Aerosol aliran semprotan<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span><span> </span>- Aerosol busa<o:p></o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><div class="MsoNormal"><br />
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</div><h1><b><span lang="EN-US" style="font-size: 14.0pt;"><o:p> </o:p></span></b></h1><h1><b><span lang="EN-US" style="font-size: 14.0pt;">FARMAKOKINETIKA<o:p></o:p></span></b></h1><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><div class="MsoNormal"><br />
</div><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>Obat yang masuk kedalam tubuh melalui berbagai macam cara pemberian umumnya mengalami proses absorpsi, distribusi dan pengikatan untuk sampai di tempat kerja dan menimbulkan efek, kemudian dengan atau tanpa biotransformasi, obat di ekskresi dari dalam tubuh, seluruh proses ini disebut proses farmakokinetik dan berjalan serentak. <o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 align="center" style="text-align: center;"><b><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></b></h2><h2 align="center" style="text-align: center;"><b><span lang="EN-US" style="font-size: 12.0pt;">“Dapat di gambarkan”</span></b><span lang="EN-US" style="font-size: 12.0pt;"><o:p></o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><div class="MsoNormal"><br />
</div><h2 style="margin-left: 11.25pt; text-align: justify; text-indent: -11.25pt;"><span lang="EN-US" style="font-size: 12.0pt;">- Kerja suatu obat merupakan hasil dari banyak proses <o:p></o:p></span></h2><h2 style="margin-left: 11.25pt; text-align: justify; text-indent: -11.25pt;"><span lang="EN-US" style="font-size: 12.0pt;">- Kebanyakan sangat rumit<o:p></o:p></span></h2><h2 style="margin-left: 11.25pt; text-align: justify; text-indent: -11.25pt;"><span lang="EN-US" style="font-size: 12.0pt;">- Tetapi pada umumnya didasari oleh suatu rangkaian reaksi yang dibagi dalam 3 fase:<o:p></o:p></span></h2><h3 style="margin-left: 36.0pt; mso-list: l8 level1 lfo5; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Fase farmasetika<o:p></o:p></span></h3><h3 style="margin-left: 36.0pt; mso-list: l8 level1 lfo5; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Fase farmakokinetika<o:p></o:p></span></h3><h3 style="margin-left: 36.0pt; mso-list: l8 level1 lfo5; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Fase farmakodinamika<o:p></o:p></span></h3><h2 style="margin-left: 11.25pt; text-align: justify; text-indent: -11.25pt;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><div class="MsoNormal"><br />
</div><h1 style="text-align: justify;"><b><i><span lang="EN-US" style="font-size: 12.0pt;">Fase farmasetika<o:p></o:p></span></i></b></h1><h2 style="margin-left: 18.0pt; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="margin-left: 18.0pt; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Meliputi hancurnya bentuk sediaan obat dan melarutnya bahan obat (disolusi) untuk sediaan obat padat<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span><span> </span>misal: <o:p></o:p></span></h2><div class="MsoNormal"><br />
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</div><h2 align="center" style="text-align: center;"><i><span lang="EN-US" style="font-size: 12.0pt;">Tablet---------------disentegrasi------------------------------disolusi<o:p></o:p></span></i></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="margin-left: 18.0pt; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="margin-left: 18.0pt; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="margin-left: 18.0pt; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="margin-left: 18.0pt; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Efek obat tidak tergantung semata-mata pada faktor-faktor farmakologi melainkan juga pada bentuk sediaan dan terutama pada formulasinya<o:p></o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h2 style="margin-left: 18.0pt; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Faktor-faktor formulasi yang dapat merubah efek obat dalam tubuh antara lain:<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>1. bentuk fisik zat aktif<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>2. keadaan kimiawi<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>3. zat-zat pembantu<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>4. proses teknik yang digunakan untuk<span> </span><span> </span><span> </span>membuat sediaan.<o:p></o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><div class="MsoNormal"><br />
</div><h1 style="text-align: justify;"><b><i><span lang="EN-US" style="font-size: 12.0pt;">Fase farmakokinetika<o:p></o:p></span></i></b></h1><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span><o:p></o:p></span></h2><h2 style="text-align: justify; text-indent: 22.5pt;"><span lang="EN-US" style="font-size: 12.0pt;">Meliputi proses-proses yang berlangsung pada pengambilan suatu bahan obat kedalam organisme yaitu proses absorpsi dan distribusi, sedangkan eliminasi merupakan proses-proses yang menyebabkan penurunan konsentrasi obat dalam organisme (biotransformasi dan ekskresi) <o:p></o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h2 style="text-align: justify; text-indent: 22.5pt;"><span lang="EN-US" style="font-size: 12.0pt;">Dari pandangan farmakokinetik, organisme diartikan sebagai sistem terbuka atau sistem aliran karena senantiasa berlangsung pertukaran bahan-bahan dan pertukaran energi dengan sekitarnya untuk mencapai kesetimbangan.<o:p></o:p></span></h2><h2 style="text-align: justify; text-indent: 22.5pt;"><span lang="EN-US" style="font-size: 12.0pt;">Organisme akan berusaha untuk mengembalikan keadaan <span> </span>kesetimbangan ini secepatnya apabila terjadi perubahan<o:p></o:p></span></h2><h2 style="text-align: justify; text-indent: 22.5pt;"><span lang="EN-US" style="font-size: 12.0pt;">Pemberian obat berarti gangguan terhadap kesetimbangan aliran yang mempengaruhi organisme untuk meniadakannya. <o:p></o:p></span></h2><div class="MsoNormal"><br />
</div><h1 style="text-align: justify;"><b><i><span lang="EN-US" style="font-size: 12.0pt;">Fase farmakodinamik<o:p></o:p></span></i></b></h1><h2 style="margin-left: 0cm; text-align: justify; text-indent: 13.5pt;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="text-align: justify; text-indent: 22.5pt;"><span lang="EN-US" style="font-size: 12.0pt;">Merupakan interaksi obat-reseptor dan juga proses-proses yang terlibat dimana akhir dari efek farmakologi terjadi.<o:p></o:p></span></h2><h1 style="text-align: justify; text-indent: 13.5pt;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h1><b><span lang="EN-US" style="font-size: 12.0pt;">Absorpsi<o:p></o:p></span></b></h1><h2 style="text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="text-align: justify; text-indent: 22.5pt;"><span lang="EN-US" style="font-size: 12.0pt;">Pengambilan dari permukaan tubuh (termasuk mukosa saluran cerna) atau dari tempat-tempat tertentu dalam organ dalam kedalam aliran darah atau kedalam sistem pembuluh darah limfe dan selanjutnya didistribusikan kedalam organisme keseluruhan<o:p></o:p></span></h2><h2 style="text-align: justify; text-indent: 22.5pt;"><span lang="EN-US" style="font-size: 12.0pt;">Obat baru akan berkhasiat apabila berhasil mencapai konsentrasi yang sesuai pada tempat kerjanya maka suatu absorpsi yang cukup merupakan suatu syarat untuk efek terapeutik<o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-size: 12.0pt;">Absorpsi kebanyakan obat terjadi secara dipusi pasif.<o:p></o:p></span></h2><h2 style="text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Kecepatan absorpsi dan kuosien (hubungan bagian yang diabsorpsi terhadap jumlah yang diberikan) bergantung pada banyak faktor, antara lain:<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>1. sifat fisika-kimia obat<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>2. derajat kehalusan partikel<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>3. sediaan obat<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US"><span> </span></span><span lang="EN-US" style="font-size: 12.0pt;">4. dosis<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>5. rute pemberian<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>6. tempat pemberian<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>7. waktu kontak dengan permukaan<span> </span><span> </span>absorpsi<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>8. besarnya luas permukaan yang <span> </span>mengabsorpsi<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>9. nilai pH dalam darah<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>10. integritas membran<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>11. aliran darah<o:p></o:p></span></h2><div class="MsoNormal"><br />
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</div><h1><b><span lang="EN-US" style="font-size: 12.0pt;">Bioavailabilitas<o:p></o:p></span></b></h1><h2 style="margin-left: 18.0pt; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><div class="MsoNormal"><br />
</div><h2 style="margin-left: 18.0pt; text-align: justify; text-indent: 18.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>Menyatakan jumlah obat dalam porsen terhadap dosis yang mencapai sirkulasi sistemik dalam bentuk utuh atau aktif.<o:p></o:p></span></h2><h2 style="margin-left: 18.0pt; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Hal ini terjadi karena untuk obat-obat tertentu tidak semua yang diabsorpsi akan mencapai sirkulasi sistemik<o:p></o:p></span></h2><h2 style="margin-left: 18.0pt; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Sebagian akan dimetabolisme oleh enzim di dinding usus (pada pemberian oral)dan atau dihati pada lintas pertama melalui organ-organ tersebut<o:p></o:p></span></h2><h2 style="margin-left: 18.0pt; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Metabolisme ini disebut metabolisme atau eliminasi lintas pertama atau eliminasi prasistemik.<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h1 align="left" style="text-align: left; text-indent: 18.0pt;"><span lang="EN-US" style="font-size: 12.0pt;">Faktor-faktor yang mempengaruhi bioavailabilitas :<br />
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<!--[endif]--><o:p></o:p></span></h1><h2 style="margin-left: 18.0pt; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">1. Faktor obat<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- sifat-sifat fisikokimia obat<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- formulasi obat<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>2. Faktor penderita<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- pH saluran cerna<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- kecepatan pengosongan lambung<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- waktu transit dalam saluran cerna<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- perfusi saluran cerna<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- kapasitas absorpsi<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- metabolisme dalam lumen sal. Cerna<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US"><span> </span>- </span><span lang="EN-US" style="font-size: 12.0pt;">kapasitas metabolisme dalam dinding saluran <span> </span>cerna dan hati<o:p></o:p></span></h2><h2 style="text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">3. Interaksi dalam absorpsi di saluran cerna<o:p></o:p></span></h2><h2 style="margin-left: 27.0pt; text-align: justify; text-indent: -27.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- adanya makanan<o:p></o:p></span></h2><h2 style="margin-left: 27.0pt; text-align: justify; text-indent: -27.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- perubahan pH saluran cerna<o:p></o:p></span></h2><h2 style="margin-left: 27.0pt; text-align: justify; text-indent: -27.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- perubahan motilitas sal. Cerna<o:p></o:p></span></h2><h2 style="margin-left: 27.0pt; text-align: justify; text-indent: -27.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- gangguan pada fungsi normal mukosa usus<o:p></o:p></span></h2><h2 style="margin-left: 27.0pt; text-align: justify; text-indent: -27.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- interaksi langsung.<o:p></o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h1><b><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></b></h1><h1><b><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></b></h1><h1><b><span lang="EN-US" style="font-size: 12.0pt;">Distribusi<o:p></o:p></span></b></h1><div class="MsoNormal"><br />
</div><h2 style="margin-left: 0cm; text-align: justify; text-indent: 13.5pt;"><span lang="EN-US" style="font-size: 12.0pt;">Merupakan penyebaran obat dari lumen pembuluh darah ke seluruh tubuh<o:p></o:p></span></h2><h2 style="text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Dalam sirkulasi sistemik obat yang di absorpsi sebagia akan berikatan dengan protein plasma sehingga bersifat farmakologis inaktif<o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 13.5pt;"><span lang="EN-US" style="font-size: 12.0pt;">Hanya obat yang bebas akan didistribusikan dan mencapai <b><i>site of action<o:p></o:p></i></b></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 13.5pt;"><span lang="EN-US" style="font-size: 12.0pt;">Distribusi organ khusus:<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- otak<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- plasenta<o:p></o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h1 align="left" style="text-align: left;"><b><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></b></h1><h1><b><span lang="EN-US" style="font-size: 12.0pt;">Biotransformasi<o:p></o:p></span></b></h1><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Merupakan proses perubahan struktur kimia obat yang terjadi dalam tubuh dan dikatalisis oleh enzim<o:p></o:p></span></h2><h2 style="margin-left: 18.0pt; text-align: justify; text-indent: 18.0pt;"><span lang="EN-US" style="font-size: 12.0pt;">Tujuan biotransformasi yaitu agar obat menjadi lebih polar (lebih larut dalam air) sehingga lebih mudah di ekskresikan<o:p></o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h2 style="margin-left: 18.0pt; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Terdiri dari dua tahap :<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>1. reaksi fase I (Non Sintetis)<o:p></o:p></span></h2><h2 style="margin-left: 36.0pt; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">obat asal dengan proses oksidasi, reduksi <span> </span>dan hidrolisis diubah menjadi metabolic yang <span> </span>lebih polar, yang dapat bersifat inaktif, kurang aktif atau lebih aktif dari bentuk aslinya<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>2. reaksi fase II (sintetis)<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>Merupakan konjugasi metabolic hasil fase I <span> </span>dengan substrat endogen. <o:p></o:p></span></h2><h2 style="margin-left: 36.0pt; text-align: justify; text-indent: -36.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>hasil konjugasi ini bersifat lebih polar dan <span> </span>lebih mudah terionisasi sehingga lebih mudah <span> </span>diekskresikan<span> </span><o:p></o:p></span></h2><h2 style="text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Tempat terjadi : Hepar, paru-paru ginjal, dinding usus dan darah<o:p></o:p></span></h2><h1 style="text-indent: 13.5pt;"><b><span lang="EN-US" style="font-size: 12.0pt;">Ekskresi<o:p></o:p></span></b></h1><div class="MsoNormal"><br />
</div><h2 style="margin-left: 18.0pt; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Obat dikeluarkan dari tubuh melalui organ ekskresi<o:p></o:p></span></h2><h2 style="margin-left: 18.0pt; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Organ ekskresi terpenting adalah :<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- ginjal<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- air mata<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- air susu<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- rambut<o:p></o:p></span></h2><h2 style="margin-left: 18.0pt; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Ekskresi obat menurun pada gangguan ginjal sehingga dosis harus diturunkan atau interval diperpanjang<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><div class="MsoNormal"><br />
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</div><h1><b><span lang="EN-US" style="font-size: 16.0pt;">FARMAKODINAMIKA<o:p></o:p></span></b></h1><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Merupakan cabang ilmu yang mempelajari efek biokimiawi dan fisiologi obat serta mekanisme kerjanya<o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><b><i><span lang="EN-US" style="font-size: 12.0pt;">Tujuannya</span></i></b><span lang="EN-US" style="font-size: 12.0pt;"> adalah mempelajari mekanisme kerja obat yaitu untuk meneliti efek utama obat, mengetahui interaksi obat dengan sel dan mengetahui urutan peristiwa serta sepektrum efek dan respon yang terjadi<o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h2 style="text-align: justify;"><b><span lang="EN-US" style="font-size: 12.0pt;">Kerja dan Efek<o:p></o:p></span></b></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 13.5pt;"><span lang="EN-US" style="font-size: 12.0pt;">kerja : perubahan kondisi yang mengakinatkan timbulnya efek atau respon<o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 13.5pt;"><span lang="EN-US" style="font-size: 12.0pt;">Efek : perubahan fungsi struktur atau proses sebagai akibat kerja obat<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><b><span lang="EN-US" style="font-size: 12.0pt;">Tempat Kerja<o:p></o:p></span></b></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><b><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></b></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;">Obat dapat bekerja pada:<o:p></o:p></span></h2><h2 style="text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">- Pada tempat aplikasi. Mis: salap<o:p></o:p></span></h2><h2 style="text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">- Selama transport dalam tubuh<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>Mis: diuretik osmotik seperti manitol<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- Pada tempat (jaringan atau sel) tertentu<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>mis: eter dan atropin<o:p></o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><b><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></b></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><b><span lang="EN-US" style="font-size: 12.0pt;">Mekanisme Kerja Obat<o:p></o:p></span></b></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Bagaimana obat bisa bekerja sehingga menimbulkan efek.<o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Dapat dibagi dua golongan besar:<o:p></o:p></span></h2><h2 style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: 0cm;"><!--[if !supportLists]--><span lang="EN-US"><span>•</span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;"> Yang diperantarai reseptor<o:p></o:p></span></h2><h2 style="margin-left: 36.0pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: 0cm;"><!--[if !supportLists]--><span lang="EN-US"><span>•</span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;"> Yang tidak diperantarai reseptor<o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Kerja yang tidak diperantarai reseptor ialah kerja yang berdasarkan atas sifat-sifat fisikokimia secara sederhana<o:p></o:p></span></h2><h2 style="margin-left: 0cm; mso-list: l0 level1 lfo1; text-align: justify; text-indent: 0cm;"><!--[if !supportLists]--><span lang="EN-US"><span>•</span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;"> Berdasarkan sifat fisika:<o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="text-align: justify; text-indent: 0cm;"><b><i><span lang="EN-US" style="font-size: 12.0pt;">Rasa</span></i></b><span lang="EN-US" style="font-size: 12.0pt;"> : senyawa-senyawa dengan rasa <span> </span>pahit secara reflek akan meningkatkan <span> </span>aliran asam klorida kedalam lambung, <span> </span>peristiwa ini akan menambah napsu <span> </span>makan, <i>contohnya Gentian</i> <span> </span><o:p></o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h2 style="mso-list: l0 level1 lfo1; text-align: justify;"><!--[if !supportLists]--><span lang="EN-US"><span>•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Berdasarkan sifat kimia<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span><b><i>Asam basa</i></b> : asam klorida pada pengobatan hipoklorida dan antasida pada pengobatan tukak lambung<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span><b><i>Khelasi</i></b>: logam-logam berat seperti timbal dan tembaga dapat dikeluarkan dari tubuh dengan bantuan senyawa-senyawa yang dapat membentuk kompleks khelat dengan logam itu, mis: EDTA dan Dimerkaprol <o:p></o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h1 style="text-align: justify;"><b><i><span lang="EN-US" style="font-size: 12.0pt;">Reseptor obat<o:p></o:p></span></i></b></h1><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Resept obat atau reseptor farmakologik (selanjutnya disebut <b><i>reseptor </i></b>saja) ialah:<o:p></o:p></span></h2><h2 style="margin-left: 27.0pt; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Komponen speifik sel yang dapat berinteraksidengan obat dan hasil interaksi<span> </span>ini menimbulkan peristiwa atau rangkaian<span> </span>peristiwa yang pada akhirnya menimbulkan efek atau respon.<o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Obat yang dapat menghasilkan efek setelah berinteraksi dengan reseptor dinamakan agonis<o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Sedangkan yang tidak menimbulkan efek disebut antagonis.<o:p></o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><b><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></b></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><b><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></b></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><b><span lang="EN-US" style="font-size: 12.0pt;">Sifat dan Fungsi Reseptor<o:p></o:p></span></b></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><b><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></b></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Dari data analisis fisiko-kimiawi menunjukan bahwa reseptor merupakan makromolekul yang dapat berupa lipoprotein, glikoprotein, lipid, protein atau asam nukleat<o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Reseptor obat dalam tubuh hewan pada umumnya merupakan reeptor fisiologik yaitu reseptor untuk senyawa-senyawa endogen seperti hormon,neurotransmiter dan autokoid.<o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Kebanyakan reseptor merupakan komponen fungsional membran plasma dan hanya sebagian kecil yang berlokasi di dalam sel<o:p></o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h2 style="margin-left: 0cm; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-size: 12.0pt;">Reseptor yang terletak pada permukaan sel meliputi reseptor untuk neurotransmiter, hormon peptida (mis: insulin), sedangkan reseptor yang terdapat di dalam sel(reseptor intraseluler) mis: reseptor untuk steroid.<o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-size: 12.0pt;">Reseptor berfungsi untuk menerima rangsangan (stimulus) dengan mengikat senyawa endogen (obat) yang sesuai kemudian menyampaikan informasi yang diterimanya itu kedalam sel dengan langsung menimbulkan efek seluler melalui perubahan permiabilitas membran (mis: reseptor nikotinik)<o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-size: 12.0pt;">Disamping sebagai alat komunikasi reseptor juga dapat berfungsi sebagai enzim dan asam nukleat.<o:p></o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h1 style="text-align: justify;"><b><span lang="EN-US" style="font-size: 12.0pt;">Interaksi Obat-Reseptor<o:p></o:p></span></b></h1><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Istilah reseptor dalam fisiologi hampir selalu dikaitkan dengan proses komunikasi, baik komunikasi antar sel maupun komunikasi antar organisme dengan lingkungan luarnya<o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-size: 12.0pt;">Komunikasi antar sel bagiorganisme multiseluler mempunyai peranan penting yaitu untuk mengatur perkembangan dan organisasi dalam jaringan, mengontrol pertumbuhan dan pembelahan sel serta mengkoordinasi berbagai kegiatan kehidupan<o:p></o:p></span></h2><h1 style="text-align: justify;"><b><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></b></h1><h1 style="text-align: justify;"><b><span lang="EN-US" style="font-size: 12.0pt;">Macam-macam Efek Obat<o:p></o:p></span></b></h1><div class="MsoNormal"><br />
</div><h2 style="margin-left: 36.0pt; mso-list: l6 level1 lfo6; tab-stops: list 18.0pt; text-align: justify; text-indent: -36.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Efek sistemin<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span><span> </span>adalah obat beredar ke seluruh tubuh melalui sirkulasi darah<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;">2. <span> </span>Efek lokal<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>obat yang mempunyai efek hanya setempat dimana obat digunakan.<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Mis: oral kumur, injeksi anestesi lokal, dsb.<o:p></o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h1 style="text-align: justify;"><b><span lang="EN-US" style="font-size: 12.0pt;">Efek Obat<o:p></o:p></span></b></h1><div class="MsoNormal"><br />
</div><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Dalam pengobatan efek obat dapat di bagi menjadi:<o:p></o:p></span></h2><h2 style="margin-left: 6.75pt; text-align: justify; text-indent: -6.75pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span><b><i>- <span> </span>efek normal</i></b> : <o:p></o:p></span></h2><h2 style="margin-left: 6.75pt; text-align: justify; text-indent: -6.75pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span><span> </span>efek yang timbul pada kebanyakan <span> </span>individu<o:p></o:p></span></h2><h2 style="margin-left: 6.75pt; text-align: justify; text-indent: -6.75pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- <b><i>efek abnormal<o:p></o:p></i></b></span></h2><h2 style="margin-left: 6.75pt; text-align: justify; text-indent: -6.75pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span><span> </span>efek yang dialami individu atau <span> </span>kelompok <span> </span>tertentu<o:p></o:p></span></h2><h2 style="margin-left: 6.75pt; text-align: justify; text-indent: -6.75pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span><b><i>Kedua macam efek tersebut dapat terjadi pada dosis terapi<o:p></o:p></i></b></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h2 style="margin-left: 0cm; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-size: 12.0pt;">Kebanyakan obat jika diberikan dalam dosis terapi dapat menimbulkan lebih dari satu jenis efek:<o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><b><i><span lang="EN-US" style="font-size: 12.0pt;">Efek utama (primer):</span></i></b><span lang="EN-US" style="font-size: 12.0pt;"> <o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">efek yang menjadi tujuan utama pengobatan<o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><b><i><span lang="EN-US" style="font-size: 12.0pt;">Efek samping (efek tambahan):<o:p></o:p></span></i></b></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Efek yang tidak menjadi tujuan utama pengobatan, efek ini dapat bermanfaat atau merugikan (mengganggu) tergantung dari kondisi dan situasi pasien.<o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><b><i><span lang="EN-US" style="font-size: 12.0pt;">Sebagai contoh</span></i></b><span lang="EN-US" style="font-size: 12.0pt;">:<o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Penggunaan antihistamin yang dimaksudkan untuk menghambat kerja histamin, ternyata bahwa antihistamin dapat menimbulkan rasa ngantuk. Bagi pasien yang memerlukan istirahat (tidur) jelas efek ini menguntungkan, tetapi bagi pasien yang bekerja memerlukan kewaspadaan yang tinggi efek ini merugikan karena dapat membahayakan jiwanya.<o:p></o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h2 style="margin-left: 15.75pt; text-align: justify; text-indent: -15.75pt;"><b><i><span lang="EN-US" style="font-size: 12.0pt;">Efek utama (primer) dapat menimbulkan efek sekunder</span></i></b><span lang="EN-US" style="font-size: 12.0pt;"> <o:p></o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">yaitu efek yang tidak diinginkan dan merupakan reaksi organisme (tubuh) terhadap efek primer suatu obat.<o:p></o:p></span></h2><h2 style="margin-left: 15.75pt; text-align: justify; text-indent: -15.75pt;"><span lang="EN-US" style="font-size: 12.0pt;">Mis:<o:p></o:p></span></h2><h2 style="margin-left: 15.75pt; text-align: justify; text-indent: -15.75pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>Diare yang timbul akibat penggunaan tetrasiklin<span> </span>(antibiotik spektrum luas) secara oral. Peristiwa ini terjadi karena antibiotik itu membunuh flora usus yang mempunyai fungsi normal bagi tubuh sehingga hal ini akan merugikan kesehatan pasien, efek sekunder karena tetrasiklin ini dapat pula menyebabkan timbulnya infeksi oleh mikroorganisme lain misalnya jamur atau kuman yang resisten terhadap antibiotik yang bersangkutan.<o:p></o:p></span></h2><h1 style="text-align: justify;"><b><i><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></i></b></h1><h1 style="text-align: justify;"><b><i><span lang="EN-US" style="font-size: 12.0pt;">Efek abnormal<o:p></o:p></span></i></b></h1><h2 style="text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Meliputi:<o:p></o:p></span></h2><h2 style="text-align: justify; text-indent: 0cm;"><b><i><span lang="EN-US" style="font-size: 12.0pt;">A. Idiosinkrasi<o:p></o:p></span></i></b></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>Efek suatu obat yang secara kwalitatif berlainan sekali dengan efek terapi normalnya, dapat timbul secara individu, familier atau rasial.<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span><i>contoh:<o:p></o:p></i></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>Obat primaquin sebagai anti malaria dapat menimbulkan hemolisis yang hebat.<o:p></o:p></span></h2><h2 style="margin-left: 36.0pt; mso-list: l3 level1 lfo8; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><b><i><span lang="EN-US" style="font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>B.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></i></b><!--[endif]--><b><i><span lang="EN-US" style="font-size: 12.0pt;">Toleransi<o:p></o:p></span></i></b></h2><h2 style="text-align: justify;"><span lang="EN-US"><span> </span></span><span lang="EN-US" style="font-size: 12.0pt;">Kurang rektif (hiporeakti) Untuk menimbulkan efek dengan intensitas tertentu dibutuhkan dosis yang lebih tinggi dari pada dosis lazim. <o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -10.5pt;"><span lang="EN-US" style="font-size: 12.0pt; mso-bidi-font-style: italic; mso-bidi-font-weight: bold;"><o:p> </o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -10.5pt;"><st1:city w:st="on"><st1:place w:st="on"><b><i><span lang="EN-US" style="font-size: 12.0pt;">Ada</span></i></b></st1:place></st1:city><b><i><span lang="EN-US" style="font-size: 12.0pt;"> tiga toleransi:<o:p></o:p></span></i></b></h2><h3 style="margin-left: 36.0pt; mso-list: l9 level1 lfo7; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><b><i><span lang="EN-US" style="font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></i></b><!--[endif]--><b><i><span lang="EN-US" style="font-size: 12.0pt;">Toleransi primer </span></i></b><span lang="EN-US" style="font-size: 12.0pt;">ialah toleransi bawaan yang terdapat pada sebagian orang dan binatang<o:p></o:p></span></h3><h3 style="margin-left: 36.0pt; mso-list: l9 level1 lfo7; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><b><i><span lang="EN-US" style="font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></i></b><!--[endif]--><b><i><span lang="EN-US" style="font-size: 12.0pt;">Toleransi sekunder </span></i></b><span lang="EN-US" style="font-size: 12.0pt;">ialah toleransi yang diperoleh akibat penggunaan obat yang sering diulangi<o:p></o:p></span></h3><h3 style="margin-left: 36.0pt; mso-list: l9 level1 lfo7; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><b><i><span lang="EN-US" style="font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></i></b><!--[endif]--><b><i><span lang="EN-US" style="font-size: 12.0pt;">Toleransi silang </span></i></b><span lang="EN-US" style="font-size: 12.0pt;">ialah toleransi yang terjadi akibat penggunaan obat-obat yang mempunyai struktur kimia yang serupa, dapat pula terjadi antara zat-zat yang berlainan, mis: alkohol dan barbiturat.<o:p></o:p></span></h3><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><div class="MsoNormal"><br />
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</div><h2 style="text-align: justify; text-indent: 0cm;"><b><i><span lang="EN-US" style="font-size: 12.0pt;">C. Intoleransi<o:p></o:p></span></i></b></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>Individu yang tergolong hipereaktif akan memberikan respon terhadap obat walaupun oabt itu diberihan dalam dosis yang sangat kecil (jauh dari dosis lazim)<o:p></o:p></span></h2><div class="MsoNormal"><br />
</div><h2 style="margin-left: 36.0pt; mso-list: l4 level1 lfo9; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><b><i><span lang="EN-US" style="font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>D.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></i></b><!--[endif]--><b><i><span lang="EN-US" style="font-size: 12.0pt;">Alergi (Hipersensitif)<o:p></o:p></span></i></b></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>suatu reaksi alergi yang merupakan respon abnormal terhadap obat atau zat dimana pasien sebelumnya telah kontak dengan obat tersebut sehingga berkembang timbulnya antibodi.<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><h2 style="text-align: justify;"><b><span lang="EN-US" style="font-size: 12.0pt;">Efek lain yang timbul berkaitan dengan obat:<o:p></o:p></span></b></h2><h2 style="text-align: justify;"><b><i><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></i></b></h2><h2 style="margin-left: 36.0pt; mso-list: l1 level1 lfo10; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><b><i><span lang="EN-US" style="font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></i></b><!--[endif]--><b><i><span lang="EN-US" style="font-size: 12.0pt;">Resistensi<o:p></o:p></span></i></b></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>adalah keadaan tubuh yang tidak memberikan respon pada obat karena perubahan fisiologi tubuh<o:p></o:p></span></h2><h2 style="margin-left: 36.0pt; mso-list: l1 level1 lfo10; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><b><i><span lang="EN-US" style="font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></i></b><!--[endif]--><b><i><span lang="EN-US" style="font-size: 12.0pt;">Habituasi<o:p></o:p></span></i></b></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>suatu ketergantungan psikologik terhadap obat-obat tertentu, mis: obat penenang dengan ciri:<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- selalu ingin menggunakan obat<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- tanpa kecenderungan untuk menaikka dosis<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- timbul beberapa ketergantungan psikhis<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- Merugikan pada individu sendiri<o:p></o:p></span></h2><h2 style="margin-left: 36.0pt; mso-list: l1 level1 lfo10; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><b><i><span lang="EN-US" style="font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></i></b><!--[endif]--><b><i><span lang="EN-US" style="font-size: 12.0pt;">Adiksi<o:p></o:p></span></i></b></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>suatu ketergantungan dan ketagihan psikologik dan fisik terhadap obat-obat tertentu, Mis: Morfin, dengan ciri-ciri:<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- ada dorongan untuk selalu menggunakan suatu<span> </span>obat<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- ada kecenderungan menaikan dosis<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- ada ketergantungan psikhis dan <span> </span>ketergantungan fisik<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>- Merugikan individu dan masyarakat<o:p></o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><div class="MsoNormal"><br />
</div><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><b><i><span lang="EN-US" style="font-size: 12.0pt;">Efek Penggunaan Obat Campuran<o:p></o:p></span></i></b></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><b><i><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></i></b></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><i><span lang="EN-US" style="font-size: 12.0pt;">1.Adisi<o:p></o:p></span></i></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>campuran obat yang sejalan dan menghasilkan efek yang merupakan jumlah dari masing-masing obat<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><i><span lang="EN-US" style="font-size: 12.0pt;">2. Sinergis<o:p></o:p></span></i></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>campuran obat yang saling sejalan dan saling melengkapi<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><i><span lang="EN-US" style="font-size: 12.0pt;">3. Potensiasi<o:p></o:p></span></i></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>campuran obat yang saling menguntungkan satu sama lain<o:p></o:p></span></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><i><span lang="EN-US" style="font-size: 12.0pt;">4. Antagonis<o:p></o:p></span></i></h2><h2 style="margin-left: 24.0pt; text-align: justify; text-indent: -24.0pt;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>campuran obat yang saling berlawanan dan menghasilkan efek yang tidak diinginkan atau tidak ada efek terapinya<o:p></o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1><div class="MsoNormal"><br />
</div><h2 style="text-align: justify;"><i><span lang="EN-US" style="font-size: 12.0pt;">5. Kompetisi<o:p></o:p></span></i></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>campuran obat yang saling bersaing untuk menghasilkan<span> </span>efek terapi lebih dahulu<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span><o:p></o:p></span></h2><h2 style="text-align: justify;"><b><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></b></h2><h2 style="text-align: justify;"><b><span lang="EN-US" style="font-size: 12.0pt;">Spesifitas dan Selektivitas<o:p></o:p></span></b></h2><h2 style="text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Suatu obat dikatakan spesifik bila kerjanya terbatas satu jenis reseptor<o:p></o:p></span></h2><h2 style="text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Dikatakan selektif bila menghasilkan satu efek pada dosis rendah dan efek lain baru muncul pada dosis yang lebih besar<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><span> </span>Obat yang spesifik belum tentu selektif, tetapi obat yang tidak spesifik dengan sendirinya selektif<o:p></o:p></span></h2><h2 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 align="center" style="text-align: center;"><span lang="EN-US"><o:p> </o:p></span></h2><h2 align="center" style="text-align: center;"><span lang="EN-US"><o:p> </o:p></span></h2><h2 align="center" style="text-align: center;"><span lang="EN-US">Dosis Obat</span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h2><h2 style="margin-left: 0cm; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-size: 12.0pt;">Dosis obat yang harus diberikan pada pasien untuk menghasilkan efek yang diharapkan tergantung dari banyak faktor antara lain:<o:p></o:p></span></h2><h2 style="margin-left: 36.0pt; mso-list: l7 level1 lfo11; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Usia<o:p></o:p></span></h2><h2 style="margin-left: 36.0pt; mso-list: l7 level1 lfo11; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Bobot badan<o:p></o:p></span></h2><h2 style="margin-left: 36.0pt; mso-list: l7 level1 lfo11; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Kelamin<o:p></o:p></span></h2><h2 style="margin-left: 36.0pt; mso-list: l7 level1 lfo11; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Besarnya permukaan badan<o:p></o:p></span></h2><h2 style="margin-left: 36.0pt; mso-list: l7 level1 lfo11; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Beratnya penyakit<o:p></o:p></span></h2><h2 style="margin-left: 36.0pt; mso-list: l7 level1 lfo11; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-size: 12.0pt; mso-fareast-font-family: Arial;"><span>6.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-size: 12.0pt;">Keadaan pasien<o:p></o:p></span></h2><h1 style="text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt;"><o:p> </o:p></span></h1>salnihttp://www.blogger.com/profile/00126668517852477742noreply@blogger.com0Malalayang, Indonesia1.4546951270765189 124.829254574868861.4379466270765189 124.79642307486885 1.471443627076519 124.86208607486886tag:blogger.com,1999:blog-8321145958076225978.post-56485262104086133462011-07-21T01:01:00.000-07:002011-07-21T01:01:05.970-07:00WORLD OF DANCE 2011 - "HYPE" 1st Place Winner<iframe width="480" height="295" src="http://www.youtube.com/embed/4LX-Gi3P29c?fs=1" frameborder="0" allowfullscreen=""></iframe>salnihttp://www.blogger.com/profile/00126668517852477742noreply@blogger.com0tag:blogger.com,1999:blog-8321145958076225978.post-7477293269177021762011-07-21T01:00:00.000-07:002012-03-16T00:59:05.868-07:00ASKEP (Asuhan Keperawatan) pada kehamilan dengan penyakit Struma Diffusa toxica dan hypertiroid<div align="center" class="MsoNormal" style="text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 115%;">BAB I<o:p></o:p></span></b></div>
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<span style="color: black; font-family: Wingdings; font-size: 12pt; line-height: 150%;">§<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><b><span style="color: black; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">LATAR BELAKANG<o:p></o:p></span></b></div>
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<span style="color: black; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">Dalam hal pembelajaran kita saat ini tentunya kita ingin mendapatkan banyak pengetahuan terutama dalam hal yang menyangkut bidang kita dalam kesehatan. Untuk itu dalam tugas ini kami membuat suatu pembahasan mengenai Penyakit Tiroid dan kami mengangkat ASKEP (Asuhan Keperawatan) pada kehamilan dengan penyakit Struma Diffusa toxica dan hypertiroid.</span><span style="color: black; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;"> Tiroid merupakan kelenjar yang berbentuk cuping kembar dan di antara keduanya dapat daerah yang menggenting. Kelenjar ini terdapat di bawah jakun di depan trakea. <b><o:p></o:p></b></span></div>
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<span style="color: black; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;"> Penyakit tiroid yang diangkat dalam pembahasan ini yaitu </span><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">Struma Diffusa toxica merupakan<b> </b></span><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;"> salahsatu jenis struma yang disebabkan oleh sekresi hormon-hormon thyroid yang terlalu banyak. Histologik keadaan ini adalah sebagai suatu hipertrofi dan hyperplasi dari parenchyn kelenjar.Sedangkan Hipertiroid pada kehamilan ( morbus basodowi ) adalah hiperfungsi kelenjar tiroid ditandai dengan naiknya metabolism basal15-20 %, kadang kala diserta pembesaran ringan kelenjar tiroid. Kiranya makala ini dapat menambah lagi pengetahuan kita baik dalam teori maupun dalam pembelajaran kita bagaimana membuat Asuhan Keperawatan dengan baik.<o:p></o:p></span></div>
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<span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;">§<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><b style="mso-bidi-font-weight: normal;"><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">TUJUAN PENULISAN<o:p></o:p></span></b></div>
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<span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">Adapun maksud dan tujuan dari penulisan makala ini:<o:p></o:p></span></div>
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<span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="color: black; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">Dalam memenuhi tugas wajib terhadap dosen keperawatan maternitas khususnya pembuatan ASKEP pada kehamilan bermasalah dengan penyakit tiroid.<o:p></o:p></span></div>
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<span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="color: black; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">Sebagai pembelajaran pembuatan Asuhan Keperawatan<o:p></o:p></span></div>
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<span style="color: black; font-family: Wingdings; font-size: 12pt; line-height: 150%;">§<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><b style="mso-bidi-font-weight: normal;"><span style="color: black; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">MANFAAT<o:p></o:p></span></b></div>
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<span style="color: black; font-family: Wingdings; font-size: 12pt; line-height: 150%;">ü<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="color: black; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">Untuk mengetahui pengertian dari tiroid dan mengetahui hal-hal yang berhubungan dengan kelenjar tiroid<o:p></o:p></span></div>
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<span style="color: black; font-family: Wingdings; font-size: 12pt; line-height: 150%;">ü<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="color: black; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">Untuk dapat memahami penjelasan mengenai penyakit tiroid<o:p></o:p></span></div>
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<span style="color: black; font-family: Wingdings; font-size: 12pt; line-height: 150%;">ü<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="color: black; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">Dapat mengetahui bagaimana pembuatan ASKEP baik tahap-tahap yang ada maupun hal-hal yang berhubungan. <o:p></o:p></span></div>
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<b><span style="color: black; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">BAB II<o:p></o:p></span></b></div>
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<b><span style="color: black; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">TIROID<o:p></o:p></span></b></div>
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<span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">Tiroid merupakan kelenjar kecil, dengan diameter sekitar 5 cm dan terletak di leher, tepat dibawah jakun. Kedua bagian tiroid dihubungkan oleh ismus, sehingga bentuknya menyerupai huruf H atau dasi kupu-kupu.<o:p></o:p></span></div>
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Dalam keadaan normal, kelenjar tiroid tidak terlihat dan hampir tidak teraba, tetapi bila membesar, dokter dapat merabanya dengan mudah dan suatu benjolan bisa tampak dibawah atau di samping jakun.<o:p></o:p></span></div>
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<span style="color: black; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">Kelenjar tiroid menghasilkan hormon tiroksin yang mempengaruhi metabolisme sel tubuh dan pengaturan suhu tubuh. <o:p></o:p></span></div>
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<span style="color: black; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">Tiroksin mengandung banyak iodium. <o:p></o:p></span></div>
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<span style="color: black; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">Kekurangan iodium dalam makanan dalam waktu panjang mengakibatkan pembesaran kelenjar gondok karena kelenjar ini harus bekerja keras untuk membentuk tiroksin. Kekurangan tiroksin menurunkan kecepatan metabolisme sehingga pertumbuhan lambat dan kecerdasan menurun. <o:p></o:p></span></div>
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<span style="color: black; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">Bila ini terjadi pada anak-anak mengakibatkan <i>kretinisme, </i>yaitu kelainan fisik dan mental yang menyebabkan anak tumbuh kerdil dan idiot. Kekurangan iodium yang masih ringan dapat diperbaiki dengan menambahkan garam iodium di dalam makanan.<o:p></o:p></span></div>
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<span style="color: black; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">Produksi tiroksin yang berlebihan menyebabkan penyakit eksoftalmik tiroid <i>(Morbus Basedowi) </i>dengan gejala sebagai berikut; kecepatan metabolisme meningkat, denyut nadi bertambah, gelisah, gugup, dan merasa demam. Gejala lain yang nampak adalah bola mata menonjol keluar (eksoftalmus) dan kelenjar tiroid membesar.<o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">KELENJAR TIROID<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">Pengertian Kelenjar Tiroid<o:p></o:p></span></b></div>
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<span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">Kelenjar tiroid adalah kelenjar endokrin yang paling besar dalam tubuh manusia dan merupakan satu-satunya kelenjar yang bisa langsung diperiksa pada pemeriksaan fisik.Kelenjar tiroid merupakan organ yang berbentuk seperti kupu-kupu dan terletak pada leher bagian bawah disebelah anterior trakea.<o:p></o:p></span></div>
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<span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;"> Pemeriksaan fungsi tiroid atau kemungkinan disfungsi memerlukan pemeriksaan yang lebih dari sekedar observasi dan palpasi daerah lokasi kelenjar tiroid. Tingkat metabolik dan ritme, termasuk keteraturan menstruasi pada wanita usia subur, diatur oleh kelenjar tiroid . Efek aktivitas tiroid sangat luas. Oleh karena itu, observasi tingkah laku, penampilan, kulit, mata, rambut, dan status kardiovaskular merupakan hal yang penting. Beberapa temuan memerlukan perhatian lanjut (misalnya, pembesaran, konsistensi yang kasar dan berpasir,dan nodul). <o:p></o:p></span></div>
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<strong><span lang="EN-US">Fungsi utama kelenjar tiroid</span></strong><span lang="EN-US"> adalah mempertahankan laju metabolisme yang sesuai. Kalsitonin yang dihasilkan oleh kelenjar tiroid penting untuk metabolisme kalsium dan juga bekerja untuk mengurangi konsentrasi kalsium plasma darah. Hal ini mencegah terbentuknya osteoklas-osteoklas baru (Martinelli & Fontana, 1990). Ketidakseimbangan dapat menyebabkan tulang-tulang melemah.</span></div>
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Kelenjar tiroid menghasilkan hormon tiroid, yang mengendalikan kecepatan metabolisme tubuh.<br />
Hormon tiroid mempengaruhi kecepatan metabolisme tubuh melalui 2 cara:<br />
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1. Merangsang hampir setiap jaringan tubuh untuk menghasilkan protein<br />
2. Meningkatkan jumlah oksigen yang digunakan oleh sel. <br />
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Jika sel-sel bekerja lebih keras, maka organ tubuh akan bekerja lebih cepat.<br />
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Untuk menghasilkan hormon tiroid, kelenjar tiroid memerlukan yodium, yaitu suatu eleman yang terdapat di dalam makanan dan air.<o:p></o:p></span></div>
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Kelenjar tiroid menangkap yodium dan mengolahnya menjadi hormon tiroid.<br />
Setelah hormon tiroid digunakan, beberapa yodium di dalam hormon kembali ke kelenjar tiroid dan didaur-ulang untuk kembali menghasilkan hormon tiroid.<br />
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Tubuh memiliki mekanisme yang runit untuk menyesuaikan kadar hormon tiroid.<br />
Hipotalamus (terletak tepat di atas kelenjar hipofisa di otak) menghasilkan thyrotropin-releasing hormone, yang menyebabkan kelenjar hipofisa mengeluarkan thyroid-stimulating hormone (TSH).<o:p></o:p></span></div>
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Sesuai dengan namanya, TSH ini merangsang kelenjar tiroid untuk menghasilkan hormon tiroid.<br />
Jika jumlah hormon tiroid dalam darah mencapai kadar tertentu, maka kelenjar hipofisa menghasilkan TSH dalam jumlah yang lebih sedikit; jika kadar hormon tiroid dalam darah berkurang, maka kelenjar hipofisa mengeluarkan lebih banyak TSH. Hal ini disebut mekanisme umpan balik.<o:p></o:p></span></div>
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Hormon tiroid terdapat dalam 2 bentuk:<o:p></o:p></span></div>
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1. Tiroksin (T4), merupakan bentuk yang dihasilkan oleh kelenjar tiroid, hanya memiliki efek yang ringan terhadap kecepatan metabolisme tubuh.<o:p></o:p></span></div>
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2. Tiroksin dirubah di dalam hati dan organ lainnya ke dalam bentuk aktif, yaitu tri-iodo-tironin (T3).<br />
Perubahan ini menghasilkan sekitar 80% bentuk hormon aktif, sedangkan 20% sisanya dihasilkan oleh kelenjar tiroid sendiri. <o:p></o:p></span></div>
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Perubahan dari T4 menjadi T3 di dalam hati dan organ lainnya, dipengaruhi oleh berbagai faktor, diantaranya kebutuhan tubuh dari waktu ke waktu.<o:p></o:p></span></div>
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Sebagian besar T4 dan T3 terikat erat pada protein tertentu di dalam darah dan hanya aktif jika tidak terikat pada protein ini. Dengan cara ini, tubuh mempertahankan jumlah hormon tiroid yang sesuai dengan kebutuhan agar kecepatan metabolisme tetap stabil.<o:p></o:p></span></div>
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Agar kelenjar tiroid berfungsi secara normal, maka berbagai faktor harus bekerjasama secara benar:<br />
- hipotalamus<br />
- kelenjar hipofisa<br />
- hormon tiroid (ikatannya dengan protein dalam darah dan perubahan T4 menjadi T3 di dalam hati serta organ lainnya).<br />
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GEJALA<br />
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Gejala-gejala penyakit tiroid<o:p></o:p></span></div>
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DIAGNOSA<br />
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Untuk mengetahui fungsi kelenjar tiroid, bisa dilakukan beberapa pemeriksaan laboratorium.<br />
Salah satu pemeriksaan yang paling sering dilakukan adalah pengukuran kadar TSH di dalam darah. Hormon ini merangsang kelenjar tiroid, karena itu jika kelenjar tiroid kurang aktif maka kadar hormon ini tinggi; sedangkan jika kelenjar tiroid terlalu aktif , maka kadar hormon ini rendah.<o:p></o:p></span></div>
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Biasanya pemeriksaan yang perlu dilakukan adalah pengukuran kadar TSH dan kadar T4 yang bebas dalam darah.<o:p></o:p></span></div>
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Tetapi bisa juga dilakukan pengukuran kadar protein globulin pengikat tiroksin, karena kadar protein yang abnormal bisa menimbulkan kesalahpahaman dalam menilai kadar hormon tiroid total.<o:p></o:p></span></div>
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Penderita penyakit ginjal, beberapa penyakit keturunan atau pemakaian steroid anabolik memiliki kadar globulin pengikat tiroksin yang rendah. Sebaliknya, wanita hamil, pemakai pil KB atau estrogen lainnya, penderita hepatitis stadium awal dan beberapa penyakit lainnya, memiliki kadar globulin pengikat tiroksin yang tinggi.<o:p></o:p></span></div>
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Beberapa pemeriksaan bisa dilakukan pada kelenjar tiroid.<br />
Jika diduga terdapat pertumbuhan di dalam kelenjar tiroid, dilakukan pemeriksaan USG, untuk menentukan apakah pertumbuhan ini berupa cairan atau padat.<br />
Skening kelenjar tiroid dengan yodium radioaktif atau teknetium, bisa menunjukkan kelainan fisik pada kelenjar tiroid. Skening tiroid juga bisa membantu menentukan apakah fungsi dari suatu daerah tiroid bersifat normal, terlalu aktif atau kurang aktif.<br />
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Jika masih belum yakin apakah kelainannya terletak pada kelenjar tiroid atau kelenjar hipofisa, maka dilakukan pemeriksaan perangsangan fungsional.<br />
Pada salah satu dari pemeriksaan ini dilakukan penyuntikan thyrotropin-releasing hormone intravena dan pemeriksaan darah untuk mengukur respon dari kelenjar hipofisa.<o:p></o:p></span></div>
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<span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">Kelenjar tiroid diperiksa dengan seksama. Pemeriksaan dasar yang khas biasanya dapat diselesaikan tanpa banyak kesukaran pada wanita yang sehat.<o:p></o:p></span></div>
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<span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">Pemeriksa perlu tetap waspada terhadap petunjuk pada wanita, yang mengarahkan pengkajian selanjutnya dan mengindikasikan respons cepat yang tidak menguntungkan, misalnya hipotensi supine. <o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">Sistem Endokrin<o:p></o:p></span></b></div>
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<span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">Perubahan besar pada sistem endokrin yang esensial terjadi untuk mempertahankan kehamilan, pertumbuhan normal janin, dan pemulihan pascapartum (nifas).<o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">Kelenjar Tiroid Selama Masa Kehamilan<o:p></o:p></span></b></div>
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<span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">Selama masa hamil, pembesaran moderat kelenjar tiroid merupakan akibat hiperplasia jaringan glandular dan peningkatan vaskularitas. Konsumsi oksigen dan peningkatan BMR merupakan akibat aktivitas metabolik janin. <o:p></o:p></span></div>
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<span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">Kelenjar tiroid berkembang bersama struktur kepala dan leher selama minggu ketiga dan keempat. Sekresi tiroksin dimulai selama minggu ke-8. Tiroksin ibu tidak dengan mudah menembus plasenta. Akibatnya, janin yang tidak memproduksi hormon tiroid akan lahir menderita hipotiroidisme kongenital. Apabila kondisi ini tidak diobati,bayi akan mengalami retardasi mental berat. Semua neonatus diskrining melalui pemeriksaan darah setelah lahir untuk mengetahui apakah neonatus tersebut mengalami hipotiroidisme (Appendiks F).<o:p></o:p></span></div>
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<span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">Korteks adrenal dibentuk selama minggu keenam dan menghasilkan hormon pada minggu ke-8 dan ke-9. Menjelang aterm, janin menghasilkan lebih banyak kortisol. Hal ini diduga membantu dimulainya persalinan dengan menurunkan progesteron ibu dan merangsang produksi prostaglandin.<o:p></o:p></span></div>
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<span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">Pankreas dibentuk dari usus depan selama minggu kelima sampai ke-8. Pulau Langerhans terbentuk selama minggu ke-12. Insulin dihasilkan pada minggu ke-20. Bayi dari ibu yang diabetesnya tidak terkontrol akan mengalami hiperglikemia akibat hiperglikemia ibu, yang selanjutnya akan merangsang hiperinsulinemia dan hiperplasia sel-sel pulau Langerhans. Kondisi ini akan menghasilkan janin berukuran besar. Hiperinsulinemia juga menghambat pematangan paru, sehingga neonatus berisiko mengalami distres pernapasan dan hipoglikemia saat sumber glukosa ibu hilang saat melahirkan. Pengaturan kadar glukosa ibu selama masa hamil mengurangi masalah pada bayi. <o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">BAB III<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">ASUHAN KEPERAWATAN<o:p></o:p></span></b></div>
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<span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;">§<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><b><span style="color: black; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">ASKEP STRUMA DIFFUSA TOXICA</span></b><a href="http://www.blogger.com/blogger.g?blogID=8321145958076225978" name="more"></a><b><span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;"> <o:p></o:p></span></b></div>
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ETIOLOGI<br />
Hyperthyroid disebabkan oleh hyperskresi dari hormon-hormon thyroid tetapi yang mempengaruhiadalah faktor : umur, temperatur, iklim yang berubah, kehamilan, infeksi, kekurangan yodium dan lain-lain.<br />
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ANATOMI<br />
Kelenjar thyroid terletak di depan trakhea dan di bawah laryng yang terdiri atas dua lobus yang terletak disebelah dan kiri trakhea dan diikat bersama oleh secarik jaringan disebuit istmus yang melintasi pada cincin tulang trakhea dua dan tiga.<b><o:p></o:p></b></span></div>
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Strktur thyroid terdiri atas sejumlah besar folikel dilapisi oleh cuboid epitelium membentuk ruang yang disebut koloid yaitu lumen substansi protein.<br />
Regulasi sekresi hormon tyroid dipengaruhioleh sistim kerja balik antara kelenjar hipofisis atau pituitari lobus anterior dan kelenjarthyroid. Lobus anterior hipofisis mensekresi TSH yang berfungsi meningkatkan iodine, meningkatkan sintesis dan sekresi hormon thyroiid, meningkatkan ukuran kelenjar thyroid.<o:p></o:p></span></div>
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Apabila terjasi penurunanhormon thyroid, hipofisis anterior merangsang peningkatan sekresi TSH dan mempengaruhi kelenjar thyroid untuk meningkatkan sekresi hormon rthyroid.<o:p></o:p></span></div>
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a. Thyroxine (T4) berfungsi untuk mempertahankan metabolisme tubuh.<br />
b. Tridothyronin (T3), berfungsi untuk mempercepat metabolisme tubuh.<br />
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Fungsi utama kelenjar thyroid adalah memproduksi hormon tiroxin yang berguna untuk mengontrol metabolisme sel. Dalam produksinya sangat erat hubungannya dengan proses sintesa tyroglobulin sedbagai matrik hormon, yodium dari luar, thyroid stimuliting hormon dari hip[ofise.<o:p></o:p></span></div>
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PATOFISIOLOGI<br />
Dengan bertambahnya produksi TSH dari hipofisis ( gambar a), oleh karena banyak sekali T3 dan T4 beredar di dalam darah, maka hipofisis mengurangkan produksi TSH. Seharusnya hyperaktivitas dari thyroid berhenti akan tetapi di dalam sdarah telah terbentuk suatu zat yang disebut Long- acting Thyroid Stimulator (LATS) sebagai akibat dari suatu reaksi imunologik dan LATS ,ini merangsang thyroid untuk tetap memproduksi hormon yang banyak (gambar b).<br style="mso-special-character: line-break;" /> <br style="mso-special-character: line-break;" /> <o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;">PENGKAJIAN</b><br />
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Pengumpulan data<br />
1. Anamnese<br />
Dari anamnese diperoleh:<br />
1) Identifikasi klien.<br />
2) Keluhan utama klien.<br />
Pada klien post operasi thyroidectomy keluhan yang dirasakan pada umumnya adalah nyeri akibat luka operasi.<o:p></o:p></span></div>
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3) Riwayat penyakit sekarang<o:p></o:p></span></div>
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Biasanya didahului oleh adanya pembesaran nodul pada leher yang semakin membesar sehingga mengakibatkan terganggunyapernafasan karena penekanan trakhea eusofagus sehingga perlu dilakukan operasi.<o:p></o:p></span></div>
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4) Riwayat penyakit dahulu<o:p></o:p></span></div>
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Perlu ditanyakan riwayat penyakit dahulu yang berhubungan dengan penyakit gondok, misalnya pernah menderita gondok lebih dari satu kali, tetangga atau penduduk sekitar berpenyakit gondok.<o:p></o:p></span></div>
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5) Riwayat kesehatan keluarga<o:p></o:p></span></div>
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Dimaksutkan barangkali ada anggota keluarga yang menderitan sama dengan klien saat ini.<o:p></o:p></span></div>
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6) Riwayat psikososial<o:p></o:p></span></div>
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Akibat dari bekas luka operasi akan meninggalkan bekas atau sikatrik sehingga ada kemungkinan klien merasa malu dengan orang lain.<o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;">PEMERIKSAAN FISIK</b><o:p></o:p></span></div>
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1) Keadaan umum <o:p></o:p></span></div>
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Pada umumnya keadaan penderita lemah dan kesadarannya composmentis dengan tanda-tanda vital yang meliputi tensi, nadi, pernafasan dan suhu yang berubah.<o:p></o:p></span></div>
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2) Kepala dan leher<o:p></o:p></span></div>
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Pada klien dengan post operasi thyroidectomy biasanya didapatkan adanya luka operasi yang sudah ditutup dengan kasa steril yang direkatkan dengan hypafik serta terpasang drain. Drain perlu diobservasi dalam dua sampai tiga hari.<o:p></o:p></span></div>
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3) Sistim pernafasan<o:p></o:p></span></div>
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Biasanya pernafasan lebih seak akibat dari penumpukan sekret efek dari anestesi, atau karena adanya darah dalam jalan nafas.<o:p></o:p></span></div>
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4) Sistim Neurologi<o:p></o:p></span></div>
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Pada pejmeriksaan reflek hasilnya positif tetapi dari nyeri ajkandipaspatkan ekspresi wajah yang tegang dan gelisah karena menahan sakit.<o:p></o:p></span></div>
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5) Sistim gastrointestinal<o:p></o:p></span></div>
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Komplikasi yang paling sering adalah mual akibat peningkatan asam lambung akibat anestesi umum, dan pada akhirnya akan hilang sejalan dengan efek anestesi yang hilang.<o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;">PEMERIKSAAN PENUNJANG<o:p></o:p></b></span></div>
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1) Pemeriksaan penunjang<br />
• Human thyrologlobulin( untuk keganasan thyroid)<br />
• Kadar T3, T4<br />
Nilai normal T3=0,6-2,0 , T4= 4,6-11 <br />
• Darah rutin<br />
• Endo Crinologiie minimal tiga hari berturut turut (BMR) nilai normal antara –10s/d +15<br />
• Kadar calsitoxin (hanya pada pebnderita tg dicurigai carsinoma meduler).<o:p></o:p></span></div>
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2) Pemeriksaan radiologis<br />
• Dilakukan foto thorak posterior anterior<br />
• Foto polos leher antero posterior dan laterl dengan metode soft tissu technig <br />
• Esofagogram bila dicurigai adanya infiltrasi ke osofagus.<o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;">DIOAGNOSA KEPERAWATAN<o:p></o:p></b></span></div>
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Adapun diagnosa yang sering timbul pada penderita post operasi theroidectomy adalah<o:p></o:p></span></div>
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1) Gangguan jalan nafas yang berhubungan dengan obstruksi trakhea secunder terhadap perdarahan, sopasme laring yang ditandai dengan sesak nafas, pernafasan cuping hidung sampai dengan sianosis.<br />
2) Ganggiuan komunilasi verbal sehubungan dengan nyeri, kerusakan nervus laringeal yang ditandai dengan klien sulit berbicara dan hilang suara.<br />
3) Gangguan rasa nyaman (nyeri) sehubungan dengan dampak pembedahan, udema otot, terputusnya jaringan syaraf, yang ditandai ekspresi wajah tampak tegang.<br />
4) Kurangnya pengetahuan yang berhubungan dengan salah interprestasi yang ditandai dengan sering bertanya tentang penyakitnya.<br />
5) Potensial terjadinya perdarahan berhubungan dengan terputusnya pembulu darah sekunder terhadap pembedahan.<br style="mso-special-character: line-break;" /> <br style="mso-special-character: line-break;" /> <o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;">PERENCANAAN</b><br />
<br />
Rencana tindakan yang dilakukan pada klien post operasi thyroidectomy meliputi :<br />
<br />
Diagnosa pertama<br />
<br />
1.Tujuan:Jalan nafas klien efektif<br />
2. Kriteria:Tiadak ada sumbatan pada trakhea<br />
3. Rencana tindakan:<br />
1) Monitor pernafasan dan kedalaman dan kecepatan nafas.<br />
2) Dengarkan suara nafas, barangkali ada ronchi.<br />
3) Observasi kemungkinan adanya stridor, sianosis.<br />
4) Atur posisi semifoler<br />
5) Bantu klien dengan teknik nafas dan batuk efektif.<br />
6) Melakukan suction pada trakhea dan mulut.<br />
7) Perhatikan klien dalam hal menelan apakah ada kesulitan.<br />
4. Rasional<br />
1) Pengetahui perkembangan dari gangguan pernafasan.<br />
2) Ronchi bisa sebagai indikasi adanya sumbatan jalan nafas.<br />
3) Indikasi adanya sumbatan pada trakhea atau laring.<br />
4) Memberikan suasana yang lebih nyaman.<br />
5) Memudahkan pengeluaran sekret, memelihara bersihan jalan nafas.dan ventilsassi<br />
6) Sekresi yang menumpuk mengurangi lancarnya jalan nafas.<br />
7) Mungkin ada indikasi perdarahan sebagai efek samping opersi.<o:p></o:p></span></div>
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Diagnosa keperawatan kedua<br />
<br />
1. Tujuan : <br />
Klien dapat komunikasi secara verbal<br />
<br />
2. Kriteria hasil:<br />
Klien dapat mengungkapkan keluhan dengan kata-kata.<br />
<br />
3. Rencana tindakan:<o:p></o:p></span></div>
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1) Kaji pembicaraan klien secara periodik<br />
2) Lakukan komunikasi dengan singkat dengan jawaban ya/tidak.<br />
3) Kunjungi klien sesering mungkin<br />
4) Ciptakan lingkungan yang tenang.<br />
<br />
<b style="mso-bidi-font-weight: normal;">RASIONALISASI:</b><br />
1) Suara parau dan sakit pada tenggorokan merupakan faktor kedua dari odema jaringan / sebagai efek pembedahan.<br />
2) Mengurangi respon bicara yang terlalu banyak.<br />
3) Mengurangi kecemasan klien<br />
4) Klien dapat mendengar dengan jelas komunikasi antara perawat dan klien.<br />
<br />
Diagnosa keperawatan ketiga<br />
<br />
1. Tujuan:<br />
Rasa nyeri berkurang<br />
<br />
2. Kriteria hasil:<br />
Dapat menyatakan nyeri berkurang, tidak adanya perilaku uyg menunjukkan adanya nyeri.<br />
<br />
3. Rencana tindakan<br />
1) Atur posisi semi foler, ganjal kepala /leher dengan bantal kecil<br />
2) Kaji respon verbal /non verbal lokasi, intensitas dan lamanya nyeri.<br />
3) Intruksikan pada klien agar menggunakan tangan untuk menahan leher pada saat alih posisi .<br />
4) Beri makanan /cairan yang halus seperti es krim.<br />
5) Lakukan kolaborasi dengan dokter untuk pemberian analgesik.<br />
<br />
4. Rasionalisasi<br />
1) Mencegah ghyperekstensi leher dan melindungi integritas pada jahitan pada luka.<br />
2) Mengevaluasi nyeri, menentukan rencana tindakan keefektifan terapi.<br />
3) Mengirangi ketegangan otot.<br />
4) Makanan yang halus lebih baik bagi klien yang menjalani kesulitan menelan.<br />
5) Memutuskan transfusi SSP pada rasa nyeri.<br />
<br />
Diagnosa keperawatan keempat<br />
<br />
1. Tujuan:<br />
Pengetahuan klien bertambah.<br />
<br />
2. Kriteria hasil:<br />
Klien berpsartisipasi dalam program keperawatan<br />
<br />
3. Rencana tindakan:<br />
1) Diskusikan tentang keseimbangan nutrisi.<br />
2) Hindari makanan yang banyak mengandung zat goitrogenik misalnya makanan laut, kedelai, Lobak cina dll.<br />
3) Konsumsikan makanan tinggi calsium dan vitamin D.<br />
<br />
4. Rasionalisasi:<br />
1) Mempertahankandaya tahan tubuh klien.<br />
2) Kontra indikasi pembedahan kelenjar thyroid.<br />
3) Memaksimalkan supli dan absorbsi kalsium.<br />
<br />
Diagnosa keperawatan kelima<br />
<br />
1. Tujuan<br />
Perdarahan tidak terjadi.<br />
<br />
2. Kriteria hasil<br />
Tidak terdapat adanya tanda-tanda perdarahan.<br />
<br />
3. Rencana tindakan:<br />
1) Observasi tanda-tanda vital.<br />
2) Pada balutan tidak didapatkan tanda-tanda basah karena darah.<br />
3) Dari drain tidak terdapat cairan yang berlebih.( > 50 cc).<br />
<br />
4. Rasionalisasi:<br />
1) Dengan mengetahui perubahan tanda-tanda vital dapat digunakan untuk mengetahui perdarahan secara dini.<br />
2) Dengan adanya balutan yang basah berartiadanya perdarahan pada luka operasi.<br />
3) Cairan pada drain dapat untuk mengetahui perdarahan luka operasi.<br />
<br />
<b style="mso-bidi-font-weight: normal;">PELAKSANAAN</b><br />
Merupakan implikasi dari rencana tindakan dengan maksut agar kebutuhanklien terpenuhi.<br />
<br />
<b style="mso-bidi-font-weight: normal;">EVALUASI</b><br />
1) teruskan bila masalah masih ada.<br />
2) Revisi/modifikasi bila masalah ada tetapi rencana dirubah.<br />
3) Terpecahkan jika masalah berhasil dipecahkan.<o:p></o:p></span></div>
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<span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;">§<span style="font-family: 'Times New Roman'; font-size: 7pt; 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%;">ASKEP PADA IBU HAMIL DENGAN HYPERTIROID <o:p></o:p></span></b></div>
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<span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">Penderita hipertiroid biasanya mengalami gangguan haid ataupun kemandulan. Kadang juga terjadi kehamilan atau timbul penyakit baru, timbul dalam masa kehamilan.<br />
Kejadian penyakit ini diperkirakan 1:1000 dan dalam kehamilan umunya disebabkan oleh adenoma tunggal. Pasien dengan penyakit primer ini mungkin mengidap batu ginjal, penyakit tulang atau tanpa gejala.<o:p></o:p></span></div>
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1. Pengaruh kehamilan terhadap penyakit<br />
Kehamilan dapat membuat strua tambah besar dan keluhan penderita tambah berat.<br />
2. Pengaruh penyakit terhadap kehamilan dan persalinan<br />
- Kehamikan sering berakhir ( abortus habitualis )<br />
- Partus prematurus<br />
- Kala II hendaknya diperpendek dengan akstraksi vakum / forsial, karena bahaya kemungkinan timbulnya dekompensasi kordis.<br />
<br />
<b style="mso-bidi-font-weight: normal;">A.Etiologi</b><br />
Hipertiroid :<br />
- Pembesaran kelenjar tiroid<br />
- Hiperfungsi kelenjar tiroid<br />
- Peningkatan metabolism basal 15-20 %<br />
<br />
<b style="mso-bidi-font-weight: normal;">B.Tanda dan gejala</b><br />
Hipertiroid :<br />
- Eksoftalmus<br />
- Tremor<br />
- Takikardia<br />
- Pembesarankelenjar tiroid<br />
- Hiperkinesis<br />
- Kenaikan BMR sampai 25 %<br />
- Aneroksia<br />
- Lekas letih<br />
- Kesulitan dalam menelan<br />
- Mual dan muntah<br />
- Konstipasi<br />
- Hiptonik obat<br />
<br />
<b style="mso-bidi-font-weight: normal;">C. Penatalaksanaan</b><br />
- Pemberian obbat-obat profiltluarasil dan metiazol dosis rendah<br />
- Operasi tiroidektomi, lakukan pada trimester III<br />
<br />
D.Pengaruh Kehamilan Terhadap Penyakit<br />
Kehamilan dapat membuat struma tambah besar dan keluhan penderita bertambah berat.<o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;">E. Komplikasi dan Pengangan<o:p></o:p></b></span></div>
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Kematian meningkat dan dapat mencapai 50 %. Pembedahan adalah terapi yang dianjurkan, tetapi mungkin timbul hipokalsemia pasca bedah. Kalau perlu dilakukan pemeriksaan kalsium berkala dan bila nyata harus dilakukan koreksi dengan kalsium glokonat 2-3 x 20 ml cairan 10 %, bila keluhan menjadi ringan, diet makanan kalsium 4 gelas susu / hari dapat dianjurkan. Dalam kenyataan tetani neonatal sering membantu dalam memerlukan hiperparatiriodisme ibu, yang kemudian dioperasi untuk mengangkat adenomanya.<o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;">ASUHAN KEPERAWATAN</b><br />
A. PENGKAJIAN<br />
1. Pemeriksaan Fisik :<br />
a. Kulit<br />
1) Panas, lembab, banyak keringat, halus, licin, mengkilat, kemerahan.<br />
2) Erythema, pigmentasi, mixedema local.<br />
3) Kuku → terjadi onycholosi → terlepas, rusak.<br />
4) Ujung kuku/jari → terjadi Aerophacy, yaitu perubahan ujung jari → tabuh / clubbing finger disebut PLUMER NAIL.<br />
5) Kalau ada peningkatan suhu → lebih dari 37,8o C → indikasi Krisis Tyroid.<br style="mso-special-character: line-break;" /> <br style="mso-special-character: line-break;" /> <o:p></o:p></span></div>
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b. Mata ( Opthalmoptik )<br />
1) Retraksi kelopak mata atas → mata membelalak / tanda Dalrymple.<br />
2) Proptosis ( eksoptalmus ), karena jaringan orbita dan otot-otot mata diinfiltrasi oleh limposit.<br />
3) Iritasi Conjunction dan Hemosis.<br />
4) Laktrimasi<br />
5) Ortalmoplegia<br />
6) Tanda Jefrey : kulit tidak dapat mengkerut pada waktu kepala sedikit menunduk dan mata melihat objek yang digerakkan ke atas.<br />
7) Tanda Rosenbach : tremor pada kelopak mata pada waktu mata menutup.<br />
8) Tanda stelwag : mata jarang berkedip.<br />
9) Tanda Dalrymple : retraksi kelopak mata bagian atas sehingga memberi kesan mata membelalak.<br />
10) Tanda Van Graefe : kelopak mata terlambat turun dibandingkan boa mata.<br />
11) Tanda Molbius : kelemahan dalam akomodasi / konvergensi mata / gagal konvergensi.<br />
<br />
c. Cardio vaskuler.<br />
1) Peningkatan tekanan darah<br />
2) Tekanan nadi meningkat<br />
3) Takhikardia<br />
4) Aritmia<br />
5) Berdebar-debar<br />
6) Gagal jantung<br />
<br />
d. Respirasi<br />
1) Perubahan pola nafas<br />
2) Dyspnea<br />
3) Pernafasan dalam<br />
4) Respirasi rate meningkat<br />
<br />
e. Gastrointestinal<br />
1) Poliphagia → nafsu makan meningkat.<br />
2) Diare → bising usus hyperaktif<br />
3) Enek<br />
4) Berat badan turun<br />
<br />
f. Otot<br />
1) Kekuatan menurun<br />
2) Kurus<br />
3) Atrofi<br />
4) Tremor<br />
5) Cepat lelah<br />
6) Hyperaktif refleks tendom<br />
<br />
g. Sistem persyarafan<br />
1) Iritabiltas → gelisah<br />
2) Tidak dapat berkonsentrasi<br />
3) Pelupa<br />
4) Mudah pindah perhatian<br />
5) Insomnia<br />
6) Gematar<br />
<br />
h. Status mental dan emosional<br />
1) Emosi labil → lekas marah, menangis tanpa sebab<br />
2) Iritabilitas<br />
3) Perubahan penampilan<br />
<br />
i. Status ginjal<br />
1) Polyuri ( banyak dan sering kencing ).<br />
2) Polidipsi ( rasa haus berlebihan → banyak minum )<br />
<br />
j. Status reproduksi<br />
1) Pada wanita :<br />
a. Hypomenorrhoe<br />
b. Amenorrhoe<br />
Karena kelenjar tyroid mempengaruhi LH<br />
<br />
k. Leher<br />
1) Teraba adany apembesaran tyroid ( goiter ).<br />
2) Briut ( + ).<br />
2. Pemeriksaan Diagnostik<br />
a. Serum T3 dan T4 meningkat ( Normal : T3 :8 – 16 g. T4 4-11 g )<br />
b. TSH serum menurun<br />
c. Tyroid → radio aktif iodine up take ( RAIU ) meningkat ( Normal: 10-35 % )<br />
d. BMR meningkar<br />
e. PBI meningkat ( Normal :4 g - 8 g, hypertiroid > 8 g, hypertiroid < g)<br />
<br />
<br />
B. DIAGNOSA KEPERAWATAN<br />
1. Perubahan nutrisi kurang dari kebutuhan tubuh yang berhubungan dengan diare, mual, nyeri abdomen dan atau peningkatan BMR ditandai dengan BB turun, diaporesis.<br />
Tujuan : nutrisi adekuat.<br />
Intervensi :<br />
a. Pantau masukan diet tinggi kalori, tinggi protein, tinggi karbohidrat, tinggi vitanin B.<br />
b. Tawarkan makanan dalam jumlah kecil tapi sering dan tambahan diantara waktu makan.<br />
c. Konsulkan pasien untuk makanan yang disukai.<br />
d. Hindari stimulan : kopi, the, cola, atau makanan yang lain yang mengandung kafein atau teobromin yang meningkatkan perasaan kenyang dan paristaltik.<br />
e. Hindari makanan dengan jumlah yang banyak serat atau makanan yang banyak mengandung bumbu.<br />
f. Berikan dorongan untuk memperbanyak minum 2 sampai 3 liter setiap hari ; hindari jus yang mungkin dapat menyebabkan diare.<br />
g. Berikan lingkungan dengan pengunjung yang cocok bila pasien yang menginginkannya.<br />
h. Timbang pasien setiap hari, pada waktu yang sama dengan timbangan dan pakaian yang sama.<br />
i. Pantau masukan dan haluaran setiap 8 jam.<br />
j. Kaji efektifitas pengobatan untuk mengatasi mual dan nyeri abdomen.<br />
<br />
<b style="mso-bidi-font-weight: normal;">Hasil yang diharapkan / evaluasi :</b><br />
Berat badan meningkat sampai batas yang normal bagi pasien : makan diet yang dianjurkan tanpa menunjukkan ketidaknyamanan abdomen ;tidak yang dianjurkan tanpa menunjukkan ketidaknyamanan abdomen; tidak mengalami diare; masukan dan haluaran seimbang.<br />
<br />
2. Hipetermia yang berhubungan dengan status hipermetabolik ditandai dengan panas.<br />
Tujuan : suhu normal 36,5oC – 37,5oC.<br />
<br />
Intervensi ;<br />
a. Berikan kompres hangat sesuai kebutuhan.<br />
b. Gunakan pakaian dan linen tempat tidur yang tipis.<br />
c. Pertahankan lingkungan yang sejuk.<br />
d. Kaji efektifitas selimut hipetermia bila dilakukan :<br />
- Lakukan tindakan untuk mencegah kerusakan kulit.<br />
e. Berikan asetamenofen sesuai pesanan ( aspirin merupakan kontra indikasi )<br />
f. Tingkatkan masukan cairan sampai 2500 ml / hari.<br />
g. Pantau tanda vital, tingkat kesadaran, halyaran urine setiap 2 sampai 4.<br />
h. Kolaborasikan dengan dokter dalam menggunakan tindakan pendinginan tambahan bila keadaannya membutuhkan.<br />
Hasil yang diharapkan /evaluasi :<br />
a. Pasien sadar dan responsif<br />
b. Tanda-tanda vital dan haluaran urine normal.<br />
<br />
3. Intoleran aktivitas yang berhubunagan dengan ketiddakseimbangan antara suplai oksigen dan kebutuhan karena peningkatan kecepatan metabolisme dan intoleransi terhadap panas ditandai dengan kelemahan.<br />
Tujuan : Aktifitas dapat dilakukan sesuai toleransi.<br />
<br />
Intervensi :<br />
a. Kaji tanda vital dasar dan tingkat aktivitas sebelumnya.<br />
b. Batasi akatifitas sampai tingkat toleransi pasien dengan melakukan pangkajian respon ( mis : kaji tanda vital selama melakukan aktifitas dan bandingkan dengan tanda vital dasar ).<br />
c. Biarkan pasien membuat priorotas dalam perawatan di dalam keterbatasanna.<br />
d. Berikan jarak waktu antara prosedur untuk memungkinkan waktu istitrahat yang cukup.<br />
e. Berikan peralatan yang dibutuhkan, kebutuhan lain untuk mencegah penggunaan energi yang berlebihan oleh pasien sebelum aktivitas.<br />
f. Hentikan aktifitas pada awal timbulnya gejala intoleran : dispnea, takipnea, takikardia, keletihan.<br />
g. Bantu pasien saat melakukan aktifitas yang tidak mampu dilakukan karena kelemahan atau tremor.<br />
h. Rencanakan aktifitas setiap hari dan pola istirahat yang dapat memudahkan meningkatan toleransi untuk perawatan diri.<br />
<br />
Hasil yang diharapkan / evaluasi :<br />
a. Menyelesaikan aktifitas yang direncanakan tanpa bukti-bukti intoleran.<br />
b. Meminta bantuan hanya ketika membutuhkan.<br />
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4. Perubahan proses fikir yang berhubungan dengan peningkatan rangsangan sistem saraf simpatis oleh tingginya kadar hormon tiroid ditandao dengan labil, peka rangsang, gugup.<br />
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Tujuan : tidak terjadi perubahan proses pikir.<br />
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Intervensi :<br />
a. Kaji tingkat kesadaran, orientasi, afek dan persepsi setiap 4 jam sampai 8 jam : laporkan adanya perubahan negatif.<br />
b. Diskusikan perasaan dan respon terhadap situasi dan orang : berikan penekanan bahwa hal tersebut tepat adanya.<br />
c. Berikan lingkungan yang stabil, tenang, tanpa stress, dan tidak merangsang.<br />
1) Atasi lingkunangan yang terlalu berisik.<br />
2) Konsisten dalam waktu dan saat melakukan prosedur atau aktifitas.<br />
3) Batasi pengunjung sesuai kebutuhan.<br />
4) Hindari pergantian personel yang sering.<br />
5) Cegah situasi yang menimulkan kemarahan emosional bila memungkinkan<br />
d. Rencanakan perawatan bersama pasien; berikan penjelasan yang jelas dan singkat.<br />
e. Antisipasi kebutuhan akan pencegahan reaksi hiperaktif.<br />
f. Informasikan pasien bahwa aktifitasnya mungkin dibatasi.<br />
g. Ajarkan teknik menurunkan stress dan kaji penggunaannya oleh pasien.<br />
h. Berikan aktifitas yang menghibur dan benda-benda yang menurunkan rangsangan ; hindari <o:p></o:p></span></div>
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<span style="font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">hal-hal yang membutuhkan manipulasi motorik halus.<br />
i. Orientasikan kembali pasien pada lingkungan sesuai dengan yang dibutuhkan dan berikan petunjuk yang mengorientasikan ( misalnya : jam, kalender, gambar-gambar yang dikenal pasien dan sebagainya ).<br />
j. Panyau terhadap reaksi buruk terhadap pengobatan.<br />
<br />
Hasil yang diharapkan :<br />
a. Pasien berorientasi<br />
b. Berespon sesuai terhadap situasi dan orang<br />
c. Menggunakan teknik reduksi stress <b><o:p></o:p></b></span></div>
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<b style="mso-bidi-font-weight: normal;"><span style="color: #4f81bd; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">REFERENSI<o:p></o:p></span></b></div>
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<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;">
<span style="color: #4f81bd; font-family: Wingdings; font-size: 12pt; line-height: 150%;">§<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><b style="mso-bidi-font-weight: normal;"><span style="color: #4f81bd; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">Buku Ajar Keperawatan Maternitas Edisi 4. Bobak. Lowdermilk. Jensen, Penerbit. Buku Kedokteran EGC. Tahun 2005<o:p></o:p></span></b></div>
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<span style="color: #4f81bd; font-family: Wingdings; font-size: 12pt; line-height: 150%;">§<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><b style="mso-bidi-font-weight: normal;"><span style="color: #4f81bd; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;"> Cunningham, dkk.,1993<o:p></o:p></span></b></div>
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<span style="color: #4f81bd; font-family: Wingdings; font-size: 12pt; line-height: 150%;">§<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><b style="mso-bidi-font-weight: normal;"><span style="color: #4f81bd; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">Scott, dkk.,1990<o:p></o:p></span></b></div>
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<span style="color: #4f81bd; font-family: Wingdings; font-size: 12pt; line-height: 115%;">§<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><a href="http://rinton.wordpress.com/2009/10/21/tiroid-kelenjar-gondok/"><b style="mso-bidi-font-weight: normal;"><span style="color: #4f81bd; font-size: 12pt; line-height: 115%;">http://rinton.wordpress.com/2009/10/21/tiroid-kelenjar-gondok/</span></b></a><b style="mso-bidi-font-weight: normal;"><span style="color: #4f81bd; font-size: 12pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<span style="color: #4f81bd; font-family: Wingdings; font-size: 12pt; line-height: 115%;">§<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><a href="http://www.indonesiaindonesia.com/f/11231-kelenjar-tiroid/"><b style="mso-bidi-font-weight: normal;"><span style="color: #4f81bd; font-size: 12pt; line-height: 115%;">http://www.indonesiaindonesia.com/f/11231-kelenjar-tiroid/</span></b></a><b style="mso-bidi-font-weight: normal;"><span style="color: #4f81bd; font-size: 12pt; line-height: 115%;"><o:p></o:p></span></b></div>
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<span style="color: #4f81bd; font-family: Wingdings; font-size: 12pt; line-height: 115%;">§<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><b style="mso-bidi-font-weight: normal;"><span style="color: #4f81bd; font-size: 12pt; line-height: 115%;">http://artikelkedokteran.net/fungsi-kelenjar-tiroid.html<o:p></o:p></span></b></div>
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<span style="color: #4f81bd; font-family: Wingdings; font-size: 12pt; line-height: 150%;">§<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><b style="mso-bidi-font-weight: normal;"><span style="color: #4f81bd; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">http://healthycaus.blogspot.com/2009/07/askep-pada-ibu-hamil-dgn-hypertiroid.html<o:p></o:p></span></b></div>
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<span style="color: #4f81bd; font-family: Wingdings; font-size: 12pt; line-height: 150%;">§<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><a href="http://keperawatantakim.blogspot.com/2009/09/04/askep-gangguan-tiroid.html(tinjauanteoritis)"><b style="mso-bidi-font-weight: normal;"><span style="color: #4f81bd; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">http://keperawatantakim.blogspot.com/2009/09/04/askep-gangguan-tiroid.html(tinjauanteoritis)</span></b></a><b style="mso-bidi-font-weight: normal;"><span style="color: #4f81bd; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div>
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<span style="color: #4f81bd; font-family: Wingdings; font-size: 12pt; line-height: 150%;">§<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><a href="http://www.asuhan-kep-kebidanan.co.cc/2010/03/askep-ibu-hamil-dgn-hyprtiroid.html"><b style="mso-bidi-font-weight: normal;"><span style="color: #4f81bd; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">http://www.asuhan-kep-kebidanan.co.cc/2010/03/askep-ibu-hamil-dgn-hyprtiroid.html</span></b></a><b style="mso-bidi-font-weight: normal;"><span style="color: #4f81bd; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div>
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<span style="color: #4f81bd; font-family: Wingdings; font-size: 12pt; line-height: 150%;">§<span style="font-family: 'Times New Roman'; font-size: 7pt; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><b style="mso-bidi-font-weight: normal;"><span style="color: #4f81bd; font-family: 'Times New Roman', serif; font-size: 12pt; line-height: 150%;">Buku Ajar Keperawatan Medical Bedah Vol.2 Biunner dan Suddarth Edisi 8, Penerbit EGC Buku Kedokteran.Tahun 2002<o:p></o:p></span></b></div>salnihttp://www.blogger.com/profile/00126668517852477742noreply@blogger.com0tag:blogger.com,1999:blog-8321145958076225978.post-51672462502924433122011-07-21T00:14:00.000-07:002011-07-21T00:14:46.543-07:00Hiperemesis Gravidarum<div align="center" class="MsoNoSpacing" style="line-height: 150%; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 14.0pt; line-height: 150%;">BAB I <o:p></o:p></span></b></div><div align="center" class="MsoNoSpacing" style="line-height: 150%; text-align: center;"><br />
</div><div align="center" class="MsoNoSpacing" style="line-height: 150%; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 14.0pt; line-height: 150%;">PENDAHULUAN</span></b></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
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</div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 19.5pt; mso-list: l1 level2 lfo1; text-align: justify; text-indent: -19.5pt;"><!--[if !supportLists]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">1.1<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Latar Belakang<o:p></o:p></span></b></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 19.5pt; text-align: justify; text-indent: 30.15pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Mual (nausea) dan muntah (emesis gravidarum) adalah gejala yang wajar dan sering kedapatan pada kehamilan trimester I. Mual biasanya terjadi pada pagi hari, tetapi dapat pula timbul setiap saat dan malam hari. Gejala – gejala ini kurang lebih terjadi 6 minggu setelah hari pertama haid terakhir dan berlangsung selama kurang lebih 10 minggu. Mual dan muntah terjadi pada 60 – 80% primi gravida dan 40 – 60% multi gravida. Satu diantara seribu kehamilan, gejala – gejala ini menjadi lebih berat.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 19.5pt; text-align: justify; text-indent: 30.15pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Perasaan mual ini desebabkan oleh karena meningkatnya kadar hormon estrogen dan HCG (Human Chorionic Gonadrotropin) dalam serum. Pengaruh Fisiologik kenaikan hormon ini belum jelas, mungkin karena sistem saraf pusat atau pengosongan lambung yang berkurang. Pada umumnya wanita dapat menyesuaikan dengan keadaan ini, meskipun demikian gejala mual dan muntah yang berat dapat berlangsung sampai 4 bulan. Pekerjaan sehari – hari menjadi terganggu dan keadaan umum menjadi buruk. Keadaan inilah yang disebut hiperemesis gravidarum. Keluhan gejala dan perubahan fisiologis menentukan berat ringannya penyakit. (Prawirohardjo, 2002)<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 19.5pt; text-align: justify; text-indent: 30.15pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Mual dan muntah merupakan gangguan yang paling sering kita jumpai pada kehamilan muda dan dikemukakan oleh 50 – 70% wanita hamil dalam 16 minggu pertama. Kurang lebih 66% wanita hamil trimester pertama mengalami mual- mual dan 44% mengalami muntah – muntah. Wanita hamil memuntahkan segala apa yang dimakan dan diminum hingga berat badannya sangat turun, turgor kulit berkurang, diuresis berkurang dan timbul asetonuri, keadaan ini disebut hiperemesis gravidarum dan memerlukan perawatan di rumah sakit. Perbandingan insidensi hiperemesis gravidarum adalah 4 : 1000 dari angka kehamilan. (Sastrawinata, 2004)<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 19.5pt; text-align: justify; text-indent: 30.15pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Diduga 50% sampai 80% ibu hamil mengalami mual dan muntah dan kira – kira 5% dari ibu hamil membutuhkan penanganan untuk penggantian cairan dan koreksi ketidakseimbangan elektrolit. Mual dan muntah khas kehamilan terjadi selama trimester pertama dan paling mudah disebabkan oleh peningkatan jumlah HCG. Mual juga dihubungkan dengan perubahan dalam indra penciuman dan perasaan pada awal kehamilan. (Walsh, 2007)<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 19.5pt; text-align: justify; text-indent: 30.15pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Hiperemesis gravidarum didefinisikan sebagai vomitus yang berlebihan atau tidak terkendali selama masa hamil, yang menyebabkan dehidrasi, ketidakseimbangan elektrolit, defisiensi nutrisi dan kehilangan berat badan. Insiden kondisi ini sekitar 3,5 per 1000 kelahiran. Walaupun kebanyakan kasus hilang seiring perjalanan waktu, satu dari setiap 1000 wanita hamil akan menjalani rawat inap. Hiperemesis gravidarum umumnya hilang dengan sendirinya (self-limiting), tetapi penyembuhan berjalan lambat dan relaps sering umum terjadi. Kondisi sering terjadi diantara wanita primigravida dan cenderung terjadi lagi pada kehamilan berikutnya. (Lowdermilk, 2004)<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
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</div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 19.5pt; mso-list: l1 level2 lfo1; text-align: justify; text-indent: -19.5pt;"><!--[if !supportLists]--><span class="fullpost"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">1.2<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b></span><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Rumusan Masalah<span class="fullpost"><o:p></o:p></span></span></b></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 19.5pt; tab-stops: 75.05pt; text-align: justify;"><span class="fullpost"><span style="color: #333333; font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Wanita hamil yang mengalami hiperemesis gravidarium.</span></span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span><o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 19.5pt; text-align: justify;"><br />
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</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">1.3 Tujuan Penulisan</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US;"><o:p></o:p></span></b></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 19.5pt; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">1. Untuk mengetahui definisi hiperemesis gravidarum<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 19.5pt; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">2. Untuk mengetahui etiologi hiperemesis gravidarum<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 19.5pt; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">3. Untuk mengetahui patofisiologi hiperemesis gravidarum<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 19.5pt; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">4. Untuk mengetahui gejala dan tanda hiperemesis gravidarum<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 19.5pt; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">5. Untuk mengetahui diagnosis hiperemesis gravidarum<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 19.5pt; tab-stops: 392.45pt; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">6. Untuk mengetahui pencegahan hiperemesis gravidarum<span style="mso-tab-count: 1;"> </span><o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 19.5pt; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">7. Untuk mengetahui penatalaksanaan hiperemesis gravidarum<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 19.5pt; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">8. Untuk mengetahui prognosis hiperemesis gravidarum<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 19.5pt; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">9. Agar mahasiswa dapat mengetahui pemberian Asuhan Keperawatan yang <span style="mso-tab-count: 1;"> </span>tepat pada ibu hamil yang mengalami hiperemesis gravidarum<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">1.4 Manfaat</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US;"><o:p></o:p></span></b></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 19.5pt; text-align: justify; text-indent: 30.15pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Diharapkan kepada pembaca sekalian agar dapat mengerti dan memahami tentang hiperemesis gravidarum sehingga dapat melakukan pencegahan dan penatalaksanaan pada ibu hamil yang mengalami hiperemesis gravidarum, serta dapat mengaplikasikan dengan baik ilmu yang di dapat dalam pemberian Asuhan Keperawatan pada pasien.<o:p></o:p></span></div><div align="center" class="MsoNoSpacing" style="line-height: 150%; text-align: center;"><br />
</div><div align="center" class="MsoNoSpacing" style="line-height: 150%; text-align: center;"><br />
</div><div align="center" class="MsoNoSpacing" style="line-height: 150%; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 14.0pt; line-height: 150%;">BAB II<o:p></o:p></span></b></div><div align="center" class="MsoNoSpacing" style="line-height: 150%; text-align: center;"><br />
</div><div align="center" class="MsoNoSpacing" style="line-height: 150%; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 14.0pt; line-height: 150%;">METODE PENULISAN<o:p></o:p></span></b></div><div class="MsoNoSpacing" style="line-height: 150%;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">2.1 Definisi<o:p></o:p></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; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Hiperemesis gravidarum adalah mual dan muntah berlebihan sehingga pekerjaan sehari – hari terganggu dan keadaan umum menjadi buruk. (Arif, 1999)<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Hiperemesis gravidarum adalah mual – muntah berlebihan sehingga menimbulkan gangguan aktivitas sehari – hari dan bahkan membahayakan hidupnya. (Manuaba, 2001)<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Wanita hamil memuntahkan segala apa yang dimakan dan diminum hingga berat badannya sangat turun, turgor kulit berkurang, diuresis berkurang dan timbul asetonuri, keadaan ini disebut hiperemesis gravidarum. (Sastrawinata, 2004)<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Hiperemesis gravidarum adalah vomitus yang berlebihan atau tidak terkendali selama masa hamil, yang menyebabkan dehidrasi, ketidakseimbangan elektrolit, atau defisiensi nutrisi, dan kehilangan berat badan. (Lowdermilk, 2004)<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Hiperemesis gravidarum adalah suatu keadaan (biasanya pada hamil muda) dimana penderita mengalami mual- muntah yang berlebihan, sedemikian rupa sehingga mengganggu aktivitas dan kesehatan penderita secara keseluruhan. (Achadiat, 2004)<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">2.2<span style="mso-spacerun: yes;"> </span>Etiologi<o:p></o:p></span></b></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Penyebab hiperemesis gravidarum belum diketahui secara pasti. Tidak ada bukti bahwa penyakit ini disebabkan oleh faktor toksik, juga tidak ditemukan kelainan biokimia. Perubahan – perubahan anatomik pada otak, jantung, hati dan susunan saraf, disebabkan oleh kekurangan vitamin serta zat – zat lain akibat in</span><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US;">isiasi</span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">. Beberapa faktor predisposisi dan faktor lain yang telah ditemukan oleh beberapa penulis sebagai berikut:<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l9 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Faktor predisposisi :<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 54.0pt; mso-list: l26 level1 lfo3; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Primigravida<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 54.0pt; mso-list: l26 level1 lfo3; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Overdistensi rahim : hidramnion, kehamilan ganda, estrogen dan HCG tinggi, mola hidatidosa<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l9 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Faktor organik :<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 54.0pt; mso-list: l25 level1 lfo4; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Masuknya vili khorialis dalam sirkulasi maternal <o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 54.0pt; mso-list: l25 level1 lfo4; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Perubahan metabolik akibat hamil <o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 54.0pt; mso-list: l25 level1 lfo4; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">resistensi yang menurun dari pihak ibu<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 54.0pt; mso-list: l25 level1 lfo4; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Alergi<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l9 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Faktor psikologis :<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 54.0pt; mso-list: l17 level1 lfo5; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Rumah tangga yang retak<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 54.0pt; mso-list: l17 level1 lfo5; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Hamil yang tidak diinginkan<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 54.0pt; mso-list: l17 level1 lfo5; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Takut terhadap kehamilan dan persalinan <o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 54.0pt; mso-list: l17 level1 lfo5; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Takut terhadap tanggung jawab sebagai ibu<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 54.0pt; mso-list: l17 level1 lfo5; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Kehilangan pekerjaan<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">2.3<span style="mso-spacerun: yes;"> </span>Patofisiologi<o:p></o:p></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; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Hiperemesis gravidarum yang merupakan komplikasi mual dan muntah pada hamil muda bila terjadi terus menerus dapat menyebabkan dehidrasi dan tidak imbangnya elektrolit dengan alkalosis hipokloremik.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l8 level1 lfo6; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Hiperemesis gravidarum dapat mengakibatkan cadangan karbohidrat dan lemak habis terpakai untuk keperluan energi. Karena oksidasi lemak yang tidak sempurna terjadilah ketosis dengan tertimbunnya asam aseton – asetik, asam hidroksi butirik dan aseton dalam darah.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l8 level1 lfo6; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Kekurangan cairan yang diminum dan kehilangan karena muntah menyebabkan dehidrasi sehingga cairan ekstraseluler dan plasma berkurang. Natrium dan khlorida darah dan khlorida air kemih turun. Selain itu juga dapat menyebabkan hemokonsentrasi sehingga aliran darah ke jaringan berkurang.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l8 level1 lfo6; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Kekurangan kalium sebagai akibat dari muntah dan bertambahnya ekskresi lewat ginjal menambah frekuensi muntah – muntah lebih banyak, dapat merusak hati dan terjadilah lingkaran setan yang sulit dipatahkan.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l8 level1 lfo6; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Selain dehidrasi dan terganggunya keseimbangan elektrolit dapat terjadi robekan pada selaput lendir esofagus dan lambung (Sindroma Mallory-Weiss) dengan akibat perdarahan gastro intestinal.<o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; mso-add-space: auto; mso-list: l8 level1 lfo6; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; mso-fareast-language: IN;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Adapun komplikasi yang dapat terjadi akibat Hiperemesis Gravidarum ini, yaitu Dehidrasi berat, ikterik, takikardia, suhu meningkat, alkalosis, kelaparan, gangguan emosional yang berhubungan dengan kehamilan dan hubungan keluarga, menarik diri dan depresi.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">2.4</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;">Gejala dan Tanda</b><o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Batas jelas antara mual yang masih fisiologik dalam kehamilan dengan hiperemesis gravidarum tidak ada, tetapi bila keadaan umum penderita terpengaruh, sebaiknya ini dianggap sebagai hiperemesis gravidarum. Hiperemesis gravidarum menurut berat ringannya gejala dapat dibagi :<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 21.3pt; mso-list: l14 level1 lfo7; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Tingkatan I<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 39.3pt; mso-list: l5 level1 lfo8; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Muntah terus menerus sehingga menimbulkan :<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 63.8pt; mso-list: l2 level1 lfo9; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">1)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Dehidrasi : turgor kulit turun<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 63.8pt; mso-list: l2 level1 lfo9; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">2)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Nafsu makan berkurang<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 63.8pt; mso-list: l2 level1 lfo9; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">3)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Berat badan turun<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 63.8pt; mso-list: l2 level1 lfo9; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">4)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Mata cekung dan lidah kering<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 39.3pt; mso-list: l5 level1 lfo8; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Nyeri di bagian epigastrium karena asam lambung meningkat dan terjadi regurgitasi ke esofagus<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 39.3pt; mso-list: l5 level1 lfo8; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Nadi meningkat dan tekanan darah turun<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 39.3pt; mso-list: l5 level1 lfo8; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Frekuensi nadi sekitar 100 kali/menit<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 39.3pt; mso-list: l5 level1 lfo8; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Tampak lemah dan lemas <o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">2. <span style="mso-spacerun: yes;"> </span>Tingkatan II<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 42.55pt; mso-list: l24 level1 lfo10; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Dehidrasi semakin meningkat akibatnya :<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 63.8pt; mso-list: l12 level1 lfo11; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">1)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Turgor kulit makin turun<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 63.8pt; mso-list: l12 level1 lfo11; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">2)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Lidah kering dan kotor<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 63.8pt; mso-list: l12 level1 lfo11; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">3)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Mata tampak cekung dan sedikit ikteris<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 42.55pt; mso-list: l24 level1 lfo10; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Kardiovaskuler<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 63.8pt; mso-list: l13 level1 lfo12; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">1)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Frekuensi nadi semakin cepat > 100 kali/menit<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 63.8pt; mso-list: l13 level1 lfo12; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">2)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Nadi kecil karena volume darah turun<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 63.8pt; mso-list: l13 level1 lfo12; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">3)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Suhu badan meningkat<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 63.8pt; mso-list: l13 level1 lfo12; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">4)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Tekanan darah turun<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 42.55pt; mso-list: l24 level1 lfo10; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Liver<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 6.55pt; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Fungsi hati terganggu sehingga menimbulkan ikterus<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 42.55pt; mso-list: l24 level1 lfo10; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Ginjal<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 6.55pt; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Dehidrasi menimbulkan gangguan fungsi ginjal yang yang menyebabkan :<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 63.8pt; mso-list: l27 level1 lfo13; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">1)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Oliguria<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 63.8pt; mso-list: l27 level1 lfo13; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">2)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Anuria<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 63.8pt; mso-list: l27 level1 lfo13; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">3)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Terdapat timbunan benda keton aseton<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 42.55pt; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Aseton dapat tercium dalam hawa pernafasan<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 42.55pt; mso-list: l24 level1 lfo10; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Kadang – kadang muntah bercampur darah akibat ruptur esofagus dan pecahnya mukosa lambung pada sindrom mallory weiss.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">3. Tingkatan III<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l3 level1 lfo14; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Keadaan umum lebih parah<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l3 level1 lfo14; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Muntah berhenti<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l3 level1 lfo14; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Sindrom mallory weiss<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l3 level1 lfo14; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Keadaan kesadran makin menurun hingga mencapai somnollen atau koma<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l3 level1 lfo14; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Terdapat ensefalopati werniche :<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 2.0cm; mso-list: l10 level1 lfo15; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">1)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Nistagmus<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 2.0cm; mso-list: l10 level1 lfo15; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">2)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Diplopia<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 2.0cm; mso-list: l10 level1 lfo15; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">3)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Gangguan mental<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l3 level1 lfo14; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Kardiovaskuler<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 2.0cm; mso-list: l28 level1 lfo16; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">1)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Nadi kecil<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 2.0cm; mso-list: l28 level1 lfo16; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">2)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Tekanan darah menurun<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 2.0cm; mso-list: l28 level1 lfo16; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">3)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Temperatur meningkat<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l3 level1 lfo14; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">g.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Gastrointestinal<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 2.0cm; mso-list: l20 level1 lfo17; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">1)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Ikterus semakin berat<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 2.0cm; mso-list: l20 level1 lfo17; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">2)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Terdapat timbunan aseton yang makin tinggi dengan bau yang makin tajam<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l3 level1 lfo14; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">h.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Ginjal<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Oliguria semakin parah dan menjadi anuria<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">2.5<span style="mso-spacerun: yes;"> </span>Diagnosis<o:p></o:p></span></b></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Diagnosis hiperemesis gravidarum biasanya tidak sukar. Harus ditentukan adanya kehamilan muda dan muntah terus menerus, sehingga mempengaruhi keadaan umum. Namun demikian harus dipikirkan kehamilan muda dengan penyakit pielonefritis, hepatitis, ulkus ventrikuli dan tumor serebri yang dapat pula memberikan gejala muntah. Hiperemesis gravidarum yang terus menerus dapat menyebabkan kekurangan makanan yang dapat mempengaruhi perkembangan janin, sehingga pengobatan perlu segera diberikan.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Adapun beberapa pemeriksaan diagnostik yang dapat dilakukan pada penderita Hiperemesis Gravidarum, yaitu :<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l15 level1 lfo24; text-align: justify; text-indent: -36.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">USG (dengan menggunakan waktu yang tepat) : mengkaji usia gestasi janin dan adanya gestasi multipel, mendeteksi abnormalitas janin, melokalisasi plasenta.</span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l15 level1 lfo24; text-align: justify; text-indent: -36.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Urinalisis : kultur, mendeteksi bakteri, BUN.</span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l15 level1 lfo24; text-align: justify; text-indent: -36.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pemeriksaan fungsi hepar: AST, ALT dan kadar LDH.</span><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">2.6<span style="mso-spacerun: yes;"> </span>Pencegahan</span></b><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;"> <o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Prinsip pencegahan adalah mengobati emesis agar tidak terjadi hiperemesis gravidarum dengan cara :<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l21 level1 lfo18; text-align: justify; text-indent: -36.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Memberikan penerangan tentang kehamilan dan persalinan sebagai suatu proses yang fisiologik.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l21 level1 lfo18; text-align: justify; text-indent: -36.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Memberikan keyakinan bahwa mual dan kadang – kadang muntah merupakan gejala yang fisiologik pada kehamilan muda dan akan hilang setelah kehamilan 4 bulan.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l21 level1 lfo18; text-align: justify; text-indent: -36.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Menganjurkan mengubah makan sehari – hari dengan makanan dalam jumlah kecil tapi sering.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l21 level1 lfo18; text-align: justify; text-indent: -36.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Menganjurkan pada waktu bangun pagi jangan segera turun dari tempat tidur, terlebih dahulu makan roti kering atau biskuit dengan dengan teh hangat.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l21 level1 lfo18; text-align: justify; text-indent: -36.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Makanan yang berminyak dan berbau lemak sebaiknya dihindarkan.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l21 level1 lfo18; text-align: justify; text-indent: -36.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Makanan seyogyanya disajikan dalam keadaan panas atau sangat dingin.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l21 level1 lfo18; text-align: justify; text-indent: -36.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Defekasi teratur.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l21 level1 lfo18; text-align: justify; text-indent: -36.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Menghindari kekurangan karbohidrat merupakan faktor penting, dianjurkan makanan yang banyak mengandung gula.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">2.7<span style="mso-spacerun: yes;"> </span>Penatalaksanaan <o:p></o:p></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; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Apabila dengan cara diatas keluhan dan gejala tidak mengurang maka diperlukan :<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 21.3pt; mso-list: l7 level1 lfo19; text-align: justify; text-indent: -21.3pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Obat – obatan <o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 42.55pt; mso-list: l19 level1 lfo20; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Sedativa : phenobarbital<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 42.55pt; mso-list: l19 level1 lfo20; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Vitamin : Vitamin B1 dan B6 atau B – kompleks<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 42.55pt; mso-list: l19 level1 lfo20; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Anti histamin : Dramamin, avomin<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 42.55pt; mso-list: l19 level1 lfo20; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Anti emetik (pada keadan lebih berat) : Disiklomin hidrokhloride atau khlorpromasin<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 21.3pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Penanganan hiperemesis gravidarum yang lebih berat perlu dikelola di rumah sakit.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 21.3pt; mso-list: l7 level1 lfo19; text-align: justify; text-indent: -21.3pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Isolasi<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 42.55pt; mso-list: l11 level1 lfo21; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Penderita disendirikan dalam kamar yang tenang, tetapi cerah dan peredaran udara yang baik.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 42.55pt; mso-list: l11 level1 lfo21; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Catat cairan yang keluar masuk.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 42.55pt; mso-list: l11 level1 lfo21; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Hanya dokter dan perawat yang boleh masuk ke dalam kamar penderita, sampai muntah berhenti dan penderita mau makan.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 42.55pt; mso-list: l11 level1 lfo21; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Tidak diberikan makanan/minuman dan selama 24 jam. <o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 21.3pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Kadang – kadang dengan isolasi saja gejala – gejala akan berkurang atau hilang tanpa pengobatan.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 21.3pt; mso-list: l7 level1 lfo19; text-align: justify; text-indent: -21.3pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Terapi psikologik<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 42.55pt; mso-list: l22 level1 lfo22; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Perlu diyakinkan kepada penderita bahwa penyakit dapat disembuhkan.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 42.55pt; mso-list: l22 level1 lfo22; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Hilangkan rasa takut oleh karena kehamilan.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 42.55pt; mso-list: l22 level1 lfo22; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Kurangi pekerjaan sera menghilangkan masalah dan konflik <o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 21.3pt; mso-list: l7 level1 lfo19; text-align: justify; text-indent: -21.3pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Cairan parenteral<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 42.55pt; mso-list: l18 level1 lfo23; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Cairan yang cukup elektrolit, karbohidrat dan protein dengan glukose 5% dalam cairan fisiologis (2 – 3 liter/hari).<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 42.55pt; mso-list: l18 level1 lfo23; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Dapat ditambah kalium, dan vitamin(vitamin B kompleks, Vitamin C).<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 42.55pt; mso-list: l18 level1 lfo23; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Bila kekurangan protein dapat diberikan asam amino secara intravena.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 42.55pt; mso-list: l18 level1 lfo23; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Bila dalam 24 jam penderita tidak muntah dan keadaan umum membaik dapat diberikan minuman dan lambat laun makanan yang tidak cair.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 21.3pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Dengan penanganan diatas, pada umumnya gejala – gejala akan berkurang dan keadaan akan bertambah baik<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 21.3pt; mso-list: l7 level1 lfo19; text-align: justify; text-indent: -21.3pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Menghentikan kehamilan <o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 21.3pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Bila pegobatan tidak berhasil, bahkan gejala semakin berat hingga timbul ikterus, delirium, koma, takikardia, anuria, dan perdarahan retina, pertimbangan abortus terapeutik.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">2.8<span style="mso-spacerun: yes;"> </span>Prognisis<o:p></o:p></span></b></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Dengan penanganan yang baik prognosis Hiperemesis gravidarum sangat memuaskan. Penyakit ini biasanya dapat membatasi diri, namun demikian pada tingkatan yang berat, penyakit ini dapat mengancam jiwa ibu dan janin.<b style="mso-bidi-font-weight: normal;"><o:p></o:p></b></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">2.9<span style="mso-spacerun: yes;"> </span>Asuhan Keperawatan pada penderita Hiperemesis Gravidarum<o:p></o:p></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;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">A. Pengkajian Keperawatan<o:p></o:p></span></b></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l16 level1 lfo25; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Aktifitas istirahat<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Tekanan darah sistol menurun, denyut nadi meningkat (> 100 kali per menit).<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l16 level1 lfo25; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Integritas ego<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Konflik interpersonal keluarga, kesulitan ekonomi, perubahan persepsi tentang kondisinya, kehamilan tak direncanakan.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l16 level1 lfo25; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Eliminasi<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Perubahan konsistensi defekasi pada feses, peningkatan frekuensi berkemih Urinalisis : peningkatan konsentrasi urine.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l16 level1 lfo25; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Makanan/cairan<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Mual dan muntah yang berlebihan (4 – 8 minggu) , nyeri epigastrium, pengurangan berat badan (5 – 10 Kg), membran mukosa mulut iritasi dan merah, Hb dan Ht rendah, nafas berbau aseton, turgor kulit berkurang, mata cekung dan lidah kering.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l16 level1 lfo25; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Pernafasan<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Frekuensi pernapasan meningkat.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l16 level1 lfo25; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Keamanan<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Suhu kadang naik, badan lemah, ikterus dan dapat jatuh dalam koma<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l16 level1 lfo25; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Seksualitas<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Penghentian menstruasi, bila keadaan ibu membahayakan maka dilakukan abortus terapeutik.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l16 level1 lfo25; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Interaksi sosial<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Perubahan status kesehatan / stressor kehamilan, perubahan peran, respon anggota keluarga yang dapat bervariasi terhadap hospitalisasi dan sakit, sistem pendukung yang kurang.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l16 level1 lfo25; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">9.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Pembelajaran dan penyuluhan.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l15 level1 lfo24; text-align: justify; text-indent: -36.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Segala yang dimakan dan diminum dimuntahkan, apalagi apalahi kalau belangsung sudah lama.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l15 level1 lfo24; text-align: justify; text-indent: -36.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Berat badan turun lebih dari 1/10 dari berast badan normal<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l15 level1 lfo24; text-align: justify; text-indent: -36.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Turgor kulit, lidah kering.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l15 level1 lfo24; text-align: justify; text-indent: -36.0pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Adanya aseton dalam urine.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">B. Diagnosa Keperawatan<o:p></o:p></span></b></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l0 level1 lfo26; text-align: justify; text-indent: -36.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">1)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Perubahan nutrisi kurang dari kebutuhan berhubungan dengan frekuensi mual dan muntah berlebihan.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l0 level1 lfo26; text-align: justify; text-indent: -36.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">2)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Deflsit volume cairan berhubungan dengan kehilangan cairan yang berlebihan.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l0 level1 lfo26; text-align: justify; text-indent: -36.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">3)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Koping tidak efektif berhubungan dengan perubahan psikologi kehamilan.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l0 level1 lfo26; text-align: justify; text-indent: -36.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">4)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Intoleransi aktivitas berhubungan dengan kelemahan.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">C. Rencana Keperawatan<o:p></o:p></span></b></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">1)<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Perubahan nutrisi kurang dari kebutuhan berhubungan dengan frekuensi mual dan muntah berlebihan.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l23 level1 lfo28; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><u><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Intervensi :<o:p></o:p></span></u></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Batasi intake oral hingga muntah berhenti.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Rasional : Memelihara keseimbangan cairan elektfolit dan mencegah muntah selanjutnya.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Berikan obat anti emetik yang diprogramkan dengan dosis rendah, misalnya Phenergan 10-20mg/i.v.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Rasional : Mencegah muntah serta memelihara keseimbangan cairan dan elektrolit.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Pertahankan terapi cairan yang diprogramkan.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Rasional : Koreksi adanya hipovolemia dan keseimbangan elektrolit.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Catat intake dan output.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Rasional : Menentukan hidrasi cairan dan pengeluaran melului muntah.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Anjurkan makan dalam porsi kecil tapi sering.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Rasional : Dapat mencukupi asupan nutrisi yang dibutuhkan tubuh.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Anjurkan untuk menghindari makanan yang berlemak<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Rasional : dapat menstimulus mual dan muntah<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Anjurkan untuk makan makanan selingan seperti biskuit, roti dan the (panas) hangat sebelum bagun tidur pada siang hari dan sebelum tidur<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Rasional : Makanan selingan dapat mengurangi atau menghindari rangsang mual muntah yang berlebih<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Catal intake TPN, jika intake oral tidak dapat diberikan dalam periode tertentu.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Rasional : Untuk mempertahankan keseimbangan nutrisi.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Inspeksi adanya iritasi atau Iesi pada mulut.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Rasional : Untuk mengetahui integritas inukosa mulut.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Kaji kebersihan oral dan personal hygiene serta penggunaan cairan pembersih mulut sesering mungkin.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Rasional : Untuk mempertahankan integritas mukosa mulut.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Pantau kadar Hemoglobin dan Hemotokrit.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Rasional : Mengidenfifikasi adanya anemi dan potensial penurunan kapasitas pembawa oksigen ibu. Klien dengan kadar Hb < 12 mg/dl atau kadar Ht rendah dipertimbangkan anemi pada trimester I.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Test urine terhadap aseton, albumin dan glukosa..<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Rasional : Menetapkan data dasar ; dilakukan secara rutin untuk mendeteksi situasi potensial resiko tinggi seperti ketidakadekuatan asupan karbohidrat, Diabetik kcloasedosis dan Hipertensi karena kehamilan.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Ukur pembesaran uterus<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Rasional : Malnutrisi ibu berdampak terhadap pertumbuhan janin dan memperberat penurunan komplemen sel otak pada janin, yang mengakibatkan kemunduran pcrkembangan janin dan kcmungkinan-kemungkinan lebih lanjUT<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">2)<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Defisit volume cairan berhubungan dengan kehilangan cairan yang berlebihan<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l23 level1 lfo28; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><u><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Intervensi :<o:p></o:p></span></u></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Tentukan frekuensi atau beratnya mual/muntah.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Rasional : Memberikan data berkenaan dengan semua kondisi. Peningkatan kadar hormon Korionik gonadotropin (HCG), perubahan metabolisme karbohidrat dan penurunan motilitas gastrik memperberat mual/muntah pada trimester<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Tinjau ulang riwayat kemungkinah masalah medis lain (misalnya Ulkus peptikum, gastritis.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Rasional : Membantu dalam mengenyampingkan penyebab lain untuk mengatasi masalah khusus dalam mengidentifikasi intervensi.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Kaji suhu badan dan turgor kulit, membran mukosa, TD, input/output dan berat jenis urine. Timbang BB klien dan bandingkan dengan standar.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Rasional : Sebagai indikator dalam membantu mengevaluasi tingkat atau kebutuhan hidrasi.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Anjurkan peningkatan asupan minuman berkarbonat, makan sesering mungkin dengan jumlah sedikit. Makanan tinggi karbonat seperti : roti kering sebelum bangun dari tidur.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Rasional : Membantu dalam meminimalkan mual/muntah dengan menurunkan keasaman lambung.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">3)<span style="mso-tab-count: 1;"> </span>Cemas berhubungan dengan Koping tidak efektif; perubahan psikologi kehamilan<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l23 level1 lfo28; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><u><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Intervensi</span></u><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;"> :<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Kontrol lingkungan klien dan batasi pengunjung<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Rasional : Untuk mencegah dan mengurangi kecemasan<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Kaji tingkat fungsi psikologis klien<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Rasional : Untuk menjaga intergritas psikologis<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Berikan support psikologis<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Rasional : Untuk menurunkan kecemasan dan membina rasa saling percaya<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Berikan penguatan positif<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Rasional : Untuk meringankan pengaruh psikologis akibat kehamilan<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Berikan pelayanan kesehatan yang maksimal<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Rasional : Penting untuk meningkatkan kesehatan mental klien<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">4)<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Intoleransi aktifitas berhubungan dengan kelemahan<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l23 level1 lfo28; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><u><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Intervensi</span></u><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;"> :<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Anjurkan klien membatasi aktifitas dengan isrirahat yang cukup.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Rasional : Menghemat energi dan menghindari pengeluaran tenaga yang terus-menerus untuk meminimalkan kelelahan/kepekaan uterus<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Anjurkan klien untuk menghindari mengangkat berat.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Rasional : Aktifitas yang ditoleransi sebelumnya mungkin tidak dimodifikasi untuk wanita beresiko.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Bantu klien beraktifitas secara bertahap.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Rasional : Aktifitas bertahap meminimalkan terjadinya trauma seita meringankan dalam memenuhi kebutuhannya.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo27; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Courier New";"><span style="mso-list: Ignore;">o<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Anjurkan tirah baring yang dimodifikasi sesuai indikasi<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Rasional : Tingkat aktifitas mungkin periu dimodifikasi sesuai indikasi.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">D. Evaluasi<o:p></o:p></span></b></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 21.3pt; mso-list: l4 level1 lfo29; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Mual dan mutah tidak ada lagi.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 21.3pt; mso-list: l4 level1 lfo29; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Keluhan subyektif tidak ada.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 21.3pt; mso-list: l4 level1 lfo29; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Tanda-tanda vital baik.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
</div><div align="center" class="MsoNoSpacing" style="line-height: 150%; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 14.0pt; line-height: 150%;">BAB III<o:p></o:p></span></b></div><div align="center" class="MsoNoSpacing" style="line-height: 150%; text-align: center;"><br />
</div><div align="center" class="MsoNoSpacing" style="line-height: 150%; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 14.0pt; line-height: 150%;">PENUTUP<o:p></o:p></span></b></div><div align="center" class="MsoNoSpacing" style="line-height: 150%; text-align: center;"><br />
</div><div align="center" class="MsoNoSpacing" style="line-height: 150%; text-align: center;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 1.0cm; mso-list: l9 level2 lfo2; text-align: justify; text-indent: -1.0cm;"><!--[if !supportLists]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">3.1<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Kesimpulan<o:p></o:p></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; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Hiperemesis Gravidarum adalah suatu keadaan yang di derita oleh ibu hamil, di mana ibu hamil mengalami mual dan muntah yang berlebihan, yang biasanya di alami pada usia awal kehamilan. Beberapa faktor penyebab dari Hiperemesis Gravidarum, yaitu faktor predisposisi, faktor organik dan faktor psikologis. Dehidrasi, ketidakseimbangan cairan dan elektrolit dalam tubuh dan rasa merupakan beberapa akibat dari Hiperemesis Gravidarum.<span style="mso-spacerun: yes;"> </span>Batas jelas antara mual yang masih fisiologik dalam kehamilan dengan hiperemesis gravidarum tidak ada, tetapi bila keadaan umum penderita terpengaruh, sebaiknya ini dianggap sebagai hiperemesis gravidarum. Hiperemesis gravidarum menurut berat ringannya gejala dibagi menjadi 3 tingkatan. <b style="mso-bidi-font-weight: normal;"><o:p></o:p></b></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 1.0cm;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 1.0cm; mso-list: l9 level2 lfo2; text-align: justify; text-indent: -1.0cm;"><!--[if !supportLists]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">3.2<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><!--[endif]--><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Saran<o:p></o:p></span></b></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 1.0cm; text-align: justify;"><br />
</div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Pencegahan adalah mengobati emesis agar tidak terjadi hiperemesis gravidarum, yaitu dengan cara :<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l23 level1 lfo28; text-align: justify; text-indent: -36.0pt;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Memberikan penerangan tentang kehamilan dan persalinan sebagai suatu proses yang fisiologik.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l23 level1 lfo28; text-align: justify; text-indent: -36.0pt;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Memberikan keyakinan bahwa mual dan kadang – kadang muntah merupakan gejala yang fisiologik pada kehamilan muda dan akan hilang setelah kehamilan 4 bulan.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l23 level1 lfo28; text-align: justify; text-indent: -36.0pt;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Menganjurkan mengubah makan sehari – hari dengan makanan dalam jumlah kecil tapi sering.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l23 level1 lfo28; text-align: justify; text-indent: -36.0pt;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Menganjurkan pada waktu bangun pagi jangan segera turun dari tempat tidur, terlebih dahulu makan roti kering atau biskuit dengan dengan teh hangat.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l23 level1 lfo28; text-align: justify; text-indent: -36.0pt;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Makanan yang berminyak dan berbau lemak sebaiknya dihindarkan.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l23 level1 lfo28; text-align: justify; text-indent: -36.0pt;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Makanan seyogyanya disajikan dalam keadaan panas atau sangat dingin.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l23 level1 lfo28; text-align: justify; text-indent: -36.0pt;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Defekasi teratur.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l23 level1 lfo28; text-align: justify; text-indent: -36.0pt;"><!--[if !supportLists]--><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">ü<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Menghindari kekurangan karbohidrat merupakan faktor penting, dianjurkan makanan yang banyak mengandung gula.<o:p></o:p></span></div><div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12.0pt; line-height: 150%;">Adapun beberapa cara yang dapat dilakukan apabila keluhan dan gejala tidak berkurang, yaitu dapat diberikan beberapa jenis obat-obatan untuk penderita Hiperemesis Gravidarum, dapat melakukan isolasi, terapi psikologik, pemberian cairan parenteral, dan dapat juga menghentikan kehamilan. Dengan penanganan yang baik prognosis Hiperemesis gravidarum dapat sangat memuaskan. <o:p></o:p></span></div>salnihttp://www.blogger.com/profile/00126668517852477742noreply@blogger.com0tag:blogger.com,1999:blog-8321145958076225978.post-9699411243277315992011-07-20T23:43:00.000-07:002011-07-20T23:43:13.092-07:00Askep kehamilan Ektopik<div class="Section1"> <div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b style="mso-bidi-font-weight: normal;">A.<span style="mso-spacerun: yes;"> </span>KONSEP DASAR<o:p></o:p></b></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l18 level1 lfo1; tab-stops: list 18.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Defenisi</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18.7pt; text-align: justify; text-indent: 17.3pt;">Kehamilan Ektopik adalah kehamilan dengan ovum yang dibuahi berimplantasi dan tumbuh diluar endometrium kavum uteri.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18.7pt; text-align: justify; text-indent: 17.3pt;">Kehamilan Ektopik Terganggu (KET) adalah suatu keadaan berbahaya bagi wanita yang bersangkutan berhubung dengan besarnya kemungkinan terjadi keadaan yang gawat.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18.7pt; text-align: justify; text-indent: 17.3pt;">Sebagian besar kehamilan ektopik berlokasi di tuba. Sangat jarang terjadi implementasi pada ovarium, rongga perut, kanalis servikalis, uteri, tunduk uterus yang rudimenten dan diventrikel pada uterus. Berdasarkan hasil implantasi pada tuba, terdapat kehamilan pars interstisialis tuba, kehamilan pars ismika tuba, kehamilan pars ampullaris tuba, dan kehamilan infundibulum tuba. Kehamilan intrauterin dapat terjadi bersamaan dengan kehamilan ektopik, disebut Combined Ectopic Pregnancy dan Compound Ektopic Pregnancy bila kehamilan ektopik terjadi lebih dahulu dengan janin sudah mati dan terjadi litopedion.</div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-list: l18 level1 lfo1; tab-stops: list 18.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Etiologi</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18.7pt; text-align: justify; text-indent: 17.3pt;">Etiologi kehamilan ektopik telah banyak di selidiki, tetapi sebagian besar penyebabnya tidak diketahui. Tiap kehamilan dimulai dengan pembuahan telur dibagian ampula tuba dan dalam perjalanannya ke uterus, telur mengalami hambatan sehingga saat nidasi masih di tuba, atau nidasinya di tuba dipermudah. Ada beberapa faktor yang mempengaruhi terjadinya kehamilan ektopik, yaitu :</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18.7pt; mso-list: l18 level2 lfo1; text-align: justify; text-indent: 0cm;"><!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Faktor dalam lumen tuba :</div><div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l18 level3 lfo1; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Endosalpingitis dapat menyebabkan perlekatan endosalping, sehingga lumen tuba menyempit atau membentuk kantong buntu.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l18 level3 lfo1; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Pada hipoplasia uteri lumen tuba sempit dan berkeluk-keluk dan hal ini sering<span style="mso-spacerun: yes;"> </span>disertai gangguan fungsi silia endosalping</div><div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l18 level3 lfo1; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Operasi plastik tuba dan sterilisasi yang tak sempurna<span style="mso-spacerun: yes;"> </span>dapat menjadi sebab lumen menyempit.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l18 level2 lfo1; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Faktor pada dinding tuba :</div><div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l18 level3 lfo1; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Endometriosis tuba dapat memudahkan implantasi telur yang dibuahi dalam tuba.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l18 level3 lfo1; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Difertikel tuba kongerital atau ostium assesorius tubae dapat menahan telur ditempat itu.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l3 level1 lfo2; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Faktor diluar dinding tuba :</div><div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l3 level2 lfo2; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Perlekatan peritubal dengan distorsi atau lekukan tuba dapat menghambat perjalanan telur</div><div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l3 level2 lfo2; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Tumor yang menekan dinding tuba dapat menyempitkan lumen tuba.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l3 level1 lfo2; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Faktor lain :</div><div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l3 level2 lfo2; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Migrasi luar ovum</div><div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l3 level2 lfo2; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Fertilisasi in vitro</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;">3.<span style="mso-spacerun: yes;"> </span>Manifestasi klinis</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18.7pt; text-align: justify; text-indent: -18.7pt;"><span style="mso-tab-count: 1;"> </span>Beberapa tanda dan gejala yang dapat di temukan pada penyakit ini adalah :</div><div class="MsoNormal" style="line-height: 150%; margin-left: 92.8pt; mso-list: l5 level1 lfo3; text-align: justify; text-indent: -74.1pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Amenore</div><div class="MsoNormal" style="line-height: 150%; margin-left: 92.8pt; mso-list: l5 level1 lfo3; text-align: justify; text-indent: -74.1pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Gajala hamil muda</div><div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l5 level1 lfo3; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Nyeri perut bagin bawah. Pada ruptur tuba, nyeri terjadi tiba-tiba dan hebat, mnyebabkan penderita pingsan sampai syok. Pada abortus tuba, nyeri mula-mula pada satu sisi kemudian menjalar ditempat lain. </div><div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; text-align: justify; text-indent: -1.4pt;">Bila darah sampai ke diagfarma, bisa menyebabkan nyeri bahu dan bila terjadi hematokel petrouterina, terdapat nyeri detekasi.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l25 level1 lfo4; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Perdarahan pervaginaan coklat tua</div><div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l25 level1 lfo4; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Tanda culen</div><div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l25 level1 lfo4; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Tanda akut abdomen : detance musculair, muntah, gelisah, pucat, nadi kecil dan halus, tensi menurun<span style="mso-spacerun: yes;"> </span>atau tidak<span style="mso-spacerun: yes;"> </span>teruur, syok.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l25 level1 lfo4; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Pada pemeriksaan ginekologik terdapat nyeri ayun saat menggerakkan porsio dan serviks, donglas crise, cavum donglasi teraba menonjol</div><div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l25 level1 lfo4; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Adanya shitting dullness</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18.7pt; text-align: justify;">Perlu di ketahui bahwa gejala-gejala penyakit ini sangat bervariasi menurut kapan penderita kita lihat atau periksa, sebelum atau sesudah terjadinya ruptur.</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;">4. <span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Patofisiologi </div><div class="MsoNormal" style="line-height: 150%; margin-left: 18.7pt; text-align: justify; text-indent: -18.7pt;"><span style="mso-tab-count: 1;"> </span>Mukosa pada tube bukan merupakan medium yang baik untuk pertumbuhan blastokista yang berimplantasi didalamnya. Vaskularisasi kurang baik dan orsidun tidak tumbuh dengan, dengan demikian ada 3 kemungkinan:</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l30 level1 lfo5; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">1)<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Ovum mati dan kemudian diresorbsi, dalam hal ini sering kali adanya kehamilan tidak dietahui, dan perdarahan dari uterus yang timbul setelah meningalnya ovum, dianggap sebagai haid yang datangnya agak terlambat.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l30 level1 lfo5; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">2)<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Trofoblast dan villus korialisnya menembus lapisan psendokapiuliris dan menyebabkan pembesaran tuba. Darah itu menyebabkan pembesaran tuba (hematosalping) dan dapat pula mengalir terus kerongga peritoneum, berkumpul dikavum donglasia, dan menyebabkan hematokele netroutenia.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;">Pada peristiwa ini terkenal dengan nama Abortus Tuba, Ovum untuk sebagian atau seluruhnya ikut memasuki lumen tuba dan keluar dari obstrium tuba abdominalis. Abortus tuba biasanya terjadi pada kehamilan pada ampulla, darah yang keluar kemudian masuk kerongga peritoneum, biasanya tidak begitu banyak karena dibatasi oleh<span style="mso-spacerun: yes;"> </span>tekanan dari dinding tuba.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l30 level1 lfo5; tab-stops: 18.7pt list 36.0pt; text-align: justify; text-indent: -18.0pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">3)<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Trotoblas dan villus korialis menembus lapisan muskularis dan peritonium pada dinding tuba dan menyebabkan pendarahan langsung kerongga peritonium. Peristiwa ini yang sering terjadi pada kehamilan di istumus, dapat menyebabkan pendarahan banyak karena darah mengalir secara benar dalam rongga peritoneum, dan dapat menyebabkan keadaan yang gawat pada penderita, yaitu bisa terjadi ruptur</div><div class="MsoNormal" style="line-height: 150%; tab-stops: 18.7pt; text-align: justify;"><br />
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</div><div align="center" class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 18.7pt; text-align: center; text-indent: -36.0pt;">Proses nidasi</div><div align="center" class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 18.7pt; text-align: center; text-indent: -36.0pt;">↓</div><div align="center" class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 18.7pt; text-align: center; text-indent: -36.0pt;">Gangguan pada tuba</div><div align="center" class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 18.7pt; text-align: center; text-indent: -36.0pt;">↓</div><div align="center" class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 18.7pt; text-align: center; text-indent: -36.0pt;">Penyempitan dinding tuba </div><div align="center" class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 18.7pt; text-align: center; text-indent: -36.0pt;">Disfungsi silia </div><div align="center" class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 18.7pt; text-align: center; text-indent: -36.0pt;">Difertikal<span style="mso-spacerun: yes;"> </span>tuba konyenital</div><div align="center" class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 18.7pt; text-align: center; text-indent: -36.0pt;">↓</div><div align="center" class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 18.7pt; text-align: center; text-indent: -36.0pt;">Perjalanan telur terhambat</div><div align="center" class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 18.7pt; text-align: center; text-indent: -36.0pt;">↓</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">Kehamilan ektopit</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;">5.<span style="mso-spacerun: yes;"> </span>Pemeriksaan penunjang</div><div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l12 level1 lfo6; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Pemeriksaan laboratorium</div><div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l12 level7 lfo6; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Darah<span style="mso-tab-count: 1;"> </span>: terjadi penurunan kadar HB</div><div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l12 level7 lfo6; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Urine<span style="mso-tab-count: 1;"> </span>: adanya leuositosis</div><div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l12 level1 lfo6; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->USG</div><div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l12 level1 lfo6; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Larparoskopi</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;">6.<span style="mso-spacerun: yes;"> </span>Penanganan </div><div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l21 level1 lfo7; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Pendeerita yang disangka KET harus dirawat inap dirumah sakit untuk penanggulangannya</div><div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l21 level1 lfo7; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Bila wanita dalam keadaan syo, perbaiki keadaan umumnya dengan pemberian cairang yang cukup (dextrose 5%, gluosa 5%, garam fisiologis) dan transfusi darah</div><div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l21 level1 lfo7; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Kemoterapi dengan metrelesat 1mg/kg IV dan faktor sitrovorum 0,1 mg/kg Im berselang-seling selama 8 hari bila kehamilan di pars ampalaris tuba belum pecah, diameter kantong gestasi<span style="mso-spacerun: yes;"> </span>< 4 cm, perdarangan dalam rongga perut < 400 ml, dan tanda vital baik</div><div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l21 level1 lfo7; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Bila diagnosa jelas atau sangat disangka KET, dan keadaan umum baik atau lumayan, segera lakukan laparotomy untuk menghilangkan sumber perdarahan. Dicari, diklem dan dieksisi sebersih mungkin (Salpingektomy) kemudian diikat sebaik-baiknya</div><div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l21 level1 lfo7; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Sisa-sisa darah dikeluarkan dan dibersihkan sedapat mungin supaya penyembuhan agar lebih cepat</div><div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l21 level1 lfo7; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Berian antobiotika dan perawatan luka operasi.</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
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</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b style="mso-bidi-font-weight: normal;">B.<span style="mso-spacerun: yes;"> </span>ASUHAN KEPERAWATAN<o:p></o:p></b></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18.7pt; mso-list: l21 level2 lfo7; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Pengkajian</div><div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l21 level3 lfo7; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">A.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Identitas Pasien </div><div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">Nama<span style="mso-tab-count: 3;"> </span>:</div><div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">Umur<span style="mso-tab-count: 3;"> </span>:</div><div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">Jenis kelamin<span style="mso-tab-count: 2;"> </span>:</div><div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">Alamat<span style="mso-tab-count: 3;"> </span>:</div><div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">Status<span style="mso-tab-count: 3;"> </span>:</div><div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">Pendidikan<span style="mso-tab-count: 2;"> </span>:</div><div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">Pekerjaan <span style="mso-tab-count: 2;"> </span>:</div><div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">Suku/Bangsa<span style="mso-tab-count: 2;"> </span>:</div><div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">Agama<span style="mso-tab-count: 3;"> </span>:</div><div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">Tanggal MRS<span style="mso-tab-count: 2;"> </span>:</div><div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">Tangal pengkajian<span style="mso-tab-count: 1;"> </span>:</div><div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;">Diagnosa medis<span style="mso-tab-count: 1;"> </span>:</div><div class="MsoNormal" style="margin-left: 36.0pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-left: 38.25pt; mso-list: l16 level1 lfo8; tab-stops: list 38.25pt; text-align: justify; text-indent: -20.25pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">B.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Riwayat kesehatan sekarang</div><div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l16 level4 lfo8; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->yang menjadi keluhan utama ialah nyeri</div><div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l16 level4 lfo8; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->riwayat keluhan utama biasanya nyeri disertai dengan perdarahan vagina dalam jumlah yang sedikit, berwarna cokelat tua, pasien akan juga merasa mual/muntah bahkan sampai pingsan.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 38.25pt; mso-list: l16 level1 lfo8; tab-stops: list 38.25pt; text-align: justify; text-indent: -20.25pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">C.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Riwayat kesehatan dahulu</div><div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; text-align: justify; text-indent: 18.7pt;">Ada kemungkinan pasien pernah mengalami suatu penyakit yang diberikan terapi antibiotika, apakah pasien menggunakan alat kontrasepsi, bisa saja sebelumnya pasien sudah pernah mengalami penyakit yang sama.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 38.25pt; mso-list: l16 level1 lfo8; tab-stops: list 38.25pt; text-align: justify; text-indent: -20.25pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">D.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Riwayat kesehatan keluarga</div><div class="MsoNormal" style="line-height: 150%; margin-left: 38.25pt; text-align: justify;">Penyakit ini juga merupakan penyakit kongenital, jadi bisa saja ada anggota keluarganya yang juga pernah mengalami penyakit yang sama.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 38.25pt; mso-list: l16 level1 lfo8; tab-stops: list 38.25pt; text-align: justify; text-indent: -20.25pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">E.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Kebutuhan dasar</div><div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l24 level1 lfo9; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Nutrisi<span style="mso-tab-count: 1;"> </span>: - kebutuhan nutrisi berkurang </div><div class="MsoNormal" style="line-height: 150%; margin-left: 108.0pt; text-align: justify;"><span style="mso-spacerun: yes;"> </span>- mual/muntah</div><div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l24 level1 lfo9; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Eliminasi<span style="mso-tab-count: 1;"> </span>: - BAB<span style="mso-tab-count: 1;"> </span>:</div><div class="MsoNormal" style="line-height: 150%; margin-left: 108.0pt; text-align: justify;"><span style="mso-spacerun: yes;"> </span>- BAK<span style="mso-tab-count: 1;"> </span>: Inkontinensia</div><div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l24 level1 lfo9; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Istirahat dan tidur<span style="mso-tab-count: 1;"> </span>: terganggu</div><div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l24 level1 lfo9; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Aktivitas<span style="mso-tab-count: 2;"> </span>: pasien tidak mampu melakuan aktivitas sendiri</div><div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l24 level1 lfo9; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Personal hygiene<span style="mso-tab-count: 1;"> </span>: dalam melakukan kebersihan diri, pasien dibantu<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>oleh perawat dan keluarga</div><div class="MsoNormal" style="line-height: 150%; margin-left: 38.25pt; mso-list: l16 level1 lfo8; tab-stops: list 38.25pt; text-align: justify; text-indent: -20.25pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">F.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Pemeriksaan fisik<span style="mso-tab-count: 1;"> </span>:</div><div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l7 level1 lfo10; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Keadaan umum<span style="mso-tab-count: 1;"> </span>: tampak lemah</div><div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l7 level1 lfo10; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Kesadaran<span style="mso-tab-count: 2;"> </span>: Compos mentis</div><div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l7 level1 lfo10; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->TTV<span style="mso-tab-count: 2;"> </span>: - TD menurun<span style="mso-tab-count: 2;"> </span>R<span style="mso-spacerun: yes;"> </span>cepat</div><div class="MsoNormal" style="line-height: 150%; margin-left: 144.0pt; text-align: justify;"><span style="mso-spacerun: yes;"> </span>- N<span style="mso-spacerun: yes;"> </span>menurun<span style="mso-tab-count: 2;"> </span>SB<span style="mso-spacerun: yes;"> </span>meningkat</div><div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l20 level1 lfo11; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Kepala<span style="mso-tab-count: 1;"> </span>: - Rambut <span style="mso-tab-count: 1;"> </span>: normal</div><div class="MsoNormal" style="line-height: 150%; margin-left: 108.0pt; text-align: justify;"><span style="mso-spacerun: yes;"> </span>- Wajah<span style="mso-tab-count: 1;"> </span>: pucat</div><div class="MsoNormal" style="line-height: 150%; margin-left: 108.0pt; text-align: justify;"><span style="mso-spacerun: yes;"> </span>- Mata<span style="mso-tab-count: 1;"> </span>: konjungtiva anemis</div><div class="MsoNormal" style="line-height: 150%; margin-left: 108.0pt; text-align: justify;"><span style="mso-spacerun: yes;"> </span>- mulut<span style="mso-tab-count: 1;"> </span>: bibir sianosis</div><div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l20 level1 lfo11; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Leher<span style="mso-tab-count: 1;"> </span>: tidak ada pembesaran kelenjar putih bening</div><div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l20 level1 lfo11; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Mammae<span style="mso-tab-count: 1;"> </span>: terjadi perubahan pada mamae</div><div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l20 level1 lfo11; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Perut :<span style="mso-spacerun: yes;"> </span>-<span style="mso-spacerun: yes;"> </span>nyeri tekan abdomen bagian bawah (defance musculair)</div><div class="MsoNormal" style="line-height: 150%; margin-left: 112.2pt; mso-list: l20 level1 lfo11; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->tanda culen</div><div class="MsoNormal" style="line-height: 150%; margin-left: 93.5pt; mso-list: l20 level1 lfo11; text-align: justify; text-indent: 0cm;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->shitting dullness</div><div class="MsoNormal" style="line-height: 150%; margin-left: 56.1pt; mso-list: l20 level1 lfo11; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Genetalia : - pervaginem keluar di cidual cast</div><div class="MsoNormal" style="line-height: 150%; margin-left: 108.0pt; text-align: justify;"><span style="mso-spacerun: yes;"> </span>- perdarahan berwarna cokelat tua</div><div class="MsoNormal" style="line-height: 150%; margin-left: 108.0pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-left: 108.0pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-left: 108.0pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-left: 108.0pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-left: 108.0pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-left: 108.0pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-left: 108.0pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-left: 108.0pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;">2.<span style="mso-spacerun: yes;"> </span>Analisa Data</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-border-insideh: .5pt solid windowtext; mso-border-insidev: .5pt solid windowtext; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 480;"><tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;"> <td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 24.1pt;" valign="top" width="32"> <div class="MsoNormal" style="line-height: 150%; text-align: justify;">No</div></td> <td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 140.25pt;" valign="top" width="187"> <div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">Data</div></td> <td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 135.35pt;" valign="top" width="180"> <div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">Etiologi</div></td> <td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 99.9pt;" valign="top" width="133"> <div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">Masalah</div></td> </tr>
<tr style="mso-yfti-irow: 1;"> <td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 24.1pt;" valign="top" width="32"> <div class="MsoNormal" style="line-height: 150%; text-align: justify;">1</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 140.25pt;" valign="top" width="187"> <div class="MsoNormal" style="line-height: 150%; margin-left: 11.9pt; mso-list: l8 level1 lfo12; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Nyeri abdomen bagian bawah (defance musculair)</div><div class="MsoNormal" style="line-height: 150%; margin-left: 11.9pt; mso-list: l8 level1 lfo12; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Perdarahan vagina </div><div class="MsoNormal" style="line-height: 150%; margin-left: 11.9pt; mso-list: l8 level1 lfo12; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Mual/muntah</div><div class="MsoNormal" style="line-height: 150%; margin-left: 11.9pt; mso-list: l8 level1 lfo12; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Pusing</div><div class="MsoNormal" style="line-height: 150%; margin-left: 11.9pt; mso-list: l8 level1 lfo12; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Ekspresi wajah meringis</div><div class="MsoNormal" style="line-height: 150%; margin-left: 11.9pt; mso-list: l8 level1 lfo12; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Pucat </div><div class="MsoNormal" style="line-height: 150%; margin-left: 11.9pt; mso-list: l8 level1 lfo12; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Gelisah</div><div class="MsoNormal" style="line-height: 150%; margin-left: 11.9pt; mso-list: l8 level1 lfo12; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->TD menurun, nadi kecil</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 135.35pt;" valign="top" width="180"> <div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">Proses nidasi</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">↓</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">Gangguan pada tuba</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">↓</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">Perjalanan telur terhambat</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">↓</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">Kehamilan ektopik</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">↓</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">Responsi tuba</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">↓</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">nyeri</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><br />
</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 99.9pt;" valign="top" width="133"> <div class="MsoNormal" style="line-height: 150%; text-align: justify;">Nyeri </div></td> </tr>
<tr style="mso-yfti-irow: 2;"> <td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 24.1pt;" valign="top" width="32"> <div class="MsoNormal" style="line-height: 150%; text-align: justify;">2</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 140.25pt;" valign="top" width="187"> <div class="MsoNormal" style="line-height: 150%; margin-left: 11.85pt; mso-list: l19 level1 lfo13; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Luka post laparotomy </div><div class="MsoNormal" style="line-height: 150%; margin-left: 11.85pt; mso-list: l19 level1 lfo13; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Luka kemerahan, bengkak</div><div class="MsoNormal" style="line-height: 150%; margin-left: 11.85pt; mso-list: l19 level1 lfo13; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Luka basah</div><div class="MsoNormal" style="line-height: 150%; margin-left: 11.85pt; mso-list: l19 level1 lfo13; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Nyeri</div><div class="MsoNormal" style="line-height: 150%; margin-left: 11.85pt; mso-list: l19 level1 lfo13; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Pasien lemah</div><div class="MsoNormal" style="line-height: 150%; margin-left: 11.85pt; mso-list: l19 level1 lfo13; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Tidak dapat beraktivitas</div><div class="MsoNormal" style="line-height: 150%; margin-left: 11.85pt; mso-list: l19 level1 lfo13; text-align: justify; text-indent: -9.35pt;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-left: 11.85pt; mso-list: l19 level1 lfo13; text-align: justify; text-indent: -9.35pt;"></div><a name='more'></a><br />
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</td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 135.35pt;" valign="top" width="180"> <div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">Kehamilan ektopik terganggu</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">↓</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">Laparatomy</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">↓</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">Post laparatomy</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">↓</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">kelemahan</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><br />
</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 99.9pt;" valign="top" width="133"> <div class="MsoNormal" style="line-height: 150%; text-align: justify;">Gangguan mobilitas fisik</div></td> </tr>
<tr style="mso-yfti-irow: 3;"> <td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 24.1pt;" valign="top" width="32"> <div class="MsoNormal" style="line-height: 150%; text-align: justify;">3</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 140.25pt;" valign="top" width="187"> <div class="MsoNormal" style="line-height: 150%; margin-left: 11.9pt; mso-list: l17 level1 lfo14; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Luka post laporatomy</div><div class="MsoNormal" style="line-height: 150%; margin-left: 11.9pt; mso-list: l17 level1 lfo14; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Luka kemerahan, bengkak</div><div class="MsoNormal" style="line-height: 150%; margin-left: 11.9pt; mso-list: l17 level1 lfo14; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Luka basah</div><div class="MsoNormal" style="line-height: 150%; margin-left: 11.9pt; mso-list: l17 level1 lfo14; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Nyeri</div><div class="MsoNormal" style="line-height: 150%; margin-left: 11.9pt; mso-list: l17 level1 lfo14; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Pasien lemah</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 135.35pt;" valign="top" width="180"> <div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">Kehamilan ektopik terganggu</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">↓</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">Laparatomi</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">↓</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">Lusisi operasi</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">↓</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">Gangguan integritas kulit</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><br />
</div></td><td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 99.9pt;" valign="top" width="133"><div class="MsoNormal" style="line-height: 150%; text-align: justify;">Gangguan integritas kulit</div></td> </tr>
<tr style="mso-yfti-irow: 4;"> <td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 24.1pt;" valign="top" width="32"> <div class="MsoNormal" style="line-height: 150%; text-align: justify;">4</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 140.25pt;" valign="top" width="187"> <div class="MsoNormal" style="line-height: 150%; margin-left: 11.9pt; mso-list: l10 level1 lfo15; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Wajah tampak sedih</div><div class="MsoNormal" style="line-height: 150%; margin-left: 11.9pt; mso-list: l10 level1 lfo15; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Pasien lemah</div><div class="MsoNormal" style="line-height: 150%; margin-left: 11.9pt; mso-list: l10 level1 lfo15; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Terdiam</div><div class="MsoNormal" style="line-height: 150%; margin-left: 11.9pt; mso-list: l10 level1 lfo15; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Sering tidak mau diajak bicara</div><div class="MsoNormal" style="line-height: 150%; margin-left: 11.9pt; mso-list: l10 level1 lfo15; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Lebih suka sendiri dikamar</div><div class="MsoNormal" style="line-height: 150%; margin-left: 11.9pt; mso-list: l10 level1 lfo15; text-align: justify; text-indent: -9.35pt;"><br />
</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 135.35pt;" valign="top" width="180"> <div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">Kehamilan ektopik terganggu</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">↓</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">Laparatomy</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">↓</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">Kehilangan kehmilan</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">↓</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">berduka</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><br />
</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 99.9pt;" valign="top" width="133"> <div class="MsoNormal" style="line-height: 150%; text-align: justify;">Berduka </div></td> </tr>
<tr style="mso-yfti-irow: 5; mso-yfti-lastrow: yes;"> <td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 24.1pt;" valign="top" width="32"> <div class="MsoNormal" style="line-height: 150%; text-align: justify;">5</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 140.25pt;" valign="top" width="187"> <div class="MsoNormal" style="line-height: 150%; margin-left: 11.9pt; mso-list: l14 level1 lfo16; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Pasien bertanya tentang penyakitnya</div><div class="MsoNormal" style="line-height: 150%; margin-left: 11.9pt; mso-list: l14 level1 lfo16; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Bingung</div><div class="MsoNormal" style="line-height: 150%; margin-left: 11.9pt; mso-list: l14 level1 lfo16; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Pasien takut dengan keadaannya</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 135.35pt;" valign="top" width="180"> <div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">Kurang pengetahuan</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">↓</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">Kurangnya informasi</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">↓</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">Takut dengan keadaannya</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">↓</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">Ansietas </div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><br />
</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 99.9pt;" valign="top" width="133"> <div class="MsoNormal" style="line-height: 150%; text-align: justify;">Ansietas</div></td> </tr>
</tbody></table><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;">3.<span style="mso-spacerun: yes;"> </span>Diagnosa Keperawatan</div><ul style="margin-top: 0cm;" type="square"><li class="MsoNormal" style="line-height: 150%; mso-list: l4 level1 lfo17; tab-stops: list 36.0pt; text-align: justify;">Praoperasi</li>
</ul><div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l13 level1 lfo18; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Nyeri berhubungan dengan berimplentasinya hasil konsepsi diluar endometrium.</div><div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l13 level2 lfo18; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]-->Postoperasi</div><div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l13 level1 lfo18; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Gangguan mobilitas fisik berhubungan dengan ketidaknyamanan yang terjadi setelah operasi</div><div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l13 level1 lfo18; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Gangguan integritas kulit berhubungan dengan adanya nisisi operasi</div><div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l13 level1 lfo18; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Berduka berhubungan dengan kehilangan kehamilan</div><div class="MsoNormal" style="line-height: 150%; margin-left: 37.4pt; mso-list: l13 level1 lfo18; text-align: justify; text-indent: -18.7pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Ansietas berhubungan dengan kurangnya informasi tentang kehamilan.</div></div><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-ansi-language: IN; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br clear="all" style="mso-break-type: section-break; page-break-before: always;" /> </span> <div align="center" class="MsoNormal" style="text-align: center;">DIAGNOSA KEPERAWATAN</div><div class="MsoNormal" style="text-align: justify;">Praoperasi </div><div class="MsoNormal" style="text-align: justify;"><br />
</div><table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-bottom-style: none; border-collapse: collapse; border-color: initial; border-left-style: none; border-right-style: none; border-top-style: none; border-width: initial; margin-left: -29.9pt; width: 908px;"><tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;"> <td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 31.5pt;" valign="top" width="42"> <div class="MsoNormal" style="line-height: 150%; text-align: justify;">No</div></td> <td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 172.7pt;" valign="top" width="230"> <div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">DIAGNOSA KEPERAWATAN</div></td> <td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 121.55pt;" valign="top" width="162"> <div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">TUJUAN</div></td> <td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 177.65pt;" valign="top" width="237"> <div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">INTERVENSI</div></td> <td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 177.65pt;" valign="top" width="237"> <div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">RASIONAL </div></td> </tr>
<tr style="mso-yfti-irow: 1; mso-yfti-lastrow: yes;"> <td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 31.5pt;" valign="top" width="42"> <div class="MsoNormal" style="line-height: 150%; text-align: justify;">1</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 172.7pt;" valign="top" width="230"> <div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="mso-spacerun: yes;"> </span>Nyeri berhubungan dengan berimplentasinya hasil konsepsi diluar endometrium ditandai dengan:</div><div class="MsoNormal" style="line-height: 150%; margin-left: 15.25pt; mso-list: l23 level1 lfo19; text-align: justify; text-indent: -15.25pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Detance musticulair</div><div class="MsoNormal" style="line-height: 150%; margin-left: 15.25pt; mso-list: l23 level1 lfo19; text-align: justify; text-indent: -15.25pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Perdarahan vagina</div><div class="MsoNormal" style="line-height: 150%; margin-left: 15.25pt; mso-list: l23 level1 lfo19; text-align: justify; text-indent: -15.25pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Mual/muntah</div><div class="MsoNormal" style="line-height: 150%; margin-left: 15.25pt; mso-list: l23 level1 lfo19; text-align: justify; text-indent: -15.25pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Pusing</div><div class="MsoNormal" style="line-height: 150%; margin-left: 15.25pt; mso-list: l23 level1 lfo19; text-align: justify; text-indent: -15.25pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Ekspresi wajah meringis</div><div class="MsoNormal" style="line-height: 150%; margin-left: 15.25pt; mso-list: l23 level1 lfo19; text-align: justify; text-indent: -15.25pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Pucat</div><div class="MsoNormal" style="line-height: 150%; margin-left: 15.25pt; mso-list: l23 level1 lfo19; text-align: justify; text-indent: -15.25pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Gelisah</div><div class="MsoNormal" style="line-height: 150%; margin-left: 15.25pt; mso-list: l23 level1 lfo19; text-align: justify; text-indent: -15.25pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->TD menurun, nadi kecil</div><div class="MsoNormal" style="line-height: 150%; margin-left: 15.25pt; mso-list: l23 level1 lfo19; text-align: justify; text-indent: -15.25pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Respirasi cepat</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 121.55pt;" valign="top" width="162"> <div class="MsoNormal" style="line-height: 150%; text-align: justify;">Nyeri berkurang sampai hilang setelah diberikan tindakan keperawatan dengan kriteria:</div><div class="MsoNormal" style="line-height: 150%; margin-left: 10.85pt; mso-list: l27 level1 lfo20; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Ekspresi wajah tenang</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 177.65pt;" valign="top" width="237"> <div class="MsoNormal" style="line-height: 150%; margin-left: 10.85pt; mso-list: l27 level2 lfo20; text-align: justify; text-indent: -10.85pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->kaji tingkat nyeri, observasi lokasi, lamanya dan intensitasnya</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-left: 10.85pt; mso-list: l27 level2 lfo20; text-align: justify; text-indent: -10.85pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->jelaskan penyebab nyeri dan anjurkan pasien untuk menghindarinya</div><div class="MsoNormal" style="line-height: 150%; margin-left: 10.85pt; mso-list: l27 level2 lfo20; text-align: justify; text-indent: -10.85pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->atur posisi pasien sesuai dengan keinginan dan kenyamanannya</div><div class="MsoNormal" style="line-height: 150%; margin-left: 10.85pt; mso-list: l27 level2 lfo20; text-align: justify; text-indent: -10.85pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->alihkan perhatian pasien</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-left: 10.85pt; mso-list: l27 level2 lfo20; text-align: justify; text-indent: -10.85pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->anjurkan teknik relaksasi</div><div class="MsoNormal" style="line-height: 150%; margin-left: 10.85pt; mso-list: l27 level2 lfo20; text-align: justify; text-indent: -10.85pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->kolaborasi dengan dokter dalam pemberian analgetik</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 177.65pt;" valign="top" width="237"> <div class="MsoNormal" style="line-height: 150%; margin-left: 10.85pt; mso-list: l26 level1 lfo21; text-align: justify; text-indent: -10.85pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->Untuk mengetahui perubahan pada karakteristik nyeri dan dapat menunjukkan penyetaran penyakit</div><div class="MsoNormal" style="line-height: 150%; margin-left: 10.85pt; mso-list: l26 level1 lfo21; text-align: justify; text-indent: -10.85pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->agar pasien tahu penyebab dia merasa nyeri dan menghindarinya</div><div class="MsoNormal" style="line-height: 150%; margin-left: 10.85pt; mso-list: l26 level1 lfo21; text-align: justify; text-indent: -10.85pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->posisi yang baik dan nyman dapat mengurangi nyeri</div><div class="MsoNormal" style="line-height: 150%; margin-left: 10.85pt; mso-list: l26 level1 lfo21; text-align: justify; text-indent: -10.85pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->agar perasaannya tidak terfokus pada nyeri</div><div class="MsoNormal" style="line-height: 150%; margin-left: 10.85pt; mso-list: l26 level1 lfo21; text-align: justify; text-indent: -10.85pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->untuk mengendalikan nyeri</div><div class="MsoNormal" style="line-height: 150%; margin-left: 10.85pt; mso-list: l26 level1 lfo21; text-align: justify; text-indent: -10.85pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->untuk mengurangi nyeri</div></td> </tr>
</tbody></table><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;">Pasca<span style="mso-spacerun: yes;"> </span>operasi</div><table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-bottom-style: none; border-collapse: collapse; border-color: initial; border-left-style: none; border-right-style: none; border-top-style: none; border-width: initial; margin-left: -28.9pt; width: 905px;"><tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;"> <td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 33.5pt;" valign="top" width="45"> <div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">No</div></td> <td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 168.25pt;" valign="top" width="224"> <div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">DIAGNOSA KEPERAWATAN</div></td> <td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 121.5pt;" valign="top" width="162"> <div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">TUJUAN</div></td> <td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 180.8pt;" valign="top" width="241"> <div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">INTERVENSI</div></td> <td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 174.55pt;" valign="top" width="233"> <div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">RASIONAL</div></td> </tr>
<tr style="mso-yfti-irow: 1;"> <td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 33.5pt;" valign="top" width="45"> <div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">2</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 168.25pt;" valign="top" width="224"> <div class="MsoNormal" style="line-height: 150%; text-align: justify;">Gangguan mobilitas fisik berhubungan dengan ketidaknyamanan yang terjadi setelah operasi, ditandai dengan:</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l27 level1 lfo20; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->luka post laparatomy</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l27 level1 lfo20; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->luka kemerahan, bengkak</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l27 level1 lfo20; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->luka basah</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l27 level1 lfo20; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->nyeri</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l27 level1 lfo20; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->pasien lemah</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l27 level1 lfo20; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->tidak dapat beraktifvitas</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 121.5pt;" valign="top" width="162"> <div class="MsoNormal" style="line-height: 150%; text-align: justify;">Mobilitas fisik dapat terlaksana dengan optimal setelah diberikan perawatan, dengan kriteria:</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l31 level1 lfo22; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->pasien tampak rileks</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l31 level1 lfo22; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->pasien kuat</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l31 level1 lfo22; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->mulai beraktivitas</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 180.8pt;" valign="top" width="241"> <div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l31 level2 lfo22; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->ajarkan pasien untuk melakukan teknik relaksasi untuk pengendalian nyeri</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l31 level2 lfo22; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->membantu pasien dalam melakukan ADL</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l31 level2 lfo22; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->memberikan mandi dengan air hangat dan tidak boleh terlalu panas</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l31 level2 lfo22; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->mengajarkan dan membantu pasien melakukan latihan fisik sedikit demi sedikit secara bertahap, mis: pergerakan jari, pergelangan tangan/kaki</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l31 level2 lfo22; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->menganjurkan pasien uintuk mengimbangi istirahat dengan latihan fisik</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 174.55pt;" valign="top" width="233"> <div class="MsoNormal" style="line-height: 150%; margin-left: 10.25pt; mso-list: l6 level1 lfo23; text-align: justify; text-indent: -10.25pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->pengendalian nyeri adalah komponon yang terpenting dalam mempertahankan mobilitas otot dan persendian yang optimal </div><div class="MsoNormal" style="line-height: 150%; margin-left: 10.25pt; mso-list: l6 level1 lfo23; text-align: justify; text-indent: -10.25pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->untuk memberikan rasa puas dan percaya diri pada pasien</div><div class="MsoNormal" style="line-height: 150%; margin-left: 10.25pt; mso-list: l6 level1 lfo23; text-align: justify; text-indent: -10.25pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->air hangat dapat memberikan kenyamanan pada pasien saat mandi, tetapi air yang terlalu panas dapat menyebabkan rasa letih</div><div class="MsoNormal" style="line-height: 150%; margin-left: 10.25pt; mso-list: l6 level1 lfo23; text-align: justify; text-indent: -10.25pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->untuk mencegah terjadinya kekakuan sendi</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-left: 10.25pt; mso-list: l6 level1 lfo23; text-align: justify; text-indent: -10.25pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->untuk meningkatkan kekuatan dan fungsi serta mengurangi pelatihan sehubungan dengan tingkat aktivitas </div></td> </tr>
<tr style="mso-yfti-irow: 2;"> <td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 33.5pt;" valign="top" width="45"> <div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">3</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 168.25pt;" valign="top" width="224"> <div class="MsoNormal" style="line-height: 150%; text-align: justify;">Gangguan integritas kulit berhubungan dengan adanya insisi operasi, ditandai dengan:</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l15 level1 lfo24; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->luka post operasi</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l15 level1 lfo24; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->luka kemerahan, bengkak</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l15 level1 lfo24; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->luka basah</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l15 level1 lfo24; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->nyeri</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l15 level1 lfo24; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->pasien lemah</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 121.5pt;" valign="top" width="162"> <div class="MsoNormal" style="line-height: 150%; text-align: justify;">Integritas kulit utuh setelah diberian perawatan, dengan kriteria:</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l0 level1 lfo25; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->luka kering</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l0 level1 lfo25; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->luka tidak bengak</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l0 level1 lfo25; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->jahitan diangkat</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l0 level1 lfo25; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->luka bersih</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 180.8pt;" valign="top" width="241"> <div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l0 level2 lfo25; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->menjaga bagian yang di insisi agar tetap bersih dan kering</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l0 level2 lfo25; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->anjurkan pasien untuk berhati-hati dan perlahan-lahan dalam melakukan gerakan, hindari tekanan pada bagian perut</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l0 level2 lfo25; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->mengganti balutan, membersihkan luka dan menggunakan obat-obatan untuk luka sesuai dengan instrusi dokter</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l0 level2 lfo25; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->memberikan diet yang banyak kalori dan protein</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 174.55pt;" valign="top" width="233"> <div class="MsoNormal" style="line-height: 150%; margin-left: 10.25pt; mso-list: l11 level1 lfo26; text-align: justify; text-indent: -10.25pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->untuk mencegah terjadinya infeksi</div><div class="MsoNormal" style="line-height: 150%; margin-left: 10.25pt; mso-list: l11 level1 lfo26; text-align: justify; text-indent: -10.25pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->gerakan yang tidak hati-hati dapat menarik jahitan dan merusak jaringan didekat jahitan</div><div class="MsoNormal" style="line-height: 150%; margin-left: 10.25pt; mso-list: l11 level1 lfo26; text-align: justify; text-indent: -10.25pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->untuk mnjaga kebersihan luka dalam mempercepat proses penyembuhan</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-left: 10.25pt; mso-list: l11 level1 lfo26; text-align: justify; text-indent: -10.25pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->untuk proses pembentukan jaringan baru</div></td> </tr>
<tr style="mso-yfti-irow: 3;"> <td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 33.5pt;" valign="top" width="45"> <div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">4</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 168.25pt;" valign="top" width="224"> <div class="MsoNormal" style="line-height: 150%; text-align: justify;">Berduka berhubungan dengan kehilangan kehamilan, ditandai dengan :</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l1 level1 lfo27; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->pasien lemah</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l1 level1 lfo27; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->wajah tampak sedih</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l1 level1 lfo27; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->terdiam</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l1 level1 lfo27; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->sering tidak mau diajak bicara</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l1 level1 lfo27; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->lebih suka sendiri dikamar</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 121.5pt;" valign="top" width="162"> <div class="MsoNormal" style="line-height: 150%; text-align: justify;">Duka dapat teratasi setelah diberikan perawatan, dengan kriteria:</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l28 level1 lfo28; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->pasien tampak kuat</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l28 level1 lfo28; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->ada respon ketika diajak bicara</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 180.8pt;" valign="top" width="241"> <div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l28 level2 lfo28; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->berikan dorongan pada pasien untuk menggambarkan persepsinya tentang keadaannya/perasaannya karena proses kehilangan</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l28 level2 lfo28; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->berikan dorongan pada pasien untuk mengungkapkan/mengeksprresikan perasaannya, anjurkan untuk tidak dipendam</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l28 level2 lfo28; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->yakinkan pasien bahwa apa yang dialaminya adalah sesuatu yang normal dan akan berakhir dengan sendirinya</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l28 level2 lfo28; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->dorong pasien untuk kembali semangat dan melakukan perannya/fungsinya sebagai ibu rumah tangga baik</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l28 level2 lfo28; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->anjurkan pasien untuk lebih mendekatkan diri kepada Tuhan</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 174.55pt;" valign="top" width="233"> <div class="MsoNormal" style="line-height: 150%; margin-left: 10.2pt; mso-list: l29 level1 lfo29; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->untuik mengidentifikasi aspek khusus dari proses berduka yang sedang dialaminya sehingga perawat dapat memberikan instruksi tepat pada sasarannya</div><div class="MsoNormal" style="line-height: 150%; margin-left: 10.2pt; mso-list: l29 level1 lfo29; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->pengekspresian perasaan dapat menyalurkan perasaan berduka sehingga perasaan duka berurang</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-left: 10.2pt; mso-list: l29 level1 lfo29; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->agar supaya pasien tidak merasa bahwa dia sangat malang dan tidak membiarkan dirinya larut dalam rasa berdua</div><div class="MsoNormal" style="line-height: 150%; margin-left: 10.2pt; mso-list: l29 level1 lfo29; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->agar pasien bersemangat dan merasa baha dia masih dibutuhkan oleh keluarganya</div><div class="MsoNormal" style="line-height: 150%; margin-left: .85pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-left: 10.2pt; mso-list: l29 level1 lfo29; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->dengan mendekatkan diri kepada Tuhan, apapun masalah yang dihadapinya dapat teratasi</div></td> </tr>
<tr style="mso-yfti-irow: 4; mso-yfti-lastrow: yes;"> <td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 33.5pt;" valign="top" width="45"> <div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">5</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 168.25pt;" valign="top" width="224"> <div class="MsoNormal" style="line-height: 150%; text-align: justify;">Ansietas berhubungan dengan kurangnya informasi tentang kehamilan ektopik, ditandai dengan:</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.25pt; mso-list: l2 level1 lfo30; text-align: justify; text-indent: -13.25pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->pasien bertanya tentang penyakitnya </div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.25pt; mso-list: l2 level1 lfo30; text-align: justify; text-indent: -13.25pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->bingung</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.25pt; mso-list: l2 level1 lfo30; text-align: justify; text-indent: -13.25pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->pasien takut dengan keadaannya</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.25pt; mso-list: l2 level1 lfo30; text-align: justify; text-indent: -13.25pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->pasien tegang</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 121.5pt;" valign="top" width="162"> <div class="MsoNormal" style="line-height: 150%; text-align: justify;">Ansietas dapat diatasi setelah diberikan penjelasan , dengan kriteria:</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l9 level1 lfo31; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->pasien tidak bertanya lagi tentng penyakitnya</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.3pt; mso-list: l9 level1 lfo31; text-align: justify; text-indent: -13.3pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->pasien tenang</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 180.8pt;" valign="top" width="241"> <div class="MsoNormal" style="line-height: 150%; margin-left: 13.35pt; mso-list: l9 level2 lfo31; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->monitor tingkat ecemasasan pasien, observasi keadaan kesadaran pasien dan kemampuan dalam memecahkan masalah </div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.35pt; mso-list: l9 level2 lfo31; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->perthankan lingkungan yang aman dan nyaman dan tenang bagi pasien</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.35pt; mso-list: l9 level2 lfo31; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->berikan penjelasan pasa pasien tentang penyakitnya dan penyebabnya</div><div class="MsoNormal" style="line-height: 150%; margin-left: 13.35pt; mso-list: l9 level2 lfo31; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->berikn informasi bahwa setelah perawatan selesai paien sudah berada dalam keadaan yang aman</div></td> <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 174.55pt;" valign="top" width="233"> <div class="MsoNormal" style="line-height: 150%; margin-left: 10.2pt; mso-list: l22 level1 lfo32; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->untuk menentukan tindaan yang aan dilakuan</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-left: 10.2pt; mso-list: l22 level1 lfo32; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->lingkungan yang tenang dapat mengurangi kecemasan</div><div class="MsoNormal" style="line-height: 150%; margin-left: .85pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-left: 10.2pt; mso-list: l22 level1 lfo32; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->agar pasien mengerti dan menyadari akan keberadaannya</div><div class="MsoNormal" style="line-height: 150%; margin-left: .85pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-left: 10.2pt; mso-list: l22 level1 lfo32; text-align: justify; text-indent: -9.35pt;"><!--[if !supportLists]--><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span><!--[endif]-->agar pasien mengerti bahwa dia akan sembuh dan akan kembali melakukan fungsinya sepeti sebelum sakit.</div></td> </tr>
</tbody></table><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div>salnihttp://www.blogger.com/profile/00126668517852477742noreply@blogger.com0