tag:blogger.com,1999:blog-31213075539467121352024-03-05T02:42:35.554-08:00sang enterpreneurmusdalifah sang pemimpinhttp://www.blogger.com/profile/16028724952062600560noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-3121307553946712135.post-37098507452779799902012-03-29T22:28:00.003-07:002012-03-29T22:28:26.419-07:00<link href="file:///C:%5CUsers%5CAcer%5CAppData%5CLocal%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_filelist.xml" rel="File-List"></link><link href="file:///C:%5CUsers%5CAcer%5CAppData%5CLocal%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_editdata.mso" rel="Edit-Time-Data"></link><!--[if !mso]> <style>
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<div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Arial","sans-serif";">RANGKUMAN PEMERIKSAAN FISIK PADA ANAK<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">A. PENGERTIAN<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Arial","sans-serif";">Pengkajian merupakan tahap pertama dalam proses keperawatan,dimana tiap tahap perawatan melakukan pengkajian data yang diperoleh dari hasil wawancara, laporan teman sejawat, catatan keperawatan, atau catatan kesehatan lain dan pengkajian fisik.( Robert Priharjo, 1993 ). Physical examination merupakan tehnik maneuver yang terdiri dari beberapa rangkaian, yang masing-masing anak memlik sensifitas dan verbal baik fisik maupun spikologik.( Wong, 1993 ).<span> </span>Pemeriksaan fisik lebih dari suatu rangkaian latihan tehnikal. Hal itu merupakan tuntutan yang sama sensivitasnya dengan kebutuhan fisik dan psikologik anak yang sulit di kenal dan tidak sama dengan yang lainnya.( Wong, 1993 ).<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">B. TUJUAN PEMERIKSAAN FISIK<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Arial","sans-serif";">Tujuan pemeriksaan fisik adalah memperoleh informasi yang akurat tentang keadaan fisik pasien. Karena sifat alamiah bayi dan anak, ururan pemeriksaan tidak harus menuruti sistematika yang lazim pada orang dewasa. Dalam pemeriksan anak harus memperhatikan kebutuhan perkembangan mental anak. Penggunaan perkembanagn mental dan kronologi umur sebagai kriteria utama dalam pengkajian tiap sistem tubuh memudahkan/menyelesaikan dari beberapa tujuan, diantaranya :<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">1. Meminimalkan steres dan ansietas yang berhubungan dengan pengkajian<span> </span>pada baguan- bagian tubuh yang berbeda.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">2. Memelihara dan membina hubungan saling percaya antara perawat, anak dan orang <br />
tua.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">3. Memberikan persiapan yang maksimum pada anak.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";"><br />
4. Memberikan perlindungan yang esensial pada hubungan antara orang tua-anak, <br />
terutama dengan anak kecil.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">5. Memaksimalkan keakuratan dan reabilitas hasil pengkajian.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">C. PEMERIKSANAAN ANAK<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Arial","sans-serif";"><span> </span>pemeriksaan fisik dilakukun dengan prosedur yang tidak menyebabkan rasa saki, tetapi kepada seorang anak dengan menggunakan jari, telapak tangan, lengan, pemeriksaan dalam telinga dan mulut,menekn abdomen dan mendengarkan dasa dengan permukaan metal yang dingin dapat menimbulkan stresful. Pemeriksaan fisik ini harus menjadi hal yang menyenangkan dan sama baik hasilnya. Misalnya dengan anak pre school dan yang lebih tua perawat dapat menggunakan gambar atau boneka untuk membantu anak belajar tentang tubuh mereka.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Arial","sans-serif";">Tehnik “Paper Doll” merupakan pendekatan yang digunakan untuk mengajarkan anak tentang bagian tubuh mereka yang diperiksa. Kesimpulannya adalah saat kunjungan anak dapat membawa paper doll sebagai pengingat pengalaman. Banyak permintaan anak yang sangat kooperatif ketika orang tua bersama mereka. Hal ini ada yang menyebabkan, bagaimanapun saat anak yang lebih tua terutama adolence lebih memilih di periksa sendiri pada pemeriksaan genetalia, sering anak yang sedang diperiksa juga disertai saudara kandungnya yang dapat menyebabkan ke tidak teraturan kerena ada boredom.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Arial","sans-serif";">Sebuah taktik untuk membantu mereka adalah untuk memberikan mereka kesempatan untuk mencoba alat pemeriksaan seperti stetoskop atau spatel lidah dan memuji anak atas “Bantuannya”selama pemeriksaan.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">D. KOMUNIKASI SEBELUM PEMERIKSAAN FISIK<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Arial","sans-serif";">Sebagai tenaga medis sebelum melakukan pemeriksaan hendaknya jangan mengabaikan komunikasi walaupun pada anak sekalipun. Hal ini bertujuan agar nantinya ia mendapatkan informasi yang akurat dengan pasien. Adapun komunikasi yang dilakukan perawat sebelum melakukan pemeriksaan fisik antara lain:<br />
1. Bicara terlebih dahulu pada orang tua, tunjukkan bahwa kita akan membina hubungan <br />
yang baik dengannya. Dengan demikian, anak akan melihat bahwa kita berbuat baik <br />
terhaap orang tuanya. Kemudian perhatian kita alihkan pada anak dengan tujuan <br />
semula, yaitu melakukan pengkajian.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">2. Mulai kontak dengan anak dengan menceritakan sesuatu yang lucu. Dengan demikian <br />
harapkan anak akan tertarik dengan pembicaraan perawat dan mau bekerja sama.<br />
3. Gunakan mainan sebagai pihak ketiga dalam bentuk yang lain sebagai titik masuk <br />
berbicara pada anak. Hal ini akan sangat efektif terutama pada anak usia toddler dan <br />
anak pra sekolah<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">4. Apabila memungkinkan, ajukan pilihan pada anak tersebut tentang pemeriksaan yang <br />
diinginkan, sambil duduk atau di tempat tidur, atau di pangku oleh orangtuanya.<br />
5. Pemeriksaan yang menimbulkan trauma dilakukan paling terakhir. Dengan demikian, <br />
pilih pemeriksaan yang paling sederhana atau yang dapat dilakukan sambil bermain <br />
terlebih dahulu.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">6. Hindarkan pemeriksaan dengan menggunakan alat yang menimbulkan rasa takut, <br />
misalnya termometer atau stetoskop yang terasa dingin<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">E. PENATALAKSANAAN<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">A. PERSIAPAN ALAT<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">1. Pengukur/meteran/penggaris/Stadiometer<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">2. Penimbang BB<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">3. Termometer dan spekulum<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">4. Optalmoskop<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">5. Arloji berdetik<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">6. Manset:<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Bayi baru lahir ukurannya : lebar kantong 2,5-4,0 cm dan panjang Kantongnya 5,0-9,0 <br />
cm<br />
• Bayi ukurannya:lebar kantong 4,0-6,0 cm dan panjang kantongnya 5,0-9,0<br />
• Anak-anak lebar kantong 7,5-9,0 Cm dan panjang kantongnya 17,0-19,0 cm.<br />
7. Stesoskop<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">8. Oksilometri<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">9. Peniti,kapas, objek dingin/kapas<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">10.Spatel lidah<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">11. Garpu tala<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">12. Snellen<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">13. Senter<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">14. Gambar warna<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">E. PELAKSANAAN PEMERIKSAAN FISIK ANAK<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Posisi<br />
Urutan<br />
Persiapan Bayi<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Sebelum dapat duduk sendiri:<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Terlentang atau telungkup atau lebih baik di pangkuan orang tua.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Usia 4 sampai 6 bulan dapat di tempatkan di atas meja periksaan.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Setelah dapat duduk sendiri:<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Gunakan posisi duduk di pangkuan orang tua jika mungkin<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Jika diatas meja, tempatkan dan pandangan penuh pada orang tua.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Bila tenang auskultai jantung, paru, abdomen<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Catat frekuensi jantung dan pernafasan.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Palpasi dan perkusi area yang sama<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Lanjutkan dengan arah biasa,kepala ke kaki<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Lakukan prosedur traumatic di bagian akhir, mata, telinga, mulut (sambil menangis)<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Munculkan reflek-reflek saat bagian tubuh tersebut diperiksa<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Lakukan pemeriksaan reflek Moro di bagian akhir <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Lepaskan semua pakaian bila suhu ruangan memungkinkan.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Biarkan popok terpasang pada bayi<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Tingkatkan kerja sama dengan distraksi,obyek erang,bunyi-bunyi dengan mulut,bicara.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Berikan kotak kecil dikedua tangan bayi yang lebih besar,sampai pelepasan volunter <br />
berkembang di akhir tahun pertama,bayi tidak mampu menggenggam obyek(misalnya <br />
stetoskop,otoskop)( Farber,1991 )<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";"><br />
• Tersenyum pada bayi gunakan suara yang lembutdan perlahan<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Tenangkan dengan sebotol air gula atau makanan .<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Minta bantuan orang tua untuk memegang bayi pada pemeriksaan telinga dan mukut.<br />
• Hindari gerakan yang kasar dan mengejutkan.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Usia Bermain<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Duduk atau berdiri diatas atau disamping orang tua.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Telungkup atau terlentang dipangkuan orang tua.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span> </span>• Inspeksi area tubuh,melalui permainan “Hitung Jari” gelitik jari kaki.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Gunakan kontak fisik minimal diawal pemeriksaan.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Kenalkan alay dengan perlahan. Auskultasi,perkusi,palpasi bila tenang<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Lakukan prosedur traumatic terakhir (sama dengan bayi) <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Minta orang tua untuk melepaskan pakaian bagian luar<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Lepaskan pakaian dalam pada saat tubuh tersubut di periksa<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Izinkan untuk melihat-lihat alay,menunjukkan penggunaan alat biasanya tidak efektif<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Jika tidak kooperatif lakukan prosedur dengan cepat<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Gunakan restrain bila tepat,minta bantuan orang tua.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Bicarakan pemeriksaan bila dapat bekerja sama :gunakan kalimat pendek.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Berikan pujian untuk perilaku kooperatif.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Anak Pra Sekolah<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Lebih suka berdiri atau duduk.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Biasanya kooperatif dengan posisi telungkup/atau terlentang menyukai kedekatan <br />
dengan orang tua.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Jika kooperatif ,lakukan dari kepala ke jari kaki.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Bila tidak kooperatif,lakukan seperti pada anak usia bermain. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Minta anak melepaskan pakaiannya.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Izinkan untuk menggunakan celana dalam bila malu.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Berikan kesempata untuk melihat alat:tunjukkan dengan singkat penggunaannya.<br />
• Buat cerita tentang prosedur :”saya mau melihat seberapa kuat otot-ototmu”<br />
• Gunakan tehnik boneka kertas<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Beri pilihan jika mungkin<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";"><br />
• Hargai kerja sama : gunakan pernyataan positif ”Buka Mulutmu”<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Anak Usia Sekolah<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Menyukai duduk<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Kooperatif hampir semua posisi anak kecil menyukai kehadiran orangtua.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Anak yang lebih besar menyukai privasi.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Lakukan dari kepala dan kaki<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Bila tidak kooperatif ,lakukan seperti pada anak usia bermain. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Minta untuk melepaskan pakain sendiri.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Biarkan untuk memakai celana dalam<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Beri skor untuk dipakai<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Jelaskan tujuan peralatan dan kepentingan prosedur seperti otoskop untuk melihat <br />
gendang telinga,yang diperlukan untuk mendengar.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Ajarkan tentang fungsi tubuh dan perawatannya.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Remaja<br />
• Sama dengan anak usia sekolah<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Berikan pilihan tentang keberadaan orang tua.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Sama dengan anak usia sekolah yang lebih besar.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Izinkan melepaskan pakaian sendiri.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Beri Skor<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Buka hanya area yang akan diperiksa<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Hargai kebutuhan privacy<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Jelaskan temuan-temuan selama pemeriksaan. ”ototmu kuat dan padat”<br />
• Beri keterangan tentang perkembangan seksual : “Payudaramu sedang berkembang <br />
seperti seharusnya“<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Tekan kenormalan perkembangan.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Periksa genetalia seperti bagian tubuh yang lain:dapat di lakukan di akhir.<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";"><br />
PEMERIKSAAN FISIK BAYI BARU LAHIR<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Kegiatan ini merupakan pengkajian fisik yang dilakukan oleh bidan atau perawat yang bertujuan<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">untuk memastikan normalitas & mendeteksi adanya penyimpangan dari normal.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Arial","sans-serif";">Pengkajian ini dapat ditemukan indikasi tentang seberapa baik bayi melakukan penyesuaian terhadap kehidupan di luar uterus dan bantuan apa yang diperlukan. Dalam pelaksanaannya harus diperhatikan agar bayi tidak kedinginan, dan dapat ditunda apabila suhu tubuh bayi rendah atau bayi tampak tidak sehat.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Prinsip pemeriksaan bayi baru lahir :<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Jelaskan prosedur pada orang tua dan minta persetujuan tindakan<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Cuci dan keringkan tangan , pakai sarung tangan<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Pastikan pencahayaan baik<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">• Periksa apakah bayi dalam keadaan hangat, buka bagian yangg akan diperiksa (jika bayi telanjang pemeriksaan harus dibawah lampu pemancar) dan segera selimuti kembali dengan cepat<br />
• Periksa bayi secara sistematis dan menyeluruh<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">PERALATAN DAN PERLENGKAPAN<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">1. Kapas<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">2. senter<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">3. termometer<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">4. stetoskop<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">5. selimut bayi<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">6. bengkok<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">7. timbangan bayi<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">8. pita ukur/metlin<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";">9. pengukur panjang badan<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PROSEDUR<br />
1. Jelaskan pada ibu dan keluarga maksud dan tujuan dilakukan pemeriksaan<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2. Lakukan anamnesa riwayat dari ibu meliputi faktor genetik, faktor lingkungan, <br />
sosial,faktor ibu (maternal),faktor perinatal, intranatal, dan neonatal<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3. Susunalat secara ergonomis<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">4. Cuci tangan menggunakan sabun dibawah air mengalir, keringkan dengan handuk <br />
bersih<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">5. Memakai sarung tangan<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">6. Letakkan bayi pada tempat yang rata<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">7. Penimbangan berat badan Letakkan kain atau kertas pelindung dan atur skala penimbangan ke titik nol sebelum penimbangan. Hasil timbangan dikurangi berat alas dan pembungkus bayi<br />
8. Pengukuran panjang badan Letakkan bayi di tempat yang datar. Ukur panjang badan dari kepala sampai tumit dengan kaki/badan bayi diluruskan. Alat ukur harus terbuat dari bahan yang tidak lentur.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">9. Ukur lingkar kepala Pengukuran dilakukan dari dahi kemudian melingkari kepala kembali lagi ke dahi.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">10. Ukur lingkar dada ukur lingkar dada dari daerah dada ke punggung kembali ke dada (pengukuran dilakukan melalui kedua puting susu)<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
PEMERIKSAAN FISIK<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">11. Kepala<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Raba sepanjang garis sutura dan fontanel ,apakah ukuran dan tampilannya normal. Sutura yang berjarak lebar mengindikasikan bayi preterm,moulding yang buruk atau hidrosefalus. Pada kelahiran spontan letak kepala, sering terlihat tulang kepala tumpang tindih yang disebut moulding/moulase.Keadaan ini normal kembali setelah beberapa hari sehingga ubun-ubun mudah diraba. Perhatikan ukuran dan ketegangannya. Fontanel anterior harus diraba, fontanel yang besar dapat terjadi akibat prematuritas atau hidrosefalus, sedangkan yang terlalu kecil terjadi pada mikrosefali. Jika fontanel menonjol, hal ini diakibatkan peningkatan tekanan intakranial, sedangkan yang cekung dapat tejadi akibat deidrasi. Terkadang teraba fontanel ketiga antara fontanel anterior dan posterior, hal ini terjadi karena adanya trisomi 21<br />
Periksa adanya tauma kelahiran misalnya; caput suksedaneum, sefal hematoma, perdarahan subaponeurotik/fraktur tulang tengkorak<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perhatikan adanya kelainan kongenital seperti ; anensefali, mikrosefali, kraniotabes dan sebagainya<br />
12. Wajah<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">wajah harus tampak simetris. Terkadang wajah bayi tampak asimetris hal ini dikarenakan posisi bayi di intrauteri.Perhatikan kelainan wajah yang khas seperti sindrom down atau sindrom piere robin. Perhatikan juga kelainan wajah akibat trauma lahir seperti laserasi, paresi N.fasialis.<br />
13. Mata<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Goyangkan kepala bayi secara perlahan-lahan supaya mata bayi terbuka.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Periksa jumlah, posisi atau letak mata<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Perksa adanya strabismus yaitu koordinasi mata yang belum sempurna<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Periksa adanya glaukoma kongenital, mulanya akan tampak sebagai pembesaran<span> </span>kemudiansebagai kekeruhan pada kornea<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Katarak kongenital akan mudah terlihat yaitu pupil berwarna putih. Pupil harus tampak bulat. Terkadang ditemukan bentuk seperti lubang kunci (kolobama) yang dapat <span> </span>mengindikasikan adanya defek retina<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Periksa adanya trauma seperti palpebra, perdarahan konjungtiva atau retina<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Periksa adanya sekret pada mata, konjungtivitis oleh kuman gonokokus dapat menjadi panoftalmia dan menyebabkan kebutaan<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Apabila ditemukan epichantus melebar kemungkinan bayi mengalami sindrom down<br />
14. Hidung<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Kaji bentuk dan lebar hidung, pada bayi cukup bulan lebarnya harus lebih dari 2,5 cm<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Bayi harus bernapas dengan hidung, jika melalui mulut harus diperhatikan <span> </span>kemungkinan ada obstruksi jalan napas akarena atresia koana bilateral, fraktur tulang hidung atau ensefalokel yang menonjol ke nasofaring<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Periksa adanya sekret yang mukopurulen yang terkadang berdarah , hal ini kemungkinan adanya sifilis kongenital<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Periksa adanya pernapasa cuping hidung, jika cuping hidung mengembang menunjukkan adanya gangguan pernapasan.( Depkes Ri,2003 )<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">15. Mulut<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Perhatikan mulut bayi, bibir harus berbentuk dan simetris. Ketidaksimetrisan bibir menunjukkan adanya palsi wajah. Mulut yang kecil menunjukkan mikrognatia<br />
• Periksa adanya bibir sumbing, adanya gigi atau ranula (kista lunak yang berasal dari dasar mulut)<br />
• Periksa keutuhan langit-langit, terutama pada persambungan antara palatum keras dan lunak<br />
• Perhatika adanya bercak putih pada gusi atau palatum yang biasanya terjadi akibatvEpistein’s pearl atau gigi<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Periksa lidah apakah membesar atau sering bergerak. Bayi dengan edema otak atau tekanan intrakranial meninggi seringkali lidahnya keluar masuk (tanda foote)<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Bibir sumbing (Bennet & Brown, 1999)<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">16. Telinga<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Periksa dan pastikan jumlah, bentuk dan posisinya<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Pada bayi cukup bulan, tulang rawan sudah matang<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Dauntelinga harus berbentuk sempurna dengan lengkungan yang jelas dibagia atas<br />
• Perhatikan letak daun telinga. Daun telinga yang letaknya rendah (low set ears) terdapat pada bayi yangmengalami sindrom tertentu (Pierre-robin)<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Perhatikan adanya kulit tambahan atau aurikel hal ini dapat berhubungan dengan abnormalitas ginjal<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">17. Leher<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Leher bayibiasanya pendek dan harus diperiksa kesimetrisannya. Pergerakannya harus baik. Jika terdapat keterbatasan pergerakan kemungkinan ada kelainan tulang leher<br />
• Periksa adanya trauma leher yang dapat menyebabkan kerusakan pad fleksus brakhialis<br />
• Lakukan perabaan untuk mengidentifikasi adanya pembengkakan.periksa adanya pembesaran kelenjar tyroid dan vena jugularis<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Adanya lipata kulit yang berlebihan di bagian belakang leher menunjukkan adanya kemungkinan trisomi 21.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">18. Klavikula<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Raba seluruh klavikula untuk memastikan keutuhannya terutama pada bayi yang lahir dengan presentasi bokong atau distosia bahu. Periksa kemungkinan adanya fraktur<br />
19. Tangan<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Kedua lengan harus sama panjang, periksa dengan cara meluruskan kedua lengan ke bawah<br />
• Kedua lengan harus bebas bergerak, jika gerakan kurang kemungkinan adanya kerusakan neurologis atau fraktur<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Periksa jumlah jari. Perhatikan adanya polidaktili atau sidaktili<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Telapak tangan harus dapat terbuka, garis tangan yang hanya satu buah berkaitan dengan abnormaltas kromosom, seperti trisomi 21<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Periksa adanya paronisia pada kuku yang dapat terinfeksi atau tercabut sehingga menimbulkan luka dan perdarahan<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">20. Dada<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Periksa kesimetrisan gerakan dada saat bernapas. Apabila tidak simetris kemungkinan bayi mengalami pneumotoraks, paresis diafragma atau hernia diafragmatika. Pernapasan yang normal dinding dada dan abdomen bergerak secara bersamaan.Tarikan sternum atau interkostal pada saat bernapas perlu diperhatikan<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Pada bayi cukup bulan, puting susu sudah terbentuk dengan baik dan tampak simetris<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Payudara dapat tampak membesar tetapi ini normal<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">21. Abdomen<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Abdomen harus tampak bulat dan bergerak secara bersamaan dengan gerakan dada saat bernapas. Kaji adanya pembengkakan<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Jika perut sangat cekung kemungkinan terdapat hernia diafragmatika<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Abdomen yang membuncit kemungkinan karena hepato-splenomegali atau tumor lainnya<br />
• Jika perut kembung kemungkinan adanya enterokolitis vesikalis, omfalokel atau ductus omfaloentriskus persisten.(Lodermik, Jensen 2005)<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">22. Genetalia<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Pada bayi laki-laki panjang penis 3-4 cm dan lebar 1-1,3 cm.Periksa posisi lubang uretra. Prepusium tidak boleh ditarik karena akan menyebabkan fimosis<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Periksa adanya hipospadia dan epispadia<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Skrortum harus dipalpasi untuk memastikan jumlah testis ada dua<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Pada bayi perempuan cukup bulan labia mayora menutupi labia minora<br />
• Lubang uretra terpisah dengan lubang vagina<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Terkadang tampak adanya sekret yang berdarah dari vagina, hal ini disebabkan oleh pengaruh hormon ibu (withdrawl bedding).(Lodermik, Jensen 2005) (Lodermik, Jensen 2005)<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">23. Anus dan rectum<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Periksa adanya kelainan atresia ani , kaji posisinya<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Mekonium secara umum keluar pada 24 jam pertama, jika sampai 48 jam belumkeluar kemungkinan adanya mekonium plug syndrom, megakolon atau obstruksi saluran pencernaan<br />
24. Tungkai<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Periksa kesimetrisan tungkai dan kaki. Periksa panjang kedua kaki dengan meluruskan keduanya dan bandingkan<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Kedua tungkai harus dapat bergerak bebas. Kuraknya gerakan berkaitan dengan adanya trauma, misalnya fraktur, kerusakan neurologis.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Periksa adanya polidaktili atau sidaktili padajari kaki<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">25. Spinal<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Periksa psina dengan cara menelungkupkan bayi, cari adanya tanda-tanda abnormalitas seperti spina bifida, pembengkakan, lesung atau bercak kecil berambut yang dapat menunjukkan adanya abdormalitas medula spinalis atau kolumna vertebra.(Lodermik, Jensen 2005)<br />
26. Kulit<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Perhatikan kondisi kuli bayi.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Periksa adanya ruam dan bercak atau tanda lahir<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Periksa adanya pembekakan<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Perhatinan adanya vernik kaseosa<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Perhatikan adanya lanugo, jumlah yang banyak terdapat pada bayi kurang bulan<br />
27. jelaskan pada ibu atau kelurga tentang hasil pemeriksaan<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">28. Rapikan bayi<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">29. Bereskan alat<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">30. Lakukan pendokumentasian tindakan dan hasil pemeriksaan<o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span> </span></span><span style="font-family: "Arial","sans-serif";">Tes Apgar adalah serangkaian pemeriksaan untuk menilai kemampuan bayi baru lahir beradaptasi terhadap kehidupan di luar rahim bundanya. Ada 5 hal pokok yang diperiksa, yaitu:<o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div><div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-Dcrp-BCBLEMWcsi3Xpd5xtYE3mNXZ1ea4IBMOhu32B3KLemyIVu9s3b0zuhPUCYBBcmLN2hVEWdbI4YcmykzDvDCUFxsRwNHR28jM_tlftnurHJWAg987MQmNdaxUVsWsRX4Zh9PRIeO/s1600-h/Apgar+Score.jpg"><span style="color: blue; font-family: "Arial","sans-serif"; text-decoration: none;"><!--[if gte vml 1]><v:shapetype
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</div><div class="MsoNormal"><span style="font-family: "Arial","sans-serif";">o Appearance: Penampilan, yang dilihat dari warna kulit.<br />
o Pulse: Frekuensi denyut jantung.<br />
o Grimace: Usaha bernapas yang dilihat dari kuat lemahnya tangisan.<br />
o Activity: Aktif atau tidaknya tonus otot.<br />
o Reflex: Reaksi spontan atas rangsang yang datang.<br />
Nah, serangkaian pemeriksaan tadi masing-masing akan diberi nilai. Bila reaksi si kecil bagus, maka nilainya 2. Reaksi kurang baik bernilai 1, sedangkan reaksi buruk bernilai 0. Kesemua nilai tadi akan dijumlahkan, sehingga didapatlah hasil sebagai berikut:<br />
o Nilai 10: Bayi memberi reaksi sangat baik pada semua pemeriksaan,<br />
o Nilai 7-10: Si kecil dianggap memiliki kemampuan adaptasi yang baik.<br />
o Nilai di bawah 7: Fungsi jantung dan paru-paru bayi tidak baik, sehingga perlu pertolongan.<br />
o Nilai 0: Bayi meninggal saat lahir.<br />
Cara Penilaian :<br />
• Reaksi Terhadap Rangsangan; Ketika kateter dimasukkan ke dalam lubang hidung bayi untuk membersihkan jalan nafasnya, akan terlihat bagaimana reaksi bayi. Jika ia memberontak, itu pertanda responnya terhadap rangsangan bagus. Maka bayi mendapat nilai 2. Tapi jika bayi hanya sedikit bergerak ketika kateter dimasukkan ke dalam lubang hidungnya, itu berarti hanya mendapat nilai 1. Bayi yang tidak bergerak sama sekali diberi nilai 0. <br />
• Frekuensi Jantung; Untuk mengetahui sehat-tidaknya jantung bayi, paramedis akan meletakkan stetoskop pada dada bayi, tempat denyut jantung terdengar paling kuat. Denyut jantung dihitung dalam satu menit. Jantung yang sehat akan berdenyut di atas 100 per menit dan diberi nilai 2. Nilai 1 diberikan pada bayi yang frekuensi denyut jantungnya di bawah 100 per menit. Sementara bila denyut jantung tak terdeteksi sama sekali maka nilainya 0. <br />
• Usaha Bayi Dalam Bernafas; Kemampuan bayi bernafas dinilai dengan mendengarkan tangis bayi. Jika ia langsung menangis dengan kuat begitu lahir, itu tandanya paru-paru bayi telah matang dan mampu beradaptasi dengan baik. Berarti nilainya 2. Sedangkan bayi yang hanya merintih rintih, nilainya 1. Nilai 0 diberikan pada bayi yang terlahir tanpa tangis (diam). <br />
• Tonus Otot ; Sekarang, menilai tonus otot bayi. Hal ini dinilai dari gerakan bayi. Bila si bayi menggerakkan kedua tangan dan kakinya secara aktif begitu lahir, artinya tonus ototnya bagus. Dan, ia diberi nilai 2. Tapi jika bayi hanya sedikit bergerak, nilainya hanya 1. Bayi yang lahir dalam keadaan diam tak bergerak<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Arial","sans-serif";">ekilas mengenai Skor Apgar</span></b><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Merupakan pemeriksaan pertama yang dilakukan kepada bayi Anda ketika baru lahir, yang dilakukan masih di dalam kamar bersalin. Pemeriksaan ini secara cepat akan mengevaluasi keadaan fisik dari bayi baru lahir dan sekaligus mengenali adanya tanda-tanda darurat yang memerlukan dilakukannya tindakan segera terhadap bayi baru lahir. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Apgar Score mulai berkembang sejak tahun 1952 oleh seorang dokter anestesi/bius, yang bernama Virginia Apgar. Dan kata APGAR sendiri, merupakan gabungan dari kata: <b><i>A</i></b><i>ctivity</i> (aktivitas), <b><i>P</i></b><i>ulse</i> (Nadi), <b><i>G</i></b><i>rimace</i> (mimik), <b><i>A</i></b><i>ppearance</i> (Tampilan kasat mata), dan <b><i>R</i></b><i>espiration</i> (pernapasan). Dimana kelima hal tersbut merupakan faktor yang dinilai pada bayi baru lahir. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Tes ini, biasanya diberikan kepada bayi Anda sebanyak dua kali: pada menit pertama setelah lahir dan dilakukan kembali pada menit ke-5 setelah lahir. Jarang terjadi namun ketika penilaian kondisi bayi pada menit pertama, dan dua tanda memberikan hasil yang rendah, maka penilaian akan dilakukan lagi untuk yang ketiga kalinya pada menit ke-10 setelah kelahiran. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Lima hal yang menjadi parameter penilaian kondisi bayi baru lahir, di berikan skor 0-2, dimana 2 merupakan skor tertinggi:<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Arial","sans-serif";">1. Aktivitas otot<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Arial","sans-serif";">2. Denyut jantung<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Arial","sans-serif";">3. Ekspresi/mimik<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Arial","sans-serif";">4. Tampilan (warna kulit)<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Arial","sans-serif";">5. Pernapasan (frekuensi napas dan usaha bernapas)<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Dokter atau perawat bayi akan menjumlahkan kelima hasil penilaian di atas, untuk mendapatkan total Apgar Skor. Skor yang diberikan antara 10 dan 0, dengan 10 sebagai skor tertinggi.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Arial","sans-serif";">Penilaian Apgar</span></b><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div><table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse;"><tbody>
<tr style="height: 18.15pt;"> <td style="height: 18.15pt; padding: 0cm 5.4pt; width: 111.75pt;" valign="top" width="149"> <div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-family: "Arial","sans-serif";">TAnda Apgar<o:p></o:p></span></div></td> <td style="height: 18.15pt; padding: 0cm 5.4pt; width: 120.45pt;" valign="top" width="161"> <div align="center" class="MsoNormal" style="line-height: normal; text-align: center;"><span style="font-family: "Arial","sans-serif";">2<o:p></o:p></span></div></td> <td style="height: 18.15pt; padding: 0cm 5.4pt; width: 134.7pt;" valign="top" width="180"> <div align="center" class="MsoNormal" style="line-height: normal; text-align: center;"><span style="font-family: "Arial","sans-serif";">1<o:p></o:p></span></div></td> <td style="height: 18.15pt; padding: 0cm 5.4pt; width: 111.9pt;" valign="top" width="149"> <div align="center" class="MsoNormal" style="line-height: normal; text-align: center;"><span style="font-family: "Arial","sans-serif";">0<o:p></o:p></span></div></td> </tr>
<tr> <td style="padding: 0cm 5.4pt; width: 111.75pt;" valign="top" width="149"> <div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Denyut jantung<o:p></o:p></span></div></td> <td style="padding: 0cm 5.4pt; width: 120.45pt;" valign="top" width="161"> <div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Normal (diatas 100x/menit<o:p></o:p></span></div></td> <td style="padding: 0cm 5.4pt; width: 134.7pt;" valign="top" width="180"> <div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Dibawah 100x/menit<o:p></o:p></span></div></td> <td style="padding: 0cm 5.4pt; width: 111.9pt;" valign="top" width="149"> <div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Tidak ada<o:p></o:p></span></div></td> </tr>
<tr> <td style="padding: 0cm 5.4pt; width: 111.75pt;" valign="top" width="149"> <div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Pernapasan<o:p></o:p></span></div></td> <td style="padding: 0cm 5.4pt; width: 120.45pt;" valign="top" width="161"> <div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Normal, tanpa usaha bernapas yang berlebih, menangis kuat<o:p></o:p></span></div></td> <td style="padding: 0cm 5.4pt; width: 134.7pt;" valign="top" width="180"> <div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Pelan, tidak teratur, menangis lemah<o:p></o:p></span></div></td> <td style="padding: 0cm 5.4pt; width: 111.9pt;" valign="top" width="149"> <div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Tidak bernapas<o:p></o:p></span></div></td> </tr>
<tr> <td style="padding: 0cm 5.4pt; width: 111.75pt;" valign="top" width="149"> <div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Respon/refleks mimik<o:p></o:p></span></div></td> <td style="padding: 0cm 5.4pt; width: 120.45pt;" valign="top" width="161"> <div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Menarik diri, batuk oleh karena ada rangsangan<o:p></o:p></span></div></td> <td style="padding: 0cm 5.4pt; width: 134.7pt;" valign="top" width="180"> <div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Perubahan mimik wajah hanya ketika di rangsang<o:p></o:p></span></div></td> <td style="padding: 0cm 5.4pt; width: 111.9pt;" valign="top" width="149"> <div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Tidak ada respon terhadap rangsangan<o:p></o:p></span></div></td> </tr>
<tr> <td style="padding: 0cm 5.4pt; width: 111.75pt;" valign="top" width="149"> <div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Aktivitas otot<o:p></o:p></span></div></td> <td style="padding: 0cm 5.4pt; width: 120.45pt;" valign="top" width="161"> <div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Aktif, pergerakan spontan<o:p></o:p></span></div></td> <td style="padding: 0cm 5.4pt; width: 134.7pt;" valign="top" width="180"> <div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Lengan dan kaki menekuk dengan sedikit pergerakan<o:p></o:p></span></div></td> <td style="padding: 0cm 5.4pt; width: 111.9pt;" valign="top" width="149"> <div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Tidak ada gerakan sama sekali<o:p></o:p></span></div></td> </tr>
<tr> <td style="padding: 0cm 5.4pt; width: 111.75pt;" valign="top" width="149"> <div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Tampilan (warna kulit)<o:p></o:p></span></div></td> <td style="padding: 0cm 5.4pt; width: 120.45pt;" valign="top" width="161"> <div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Warna kulit normal, merata di seluruh tubuh<o:p></o:p></span></div></td> <td style="padding: 0cm 5.4pt; width: 134.7pt;" valign="top" width="180"> <div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Warna kulit normal (tangan dan kaki pucat)<o:p></o:p></span></div></td> <td style="padding: 0cm 5.4pt; width: 111.9pt;" valign="top" width="149"> <div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Warna pucat atau kebiruan di seluruh tubuh<o:p></o:p></span></div></td> </tr>
</tbody></table><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Arial","sans-serif";">Apa tujuan penilaian skor Apgar?</span></b><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-family: "Arial","sans-serif";">Bayi dengan hasil total, 7 atau lebih pada menit pertama setelah lahir, secara umum berada pada keadaan sehat. Bukan berarti skor yang rendah menunjukkan bahwa anak Anda tidak sehat atau tidak normal. Hasil yang rendah dalam penilaian itu, menunjukkan bahwa anak Anda membutuhkan tindakan yang sifatnya segera, seperti menyedot/mengeluarkan cairan dari saluran pernapasan atau pemberian oksigen untuk membantu pernapasan, tindakan tersebut dapat memberikan perbaikan keadaan bayi secara umum.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Arial","sans-serif";">Pada menit ke-5 setelah lahir, penilaian kembali dilakukan, dan jika skor bayi Anda tidak naik hingga nilai 7 atau lebih dan berdasarkan pertimbangan lainnya dari keadaan bayi maka dokter dan perawat akan melanjutkan tindakan medis yang perlu untuk dilakukan dan pemantauan intensif. Beberapa bayi yang lahir dengan masalah pada organ jantung dan paru-paru akan membutuhkan tindakan medis lanjutan, sedangkan yang lain hanya membutuhkan waktu yang lebih lama untuk menyesuaikan diri terhadap lingkungan luar. Kebanyakan bayi baru lahir dengan nilai Apgar pertama dibawah 7, akan baik-baik saja. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-family: "Arial","sans-serif";">Hal yang penting bagi orang tua yang baru memiliki bayi untuk mengetahui nilai Apgar. Penilaian ini dibuat untuk menolong tenaga kesehatan dalam mengkaji kondisi secara umum bayi baru lahir dan memutuskan untuk melakukan tindakan darurat atau tidak. Penilaian ini bukan ditujukan sebagai preidiksi terhadap kesehatan bayi atau perilaku bayi, atau bahkan status intelegensia/kepandaian. Beberapa bayi dapat mencapai angka 10, dan tidak jarang, bayi yang sehat memiliki skor yang lebih rendah dari biasanya, terutama pada menit pertama saat baru lahir. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-family: "Arial","sans-serif";">Perlu diingai bahwa skor Apgar agak rendah (terutama pada menit pertama) adalah normal pada beberapa bayi baru lahir, terutama bayi yang lahir dari ibu hamil dengan risiko tinggi, lahir melalui proses operasi cesar, atau ibu yang memiliki komplikasi selama kehamilan maupun proses persalinan. Skor Apgar yang rendah juga bisa terjadi pada bayi prematur, dimana kemampuan untuk menggerakkan otot/alat gerak lebih rendah daripada bayi cukup bulan. Bayi prematur dalam kasus apapun akan memerluan pemantauan ekstra dan bantuan pernapasan, dikarenakan paru-paru belum sempurna<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">FISIOLOGI CAIRAN AMNION</span></b><span style="color: black; font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">Amnion manusia pertama kali dapat diidentifikasi pada sekitar hari ke-7 atau ke-8 perkembangan mudigah. Pada awalnya sebuah vesikel kecil yaitu amnion, berkembang menjadi sebuah kantung kecil yang menutupi permukaan dorsal mudigah. Karena semakin membesar, amnion secara bertahap menekan mudigah yang sedang tumbuh, yang mengalami prolaps ke dalam rongga amnion. </span><b><sup><span style="color: black; font-family: "Arial","sans-serif";">1,2,3</span></sup></b><span style="color: black; font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><a href="http://1.bp.blogspot.com/_JdayxWe_Qak/SvqsyoauDhI/AAAAAAAAAWE/fONiJoz8dO0/s1600-h/1.jpg"><span style="color: blue; font-family: "Arial","sans-serif"; text-decoration: none;"><!--[if gte vml 1]><v:shape id="BLOGGER_PHOTO_ID_5402820688827256338"
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</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify; text-indent: -63.25pt;"><b><span style="color: black; font-family: "Arial","sans-serif";"><span> </span></span></b><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">Gambar 1. </span><span style="color: black; font-family: "Arial","sans-serif";">K</span><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">antung amnion pada hari ke-10</span><span style="color: black; font-family: "Arial","sans-serif";"> ditampakkan pada gambar sebelah kiri dan di sebelah kanan merupakan k</span><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">antung amnion pada hari ke-12 yang selanjutnya akan tumbuh menekan mudigah </span><span style="color: black; font-family: "Arial","sans-serif";">dikutip dari Cunningham<sup>.</sup></span><span style="color: black; font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 27pt;"><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">Cairan amnion pada keadaan normal berwarna putih agak keruh karena adanya campuran partikel solid yang terkandung di dalamnya yang berasal dari lanugo, sel epitel, dan material sebasea. Volume cairan amnion pada keadaan aterm adalah sekitar 800 ml, atau antara 400 ml -1500 ml dalam keadaan normal. Pada kehamilan 10 minggu rata-rata volume adalah 30 ml, dan kehamilan 20 minggu 300 ml, 30 minggu 600 ml. Pada kehamilan 30 minggu, cairan amnion lebih mendominasi dibandingkan dengan janin sendiri.</span><span style="color: black; font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 27pt;"><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">Cairan amnion diproduksi oleh janin maupun ibu, dan keduanya memiliki peran tersendiri pada setiap usia kehamilan. Pada kehamilan awal, cairan amnion sebagian besar diproduksi oleh sekresi epitel selaput amnion. </span><span style="color: black; font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 27pt;"><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">Dengan bertambahnya usia kehamilan, produksi cairan amnion didominasi oleh kulit janin dengan cara difusi membran. Pada kehamilan 20 minggu, saat kulit janin mulai kehilangan permeabilitas, ginjal janin mengambil alih peran tersebut dalam memproduksi cairan amnion.</span><span style="color: black; font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 27pt;"><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">Pada kehamilan aterm, sekitar 500 ml per hari cairan amnion di sekresikan dari urin janin dan 200 ml berasal dari cairan trakea. Pada penelitian dengan menggunakan radioisotop, terjadi pertukaran sekitar 500 ml per jam antara plasma ibu dan cairan amnion. </span><span style="color: black; font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 27pt;"><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">Pada kondisi dimana terdapat gangguan pada ginjal janin, seperti agenesis ginjal, akan menyebabkan oligohidramnion dan jika terdapat gangguan menelan pada janin, seperti atresia esophagus, atau anensefali, akan menyebabkan polihidramnion</span><sup><span style="color: black; font-family: "Arial","sans-serif";">3</span></sup><span style="color: black; font-family: "Arial","sans-serif";">.<o:p></o:p></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">A. Fungsi Cairan Amnion</span></b><span style="color: black; font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">Cairan amnion merupakan komponen penting bagi pertumbuhan dan perkembangan janin selama kehamilan. Pada awal embryogenesis, amnion merupakan perpanjangan dari matriks ekstraseluler dan di sana terjadi difusi dua arah antara janin dan cairan amnion. Pada usia kehamilan 8 minggu, terbentuk uretra dan ginjal janin mulai memproduksi urin. Selanjutnya janin mulai bisa menelan. Eksresi dari urin, sistem pernafasan, s</span><span style="color: black; font-family: "Arial","sans-serif";">i</span><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">stem digestivus, tali pusat dan permukaan plasenta menjadi sumber dari cairan amnion. Telah diketahui bahwa cairan amnion berfungsi sebagai kantong pelindung di sekitar janin yang memberikan ruang bagi janin untuk bergerak, tumbuh meratakan tekanan uterus pada partus, dan mencegah trauma mekanik dan trauma termal. </span><span style="color: black; font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 1cm;"><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">Cairan amnion juga berperan dalam sistem imun bawaan karena memiliki peptid antimikrobial terhadap beberapa jenis bakteri dan fungi patogen tertentu. Cairan amnion adalah 98% air dan elektrolit, protein , peptide, hormon, karbohidrat, dan lipid. Pada beberapa penelitian, komponen-komponen cairan amnion ditemukan memiliki fungsi sebagai <i>biomarker</i> potensial bagi abnormalitas-abnormalitas dalam kehamilan. Beberapa tahun belakangan, sejumlah protein dan peptide pada cairan amnion diketahui sebagai fa</span><span style="color: black; font-family: "Arial","sans-serif";">k</span><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">tor pertumbuhan atau sitokin, dimana kadarnya akan berubah-ubah sesuai dengan usia kehamilan. Cairan amnion juga diduga memiliki potensi dalam pengembangan medikasi </span><i><span style="color: black; font-family: "Arial","sans-serif";">stem cell</span></i><span style="color: black; font-family: "Arial","sans-serif";"> <sup>1,2,3,4</sup><o:p></o:p></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">B. Volume Cairan Amnion</span></b><span style="color: black; font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">Volume cairan amnion pada setiap minggu usia kehamilan bervariasi, secara umum volume bertambah 10 ml per minggu pada minggu ke</span><span style="color: black; font-family: "Arial","sans-serif";">-</span><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">8 usia kehamilan dan meningkat menjadi 60 ml per minggu pada usia kehamilan 21 minggu, yang kemudian akan menurun secara bertahap sampai volume yang tetap setelah usia kehamilan 33 minggu. </span><span style="color: black; font-family: "Arial","sans-serif";">N</span><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">ormal volume cairan amnion bertambah dari 50 ml pada saat usia kehamilan 12 minggu sampai 400 ml pada pertengahan gestasi dan 1000 – 1500 ml pada saat aterm. Pada kehamilan postterm jumlah cairan amnion hanya 100 sampai 200 ml atau kurang.</span><span style="color: black; font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 35.45pt;"><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">Brace dan Wolf menganalisa semua pengukuran yang dipublikasikan pada 12 penelitian dengan 705 pengukuran cairan amnion secara individual. Variasi terbesar terdapat pada usia kehamilan 32-33 minggu. Pada saat ini, batas normalnya adalah 400 – 2100 ml</span><sup><span style="color: black; font-family: "Arial","sans-serif";">1,2,3,4</span></sup><span style="color: black; font-family: "Arial","sans-serif";">.<o:p></o:p></span></div><div align="center" class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center; text-indent: 35.45pt;"><a href="http://4.bp.blogspot.com/_JdayxWe_Qak/SvqtYxjMAsI/AAAAAAAAAWM/kPfys9KJNXg/s1600-h/2.jpg"><span style="color: blue; font-family: "Arial","sans-serif"; text-decoration: none;"><!--[if gte vml 1]><v:shape id="BLOGGER_PHOTO_ID_5402821344113722050"
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</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">C. Pengukuran Cairan Amnion</span></b><span style="color: black; font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">Terdapat 3 cara yang sering dipakai untuk mengetahui jumlah cairan amnion, dengan te</span><span style="color: black; font-family: "Arial","sans-serif";">k</span><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">nik <i>single pocket</i> ,dengan memakai Indeks Cairan </span><span style="color: black; font-family: "Arial","sans-serif";">Amnion </span><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">(ICA), dan secara subjektif pemeriksa.</span><span style="color: black; font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 42.55pt;"><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">Pemeriksaan dengan metode <i>single pocket</i> pertama kali diperkenalkan oleh Manning dan Platt pada tahun 1981 sebagai bagian dari pemeriksaan biofisik, dimana 2</span><span style="color: black; font-family: "Arial","sans-serif";">c</span><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">cm dianggap sebagai batas minimal dan 8 cm dianggap sebagai polihidramnion. </span><span style="color: black; font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 42.55pt;"><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">Metode <i>single pocket</i> telah dibandingkan dengan AFI menggunakan amniosintesis sebagai <i>gold standar</i>. Tiga penelitian telah menunjukkan bahwa metode pengukuran cairan ketuban dengan te</span><span style="color: black; font-family: "Arial","sans-serif";">k</span><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">nik Indeks Cairan </span><span style="color: black; font-family: "Arial","sans-serif";">Amnion</span><span lang="IN" style="color: black; font-family: "Arial","sans-serif";"> (ICA) memiliki korelasi yang lemah dengan volume amnion sebenarnya (<i>R<sup>2</sup> dari 0.55, 0.30 dan 0.24</i>) dan dua dari tiga penelitian ini menunjukkan bahwa te</span><span style="color: black; font-family: "Arial","sans-serif";">k</span><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">nik <i>single pocket</i> memiliki kemampuan yang lebih baik. </span><span style="color: black; font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 42.55pt;"><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">Kelebihan cairan amnion seperti polihidramnion, tidak mempengaruhi fetus secara langsung, namun dapat mengakibatkan kelahiran prematur. Secara garis besar, kekurangan cairan amnion dapat berefek negatif terhadap perkembangan paru-paru dan tungkai janin, dimana keduanya memerlukan cairan amnion untuk berkembang </span><sup><span style="color: black; font-family: "Arial","sans-serif";">6,7</span></sup><span style="color: black; font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center; text-indent: 42.55pt;"><a href="http://2.bp.blogspot.com/_JdayxWe_Qak/Svqt8_J-YNI/AAAAAAAAAWU/E-iAaa5jWus/s1600-h/3.jpg"><span style="color: blue; font-family: "Arial","sans-serif"; text-decoration: none;"><!--[if gte vml 1]><v:shape id="BLOGGER_PHOTO_ID_5402821966241358034"
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</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify; text-indent: -63.8pt;"><span style="color: black; font-family: "Arial","sans-serif";"><span> </span><span> </span><span> </span></span><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">Gambar 3. Pengukuran cairan amnion berdasarkan empat kuadran </span><span style="color: black; font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify; text-indent: -7.1pt;"><span style="color: black; font-family: "Arial","sans-serif";"><span> </span>dikutip dari Gilbert<sup>5</sup></span><span style="color: black; font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">D. Distribusi Cairan Amnion</span></b><span style="color: black; font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="color: black; font-family: "Arial","sans-serif";">1</span></b><b><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">. Urin Janin</span></b><span style="color: black; font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">Sumber utama cairan amnion adalah urin janin. Ginjal janin mulai memproduksi urin sebelum akhir trimester pertama, dan terus berproduksi sampai kehamilan aterm. Wladimirof dan Campbell mengukur volume produksi urin janin secara 3 dimensi setiap 15 menit sekali, dan melaporkan bahwa produksi urin janin adalah sekitar 230 ml / hari sampai usia kehamilan 36 minggu, yang akan meningkat sampai 655 ml/hari pada kehamilan aterm. </span><span style="color: black; font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 21.3pt;"><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">Rabinowitz dan kawan-kawan, dengan menggunakan te</span><span style="color: black; font-family: "Arial","sans-serif";">k</span><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">nik yang sama dengan yang dilakukan Wladimirof dan Campbell, namun dengan cara setiap 2 sampai 5 menit, dan menemukan volume produksi urin janin sebesar 1224 ml/hari. Pada tabel menunjukkan rata-rata volume produksi urin per hari yang didapatkan dari beberapa penelitian. Jadi, produksi urin janin rata-rata adalah sekitar 1000-1200 ml/ hari pada kehamilan aterm.</span><b><sup><span style="color: black; font-family: "Arial","sans-serif";">1,2,3,5,7,8</span></sup></b><span style="color: black; font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="color: black; font-family: "Arial","sans-serif";">2</span></b><b><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">. Cairan Paru</span></b><span style="color: black; font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">Cairan paru janin memiliki peran yang penting dalam pembentukan cairan amnion. Pada penelitian dengan menggunakan domba, didapatkan bahwa paru-paru janin memproduksi cairan sampai sekitar 400 ml/hari, dimana 50% dari produksi tersebut ditelan kembali dan 50% lagi dikeluarkan melalui mulut. Meskipun pengukuran secara langsung ke manusia tidak pernah dilakukan, namun data ini memiliki nilai yang representratif bagi manusia. Pada kehamilan normal, janin bernafas dengan gerakan inspirasi dan ekspirasi, atau gerakan masuk dan keluar melalui trakea, paru-paru dan mulut. Jadi jelas bahwa paru-paru janin juga berperan dalam pembentukan cairan amnion. </span><b><sup><span style="color: black; font-family: "Arial","sans-serif";">1,2,3,5,7,8</span></sup></b><span style="color: black; font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="color: black; font-family: "Arial","sans-serif";">3</span></b><b><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">. Gerakan menelan</span></b><span style="color: black; font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">Pada manusia, janin menelan pada awal usia kehamilan. Pada janin domba, proses menelan semakin meningkat seiring dengan meningkatnya usia kehamilan. Sherman dan teman-teman melaporkan bahwa janin domba menelan secara bertahap dengan volume sekitar 100-300 ml/kg/hari. </span><span style="color: black; font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 21.3pt;"><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">Banyak te</span><span style="color: black; font-family: "Arial","sans-serif";">k</span><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">nik berbeda yang dicoba untuk menguku</span><span style="color: black; font-family: "Arial","sans-serif";">r</span><span lang="IN" style="color: black; font-family: "Arial","sans-serif";"> rata-rata volume cairan amnion yang ditelan dengan menggunakan hewan, namun pada manusia, pengukur</span><span style="color: black; font-family: "Arial","sans-serif";">an</span><span lang="IN" style="color: black; font-family: "Arial","sans-serif";"> yang tepat sangat sulit untuk dilakukan. Pritchard meneliti proses menelan pada janin dengan menginjeksi kromium aktif pada kompartemen amnioti</span><span style="color: black; font-family: "Arial","sans-serif";">k</span><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">, dan menemukan rata-rata menelan janin adalah 72 sampai 262 ml/kg/hari. </span><sup><span style="color: black; font-family: "Arial","sans-serif";">1,2,4,5,7,8</span></sup><span style="color: black; font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 21.3pt;"><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">Abramovich menginjeksi emas koloidal pada kompartemen amnioti</span><span style="color: black; font-family: "Arial","sans-serif";">k</span><span lang="IN" style="color: black; font-family: "Arial","sans-serif";"> dan menemukan bahwa volume menelan janin meningkat seiring dengan bertambahnya usia kehamilan. Penelitian seperti ini tidak dapat lagi dilakukan pada masa sekarang ini karena fa</span><span style="color: black; font-family: "Arial","sans-serif";">k</span><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">tor etik, namun dari penelitian di atas jelas bahwa kemampuan janin menelan tidak menghilangkan seluruh volume cairan amnion dari produksi urin dan paru-paru janin, karena itu, harus ada mekanisme serupa dalam mengurangi volume cairan amnion. </span><b><sup><span style="color: black; font-family: "Arial","sans-serif";">1,2,5,7,8</span></sup></b><span style="color: black; font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center; text-indent: 21.3pt;"><a href="http://1.bp.blogspot.com/_JdayxWe_Qak/SvqvScjfbcI/AAAAAAAAAWc/-ia_8YX6JTM/s1600-h/4.jpg"><span style="color: blue; font-family: "Arial","sans-serif"; text-decoration: none;"><!--[if gte vml 1]><v:shape id="BLOGGER_PHOTO_ID_5402823434421890498"
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</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="color: black; font-family: "Arial","sans-serif";"><span> </span><span> </span></span></b><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">Gambar 4. Distribusi cairan amnion pada kehamilan</span><span style="color: black; font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify; text-indent: -21.3pt;"><span style="color: black; font-family: "Arial","sans-serif";"><span> </span><span> </span><span> </span>Dikutip dari Gilbert<sup>5</sup></span><span style="color: black; font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">PATOLOGI CAIRAN AMNION</span></b><span style="color: black; font-family: "Arial","sans-serif";"><o:p></o:p></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span lang="IN" style="color: black; font-family: "Arial","sans-serif";">Pada keadaan normal, volume cairan amnion meningkat menjadi 1 liter atau lebih sedikit pada gestasi 36 minggu, tapi kemudian berkurang. Secara kasar, cairan amnion yang lebih dari 2000 ml dianggap berlebihan dan disebut hidramnion, dan kadang-kadang disebut polihidramnion. Pada kasus yang jarang, uterus mungkin mengandung cairan dalam jumlah yang sangat besar. Pada sebagian besar kasus, yang terjadi adalah hidramnion kronik, yaitu peningkatan cairan berlebihan secara bertahap. Pada hidramnion akut, uterus mungkin mengalami peregangan mencolok dalam beberapa hari. Volume cairan amnion yang kurang dari 200 ml disebut oligohidramnion. </span><span style="color: black; font-family: "Arial","sans-serif";"><o:p></o:p></span></div>musdalifah sang pemimpinhttp://www.blogger.com/profile/16028724952062600560noreply@blogger.com0tag:blogger.com,1999:blog-3121307553946712135.post-91541672127733903192011-12-30T20:10:00.001-08:002011-12-30T20:10:16.177-08:00makalah glomerulunefritis<link href="file:///C:%5CUsers%5CAcer%5CAppData%5CLocal%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_filelist.xml" rel="File-List"></link><link href="file:///C:%5CUsers%5CAcer%5CAppData%5CLocal%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_editdata.mso" rel="Edit-Time-Data"></link><!--[if !mso]> <style>
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</style> <![endif]--><!--[if gte mso 9]><xml> <o:shapedefaults v:ext="edit" spidmax="1048"/> </xml><![endif]--><!--[if gte mso 9]><xml> <o:shapelayout v:ext="edit"> <o:idmap v:ext="edit" data="1"/> </o:shapelayout></xml><![endif]--> </m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac><br />
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB I</span></b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PENDAHULUAN</span></b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><!--[endif]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">LATAR BELAKANG</span></b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Glomerulonefritis merupakan penyebab utama terjadinya gagal ginjal tahap akhir dan tingginya angka morbiditas pada anak. Terminologi glomerulonefritis yang dipakai disini adalah untuk menunjukkan bahwa kelainan yang pertama dan utama terjadi pada glomerulus, bukan pada struktur ginjal yang lain.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Glomerulonefritis merupakan penyakit peradangan ginjal bilateral. Peradangan dimulai dalam gromleurus dan bermanifestasi sebagai proteinuria dan atau hematuria. Meskipun lesi utama pada gromelurus, tetapi seluruh nefron pada akhirnya akan mengalami kerusakan, sehingga terjadi gagal ginjal. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gejala glomerulonefritis bisa berlangsung secara mendadak (akut) atau secara menahun (kronis) seringkali tidak diketahui karena tidak menimbulkan gejala. Gejalanya dapat berupa mual-mual, kurang darah (anemia), atau hipertensi. Gejala umum berupa sembab kelopak mata, kencing sedikit, dan berwarna merah, biasanya disertai hipertensi. Penyakit ini umumnya (sekitar 80%) sembuh spontan, 10% menjadi kronis, dan 10% berakibat fatal.<o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><!--[endif]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">TUJUAN PENULISAN</span></b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 18pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adapun tujuan dari pembuatan makalah ini adalah :<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui pengertian dan etiologi</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">penyakit </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Glomerulonefritis</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui bagaimana </span><span lang="DE-LU" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">insiden </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>mengenai penyakit ini.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui bagaimana patofisiologi dari penyakit tersebut.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui </span><span lang="DE-LU" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">komplikasi</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> dari glomerulonefritis.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mampu membuat asuhan keperawatan dari penyakit glomerulonefritis. <o:p></o:p></span></div><div align="right" class="MsoListParagraphCxSpLast" style="line-height: 150%; text-align: right;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB II<o:p></o:p></span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">TINJAUAN TEORI<o:p></o:p></span></b></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><!--[endif]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PENGERTIAN<o:p></o:p></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Glomerulonefritis adalah </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">penyakit peradangan ginjal bilateral. Peradangan dimulai dalam gromleurus dan bermanifestasi sebagai proteinuria dan atau hematuria. Meskipun lesi utama pada gromelurus, tetapi seluruh nefron pada akhirnya akan mengalami kerusakan, sehingga terjadi gagal ginjal. Penyakit yang mula-mula digambarkan oleh Richard Bright pada tahun 1827 sekarang diketahui merupakan kumpulan banyak penyakit dengan berbagai etiologi, meskipun respon imun agaknya menimbulkan beberapa bentuk glomerulonefritis</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">. <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Glomerulonefritis terbagi atas dua yaitu glomerulonefritis akut dan glomerulonefritis kronik.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Glomerulonefritis akut adalah istilah yang secara luas digunakan yang mengacu pada sekolompok penyakit ginjal dimana inflamasi terjadi di glomerulus. <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Glomerulonefritis Kronik adalah mungkin seperti dengan glomerulonefritis akut atau tampak sebagai tipe reaksi antigen-antibodi yang lebih ringan, kadang-kadang sangat ringan sehingga terabaikan. <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><!--[endif]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ETIOLOGI <o:p></o:p></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sebagian besar (75%) glomerulonefritis akut paska streptokokus timbul setelah infeksi saluran pernapasan bagian atas, yang disebabkan oleh kuman Streptokokus menyebabkan infeksi kulit 8-14 hari setelah infeksi streptokokus, timbul gejala-gejala klinis. Infeksi kuman streptokokus beta hemolitikus ini mempunyai resiko terjadinya glomerulonefritis akut paska streptokokus berkisar 10-15%.<b><o:p></o:p></b></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penyebab terjadinya glomerulonefritis adalah virus streptococcus ini yang dikemukakan pertama kali oleh Lohlein pada tahun 1907 dengan alasan bahwa :<o:p></o:p></span></div><ol start="1" type="1"><li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Timbulnya GNA setelah infeksi skarlatina<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diisolasinya kuman Streptococcus beta hemolyticus golongan A<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Meningkatnya titer anti-streptolisin pada serum penderita.<o:p></o:p></span></li>
</ol><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mungkin faktor iklim, keadaan gizi, keadaan umum dan faktor alergi mempengaruhi terjadinya GNA setelah infeksi dengan kuman Streptococcuss. Ada beberapa penyebab glomerulonefritis akut, tetapi yang paling sering ditemukan disebabkan karena infeksi dari streptokokus, penyebab lain diantaranya:<o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 75pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>Ø<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bakteri : streptokokus grup C, <span>meningococcocus, Sterptoccocus Viridans, Gonococcus, Leptospira, Mycoplasma Pneumoniae, Staphylococcus albus, Salmonella typhi</span> dll<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 75pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>Ø<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Virus : hepatitis B, varicella, vaccinia, echovirus, parvovirus, influenza, parotitis epidemika dll.<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 75pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>Ø<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Parasit : malaria dan toksoplasma.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><b><span lang="FR-LU" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">C. </span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">FATOFISIOLOGI</span></b><b><span lang="FR-LU" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sebenarnya bukan sterptokokus yang menyebabkan kerusakan pada ginjal. Diduga terdapat suatu antibodi yang ditujukan terhadap suatu antigen khsus yang merupakan unsur membran plasma sterptokokal spesifik. Terbentuk kompleks antigen-antibodi didalam darah dan bersirkulasi kedalam glomerulus tempat kompleks tersebut secara mekanis terperangkap dalam membran basalis.selanjutnya komplomen akan terfiksasi mengakibatkan lesi dan peradangan yang menarik leukosit polimorfonuklear (PMN) dan trombosit menuju tempat lesi. Fagositosis dan pelepasan enzim lisosom juga merusak endothel dan membran basalis glomerulus (IGBM). <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sebagai respon terhadap lesi yang terjadi, timbu proliferasi sel-sel endotel yang diikuti sel-sel mesangium dan selanjutnya sel-sel epitel. Semakin meningkatnya kebocoran kapiler gromelurus menyebabkan protein dan sel darah merah dapat keluar ke dalam urine yang sedang dibentuk oleh ginjal, mengakibatkan proteinuria dan hematuria. Agaknya kompleks komplomen antigen-antibodi inilah yang terlihat sebagai nodul-nodul subepitel pada mikroskop elektron dan sebagai bentuk granular dan berbungkah-bungkah pada mikroskop imunofluoresensi, pada pemeriksaan cahaya glomerulus tampak membengkak dan hiperseluler disertai invasi PMN.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada glomerulonefritis akut, ginjal membesar, bengkak, dan kongesti. Seluruh jaringan renal glomerulus, tubulus dan pembuluh darah dipengaruhi dalam berbagai tingkat tanpa memperhatikan tipe glomerulonefritis akut yang ada. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada glomerulonefritis kronik awitannya mungkin seperti glomerulonefitis akut atau tampak sebagai tipe reaksi antigen-antibodi yang lebih ringan, kadang-kadang sangat ringan sehingga terabaikan. Setelah kejadian berulangnya infeksi ini, ukuran ginjal sedikit berkurang sekitar seperlima dari ukuran normal, -dan terdiri dari jaringan fibrosa yang luas. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">D.INSIDEN </span></b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penyakit yang mula-mula digambarkan oleh Richard Bright pada tahun 1827 sekarang diketahui merupakan kumpulan banyak penyakit dengan berbagai etiologi, meskipun respon imun agaknya menimbulkan beberapa bentuk glomerulonefritis.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Indonesia pada tahun 1995, melaporkan adanya 170 pasien yang dirawat di rumah sakit pendidikan dalam 12 bulan. Pasien terbanyak dirawat di Surabaya (26,5%), kemudian disusul berturut-turut di Jakarta (24,7%), Bandung (17,6%), dan Palembang (8,2%). Pasien laki-laki dan perempuan berbanding 2 : 1 dan terbanyak pada anak usia antara 6-8 tahun (40,6%).<br />
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<!--[endif]--><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>E.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><!--[endif]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">MANIFESTASI KLINIK</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hematuria b/d infeksi pada ginjal</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Edema b/d kelebihan vol.cairan</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hipertensi <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nyeri panggul b/d letaknya kanan dan kiri<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Glomerulonefritis akut mungkin ringan sehingga dapat diketahui secara insidental melalui urinalisis rutin yang menujukkan episode faringitis atau tonsilitis sebelumnya, disertai demam. Pada bentuk penyakit yang lebih para, pasien mengeluh adnya sakit kepala, males, edema wajah, dan nyeri pinggul. <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gejala glomerulonefritis kronik bervariasi. Banyak pasien dengan penyakit yang telah parah memperlihatkan kondisi tanpa gejala sama sekali untuk beberapa tahun. Kondisi mereka secara insidental dijumpai ketika terjadi hipertensi atau peningkatan kadar BUN dan kreatinin serum.<span> </span><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>F.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><!--[endif]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PEMERIKSAAN </span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">DIAGNOSTIK</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Urinaris : ditemukan hematuria (darah dalam urin),mikroskopi atau makroskopi yang disebut<i> Groshematuria</i><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Protenuri,terutama albumin yang terjadi meningkatnya permeabilitas membran glomerulus.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan BUN (Blood Urea Nitrogen) dan kreatinin serum meningkat<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>G.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><!--[endif]--><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">KOMPLIKASI <o:p></o:p></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hipertensi, congestive heart failure (CHF), endokarditis.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="FR-LU" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="FR-LU" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ketidakseimbangan cairan dan eletrolit pada fase akut.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="FR-LU" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="FR-LU" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Malnutrisi <o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="DE-LU" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif";">Oliguria sampai anuria yang dapat berlangsung 2-3 hari</span><span lang="DE-LU" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 57pt; text-align: justify; text-indent: -12pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif";"><span>-<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif";">Terjadi sebagai akibat berkurangnya filtrasi glomerulus.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 57pt; text-align: justify; text-indent: -12pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif";"><span>-<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif";">Gambaran seperti insufisiensi ginjal akut dengan uremia, hiperfosfatemia, hiperkalemia dan hidremia. Walaupun oliguria/anuria yang lama jarang terdapat pada anak, jika hal ini terjadi di perlukan peritoneum dialisis (bila perlu).<o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif";"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif";">Ensefalopati hipertensi<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 92.7pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif";">Merupakan gejala serebrum karena hipertensi.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 92.7pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif";">Gejala berupa gangguan penglihatan, pusing, muntah dan kejang-kejang.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 92.7pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif";">Hal ini disebabkan karena spasme pembuluh darah lokal dengan anoksia dan edema otak.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif";"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif";">Gangguan Sirkulasi<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 99pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif";">Seperti : Dispneu, ortonea, terdapatnya ronchi basah, pembesaran jantung dan meningginya tekanan darah yang bukan saja disebabkan spasme pembuluh darah, tetapi juga disebabkan oleh bertambahnya volume plasma.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 99pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Symbol;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif";">Jantung dapat membesar dan terjadi gagal jantung akibat hipertensi yang menetap dan kelainan di miokardium.<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify;"><br />
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</div><div align="center" class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: center;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB III<o:p></o:p></span></b></div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: center;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ASUHAN KEPERAWATAN DENGAN KLIEN GLOMERULONEFRITIS<o:p></o:p></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 21.3pt; text-indent: -18pt;"><!--[if !supportLists]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><!--[endif]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PENGKAJIAN <o:p></o:p></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Riwayat atau adanya faktor-faktor risiko: <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penyakit kompleks imun seperti sistemik lupus eritematosus dan dan skleroserma.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemajanan terhadap obat nefrotoksik atauu bahan seperti antimikrobial, agen anti-inflamasi, agen kkemoterapi, media kontras, pestisida, obat narkotika, atau logam berat.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Infeksi tenggorok atau kulit sebelumnya dengan streptokokus beta-hemolitik atau hepatitis.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Pemeriksaan fisik berdasarkan survei umum (Apendiks F) dapat menunjukkan : hemturis.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Edema: secara umum tampak pada wajah (periorbital) dan kaki tetapi dapat tampak sebagai asites, edema paru, atau efusi pleural.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hipertensi.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penurunan haluaran urine dengan penurunan berat jenis.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Urine gelap (warna-teh)<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Peningkatan berat badan karena retensi cairan.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sakit kepala, peka, atau perubahan ringan pada mental karena hipertensi. <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemerksaan diagnostik: <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Urinalisis (UA) menunjukkan hematuria gross, protein, dismorfik (bentuk tidak serasi) SDM, leukosit, dan gips hialin. Adanya dismorfik SDM menunujukkan perdarahan yang berasal dari glomerulus. <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Laju filtrasi glomerulus (LFG) menurun. Klirens keratinin pada urine digunakan sebagai pengukur LFG. Spesimen urine 24 jam dikumpulkan. Sampel darah untuk kreatinin serum juga ditampung dengan cara arus setengah (midstream).<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nitrogen urea darah dan kreatinin serum meningkat bila fungsi ginjal mulai menurun. Ini adalah temuan konsisten dengan berkembangnya glomerulus nefritis. <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pieologram intravena (PIV) menunjukkan abnormalitas pada sistem penamppungan ginjal. Kewaspadaan harus diberikan bila kerusakan ginjal berat terjadi karena zat kontras dapat bertahan dan menyebabkan kerusakan ginjal tambahan. <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Biopsi ginjal secara akurat mendiagnosa jenis khusus dari glomerunefritis dan luasnya kerusakan. Glomerulonefritis prolifratif endokapiler menyebar adalah lesi patologis dasar. <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Contoh urine acak untuk elektroforesis protein mengidentifikasi jenis protein yang dikeluarkan dalam urine. <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kadar komplemen manunjukkan penurunan kadar Cɜ.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penampungan urine 24 jam mendeteksi jumlah dan jenis protein yang dikeluarkan.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Eletrolit seru menunjukkan peningkatan natrium dan peningkatan atau normal kadar kalium dan klorida.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Albumin serum dan protein total mungkin normal atau agak turun (karena hemodilusi). Pada proteinuria masif, kadar rendah secara bermakna. <o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji pemahaman pasien tentang tindakan dan prognessis. Perhatikan sering berpusat pada kemungkinan berkembangnya kerusakan ginjal. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><!--[endif]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">DAMPAK PENYIMPANGAN KDM<o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-indent: 18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terjadinya peradangan kompleks<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt;"><!--[if gte vml 1]><v:shapetype
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z-index:251648000'> <v:textbox style='layout-flow:vertical-ideographic'/> </v:shape><![endif]--><!--[if !vml]--><span style="height: 15px; left: 0px; margin-left: 102px; margin-top: 21px; position: absolute; width: 15px; z-index: 251648000;"><img height="15" src="file:///C:/Users/Acer/AppData/Local/Temp/msohtmlclip1/01/clip_image002.gif" v:shapes="_x0000_s1027" width="15" /></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terjadinya suatu peradangan<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt;"><!--[if gte vml 1]><v:shape
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text-align:left;margin-left:78.55pt;margin-top:17.6pt;width:7.15pt;height:8.8pt;
z-index:251649024'> <v:textbox style='layout-flow:vertical-ideographic'/> </v:shape><![endif]--><!--[if !vml]--><span style="height: 15px; left: 0px; margin-left: 102px; margin-top: 22px; position: absolute; width: 15px; z-index: 251649024;"><img height="15" src="file:///C:/Users/Acer/AppData/Local/Temp/msohtmlclip1/01/clip_image003.gif" v:shapes="_x0000_s1028" width="15" /></span><!--[endif]--><!--[if gte vml 1]><v:shapetype id="_x0000_t68"
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o:connectangles="270,180,90,0" textboxrect="@1,@4,@2,21600"/> <v:handles> <v:h position="#1,#0" xrange="0,10800" yrange="0,21600"/> </v:handles> </v:shapetype><v:shape id="_x0000_s1029" type="#_x0000_t68" style='position:absolute;
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height:13.95pt;z-index:251650048'> <v:textbox style='layout-flow:vertical-ideographic'/> </v:shape><![endif]--><!--[if !vml]--><span style="height: 21px; left: 0px; margin-left: 192px; margin-top: 27px; position: absolute; width: 14px; z-index: 251650048;"><img height="21" src="file:///C:/Users/Acer/AppData/Local/Temp/msohtmlclip1/01/clip_image004.gif" v:shapes="_x0000_s1029" width="14" /></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengaktifan komplement<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-indent: 18pt;"><!--[if gte vml 1]><v:shape id="_x0000_s1030" type="#_x0000_t67" style='position:absolute;
left:0;text-align:left;margin-left:78.55pt;margin-top:15.65pt;width:7.15pt;
height:8.05pt;z-index:251651072'> <v:textbox style='layout-flow:vertical-ideographic'/> </v:shape><![endif]--><!--[if !vml]--><span style="height: 13px; left: 0px; margin-left: 102px; margin-top: 20px; position: absolute; width: 15px; z-index: 251651072;"><img height="13" src="file:///C:/Users/Acer/AppData/Local/Temp/msohtmlclip1/01/clip_image005.gif" v:shapes="_x0000_s1030" width="15" /></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Aliran darah keginjal<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt;"><!--[if gte vml 1]><v:rect
id="_x0000_s1031" style='position:absolute;left:0;text-align:left;
margin-left:197.4pt;margin-top:18.4pt;width:116.8pt;height:48.5pt;z-index:251652096'
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style='mso-bidi-font-weight:normal'><span lang=IN>Gangguan perfusi jaringan<o:p></o:p></span></b></p></div><![if !mso]></td> </tr>
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id="_x0000_s1032" type="#_x0000_t67" style='position:absolute;left:0;
text-align:left;margin-left:78.55pt;margin-top:13.95pt;width:7.15pt;height:10.3pt;
z-index:251653120'> <v:textbox style='layout-flow:vertical-ideographic'/> </v:shape><![endif]--><!--[if !vml]--><span style="height: 16px; left: 0px; margin-left: 102px; margin-top: 18px; position: absolute; width: 15px; z-index: 251653120;"><img height="16" src="file:///C:/Users/Acer/AppData/Local/Temp/msohtmlclip1/01/clip_image007.gif" v:shapes="_x0000_s1032" width="15" /></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Permeabilitas kapiler meningkat <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt;"><!--[if gte vml 1]><v:shapetype
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o:connectangles="270,180,90,0" textboxrect="0,@1,@6,@2"/> <v:handles> <v:h position="#0,#1" xrange="0,21600" yrange="0,10800"/> </v:handles> </v:shapetype><v:shape id="_x0000_s1034" type="#_x0000_t13" style='position:absolute;
left:0;text-align:left;margin-left:168pt;margin-top:10.35pt;width:29.4pt;
height:16.7pt;z-index:251655168'/><![endif]--><!--[if !vml]--><span style="height: 26px; left: 0px; margin-left: 223px; margin-top: 11px; position: absolute; width: 42px; z-index: 251655168;"><img height="26" src="file:///C:/Users/Acer/AppData/Local/Temp/msohtmlclip1/01/clip_image009.gif" v:shapes="_x0000_s1034" width="42" /></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Protein plasma dan SDM bocor<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-indent: 18pt;"><!--[if gte vml 1]><v:shape id="_x0000_s1035" type="#_x0000_t67" style='position:absolute;
left:0;text-align:left;margin-left:78.55pt;margin-top:15.15pt;width:7.15pt;
height:11pt;z-index:251656192'> <v:textbox style='layout-flow:vertical-ideographic'/> </v:shape><![endif]--><!--[if !vml]--><span style="height: 17px; left: 0px; margin-left: 102px; margin-top: 19px; position: absolute; width: 15px; z-index: 251656192;"><img height="17" src="file:///C:/Users/Acer/AppData/Local/Temp/msohtmlclip1/01/clip_image010.gif" v:shapes="_x0000_s1035" width="15" /></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Melalui glomerulus <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-indent: 18pt;"><!--[if gte vml 1]><v:shape
id="_x0000_s1036" type="#_x0000_t67" style='position:absolute;left:0;
text-align:left;margin-left:78.55pt;margin-top:14.25pt;width:7.15pt;height:12.5pt;
z-index:251657216'> <v:textbox style='layout-flow:vertical-ideographic'/> </v:shape><![endif]--><!--[if !vml]--><span style="height: 19px; left: 0px; margin-left: 102px; margin-top: 18px; position: absolute; width: 15px; z-index: 251657216;"><img height="19" src="file:///C:/Users/Acer/AppData/Local/Temp/msohtmlclip1/01/clip_image011.gif" v:shapes="_x0000_s1036" width="15" /></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Membran gomerulus rusak <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt;"><!--[if gte vml 1]><v:shape
id="_x0000_s1037" type="#_x0000_t67" style='position:absolute;left:0;
text-align:left;margin-left:304.65pt;margin-top:11.9pt;width:11.55pt;height:14.7pt;
z-index:251658240'> <v:textbox style='layout-flow:vertical-ideographic'/> </v:shape><![endif]--><!--[if !vml]--><span style="height: 22px; left: 0px; margin-left: 403px; margin-top: 15px; position: absolute; width: 21px; z-index: 251658240;"><img height="22" src="file:///C:/Users/Acer/AppData/Local/Temp/msohtmlclip1/01/clip_image012.gif" v:shapes="_x0000_s1037" width="21" /></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terjadi pembengkakan (edema)<span> </span>kelemahan <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-indent: 18pt;"><!--[if gte vml 1]><v:shape
id="_x0000_s1038" type="#_x0000_t67" style='position:absolute;left:0;
text-align:left;margin-left:304.65pt;margin-top:13.2pt;width:9.55pt;height:14.7pt;
z-index:251659264'> <v:textbox style='layout-flow:vertical-ideographic'/> </v:shape><![endif]--><!--[if !vml]--><span style="height: 22px; left: 0px; margin-left: 404px; margin-top: 17px; position: absolute; width: 17px; z-index: 251659264;"><img height="22" src="file:///C:/Users/Acer/AppData/Local/Temp/msohtmlclip1/01/clip_image013.gif" v:shapes="_x0000_s1038" width="17" /></span><!--[endif]--><!--[if gte vml 1]><v:shape id="_x0000_s1039"
type="#_x0000_t67" style='position:absolute;left:0;text-align:left;
margin-left:78.55pt;margin-top:13.2pt;width:7.15pt;height:11pt;z-index:251660288'> <v:textbox style='layout-flow:vertical-ideographic'/> </v:shape><![endif]--><!--[if !vml]--><span style="height: 17px; left: 0px; margin-left: 102px; margin-top: 17px; position: absolute; width: 15px; z-index: 251660288;"><img height="17" src="file:///C:/Users/Acer/AppData/Local/Temp/msohtmlclip1/01/clip_image014.gif" v:shapes="_x0000_s1039" width="15" /></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Diruang intestimum<span> </span>masukan makanan sedikit <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-indent: 18pt;"><!--[if gte vml 1]><v:shape
id="_x0000_s1040" type="#_x0000_t67" style='position:absolute;left:0;
text-align:left;margin-left:298.05pt;margin-top:16.75pt;width:18.15pt;
height:20.55pt;z-index:251661312'> <v:textbox style='layout-flow:vertical-ideographic'/> </v:shape><![endif]--><!--[if !vml]--><span style="height: 30px; left: 0px; margin-left: 395px; margin-top: 21px; position: absolute; width: 29px; z-index: 251661312;"><img height="30" src="file:///C:/Users/Acer/AppData/Local/Temp/msohtmlclip1/01/clip_image015.gif" v:shapes="_x0000_s1040" width="29" /></span><!--[endif]--><!--[if gte vml 1]><v:shape id="_x0000_s1041"
type="#_x0000_t67" style='position:absolute;left:0;text-align:left;
margin-left:270.3pt;margin-top:2.05pt;width:7.15pt;height:14.7pt;z-index:251662336'> <v:textbox style='layout-flow:vertical-ideographic'/> </v:shape><![endif]--><!--[if !vml]--><span style="height: 22px; left: 0px; margin-left: 358px; margin-top: 2px; position: absolute; width: 14px; z-index: 251662336;"><img height="22" src="file:///C:/Users/Acer/AppData/Local/Temp/msohtmlclip1/01/clip_image016.gif" v:shapes="_x0000_s1041" width="14" /></span><!--[endif]--><!--[if gte vml 1]><v:shape id="_x0000_s1042"
type="#_x0000_t67" style='position:absolute;left:0;text-align:left;
margin-left:78.55pt;margin-top:16.75pt;width:7.15pt;height:8.8pt;z-index:251663360'> <v:textbox style='layout-flow:vertical-ideographic'/> </v:shape><![endif]--><!--[if !vml]--><span style="height: 15px; left: 0px; margin-left: 102px; margin-top: 21px; position: absolute; width: 15px; z-index: 251663360;"><img height="15" src="file:///C:/Users/Acer/AppData/Local/Temp/msohtmlclip1/01/clip_image017.gif" v:shapes="_x0000_s1042" width="15" /></span><!--[endif]--><!--[if gte vml 1]><v:shape id="_x0000_s1043"
type="#_x0000_t68" style='position:absolute;left:0;text-align:left;
margin-left:122.45pt;margin-top:2.05pt;width:7.15pt;height:10.3pt;z-index:251664384'> <v:textbox style='layout-flow:vertical-ideographic'/> </v:shape><![endif]--><!--[if !vml]--><span style="height: 16px; left: 0px; margin-left: 161px; margin-top: 1px; position: absolute; width: 14px; z-index: 251664384;"><img height="16" src="file:///C:/Users/Acer/AppData/Local/Temp/msohtmlclip1/01/clip_image018.gif" v:shapes="_x0000_s1043" width="14" /></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tekanan intestimum <span> </span><span> </span>nafsu makan <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-indent: 36pt;"><!--[if gte vml 1]><v:rect
id="_x0000_s1044" style='position:absolute;left:0;text-align:left;
margin-left:246.6pt;margin-top:15.85pt;width:108.75pt;height:61pt;
text-indent:0;z-index:251665408' fillcolor="#4bacc6 [3208]" strokecolor="#f2f2f2 [3041]"
strokeweight="3pt"> <v:shadow on="t" type="perspective" color="#205867 [1608]" opacity=".5"
offset="1pt" offset2="-1pt"/> <v:textbox> <![if !mso]> <table cellpadding=0 cellspacing=0 width="100%"><tr> <td><![endif]> <div> <p class=MsoNormal align=center style='text-align:center'><b
style='mso-bidi-font-weight:normal'><span lang=IN>Gangguan nutrisi, kurang dari kebutuhan tubuh.<o:p></o:p></span></b></p></div><![if !mso]></td> </tr>
</table><![endif]></v:textbox> </v:rect><![endif]--><!--[if !vml]--><span style="height: 93px; left: 0px; margin-left: 326px; margin-top: 19px; position: absolute; width: 156px; z-index: 251665408;"><img alt="Text Box: Gangguan nutrisi, kurang dari kebutuhan tubuh." height="93" src="file:///C:/Users/Acer/AppData/Local/Temp/msohtmlclip1/01/clip_image019.gif" v:shapes="_x0000_s1044" width="156" /></span><!--[endif]--><!--[if gte vml 1]><v:shape
id="_x0000_s1045" type="#_x0000_t67" style='position:absolute;left:0;
text-align:left;margin-left:78.55pt;margin-top:15.85pt;width:7.15pt;height:13.25pt;
z-index:251666432'> <v:textbox style='layout-flow:vertical-ideographic'/> </v:shape><![endif]--><!--[if !vml]--><span style="height: 20px; left: 0px; margin-left: 102px; margin-top: 20px; position: absolute; width: 15px; z-index: 251666432;"><img height="20" src="file:///C:/Users/Acer/AppData/Local/Temp/msohtmlclip1/01/clip_image020.gif" v:shapes="_x0000_s1045" width="15" /></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Glomerulus kolaps<span> </span><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt;"><!--[if gte vml 1]><v:shape
id="_x0000_s1046" type="#_x0000_t67" style='position:absolute;left:0;
text-align:left;margin-left:70.65pt;margin-top:17.45pt;width:21.85pt;height:22.8pt;
z-index:251667456'> <v:textbox style='layout-flow:vertical-ideographic'/> </v:shape><![endif]--><!--[if !vml]--><span style="height: 33px; left: 0px; margin-left: 91px; margin-top: 22px; position: absolute; width: 35px; z-index: 251667456;"><img height="33" src="file:///C:/Users/Acer/AppData/Local/Temp/msohtmlclip1/01/clip_image021.gif" v:shapes="_x0000_s1046" width="35" /></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Retensi cairan <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%;"><!--[if gte vml 1]><v:rect id="_x0000_s1047"
style='position:absolute;margin-left:24pt;margin-top:15.45pt;width:121.95pt;
height:49.95pt;z-index:251668480' fillcolor="#4bacc6 [3208]" strokecolor="#f2f2f2 [3041]"
strokeweight="3pt"> <v:shadow on="t" type="perspective" color="#205867 [1608]" opacity=".5"
offset="1pt" offset2="-1pt"/> <v:textbox> <![if !mso]> <table cellpadding=0 cellspacing=0 width="100%"><tr> <td><![endif]> <div> <p class=MsoNormal align=center style='text-align:center'><b
style='mso-bidi-font-weight:normal'><span lang=IN>Gangguan perfusi vol cairan tubuh<o:p></o:p></span></b></p></div><![if !mso]></td> </tr>
</table><![endif]></v:textbox> </v:rect><![endif]--><!--[if !vml]--><span style="height: 78px; margin-left: 30px; margin-top: 18px; position: absolute; width: 172px; z-index: 251668480;"><img alt="Text Box: Gangguan perfusi vol cairan tubuh" height="78" src="file:///C:/Users/Acer/AppData/Local/Temp/msohtmlclip1/01/clip_image022.gif" v:shapes="_x0000_s1047" width="172" /></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span><span> </span><span> </span><span> </span><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 54pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><!--[endif]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">DIAGNOSA, INTERVENSI DAN RASIONAL<o:p></o:p></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 42.55pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><!--[endif]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelebihan volume cairan berhubungan dengan faktor kerusakan kapiler glomerulus sekunder terhadap proses inflamasi.<o:p></o:p></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 92.7pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>Ø<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Batasan karakteristik: edema, hipertensi, penurunan haluaran urine bermakna dibandingkan dengan masukan cairan, peningkatan TD, peningkatan berat badan, hipernatremia.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 92.7pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>Ø<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hasil pasien (kolaboratif) : mmendemonstrasikan ekuilibrium cairan dan biokimia.<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 92.7pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>Ø<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kriteria evaluasi: TD antara 90/60-120/90 mmHg, natrium serum dalam batas normal, penurunan berat badan. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">INTERVENSI <o:p></o:p></span></b></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pantau: <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kecenderungan berat jenis urine dan proteinuria.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Masukan dan haluaran setiap 2-4 jam.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hasil laporan laboratorium serum: elektrollit, kreatinin, albumin.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Status umum (apendiks F) setiap 8 jam.<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Timbang berat badan setiap hari (timbangan, waktu, dan jumlah pakaian<span> </span>sama.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">RASIONAL <o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Untuk mengidektifikasi kemajuan ke arah atau penyimpangan dari hasil yang diharapkan. <o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan diuretik loop yang diprogramkan dan evaluasi efektivitasnya: resolusi edema, bunyi paru bersih, penurunan TD, peningkatan haluaran urine, penurunan berat badan, natrium serum dalam batas normal.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">RASIONAL <o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hipertensi pada glomerulonefritis akut lebih tergantung pada volume daripada renin. Diuretik mengeluarkan kelebihan cairan tubuh. Hiponatremia, hipokalemia, dan asidosis metabolik hipokeromik dapat terjadi dengan terapi diuretik agresif. <o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Beri tahu dokter tentang temuan yang menandakan berkembangnya insufisiensi ginjal yang meliputi BUN dan kratinin serum, dan penurunan secara kontinu haluaran urine disertai dengan perubanhan mental. Berikan obat yang diresepkan (agen sitotoksik seperti Cytoxan atau kortikosteroid seperti prednison) untuk mencegah kerusakan glomerulus lanjut bila perkembangan glomerulonefritis berjalan cepat. Evaluasi efektivitasnya. Jadwalkan obat untuk mencapai efektivitas terapeutik maksimum dan hindari interaksi merugikan antara obat dengan obat. Konsul pada referensi farmakologi atau farmasis bila diperlukan.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">RASIONAL <o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Tindakan awal untuk progresi glomerulonefritis adalah agen imunosupresif. Tindakan segera diperlukan untuk mencegah penyakit ginjal tahap akhir. Agen Cytotoxic menghambat deposisi kompleks imun di glomerulus, sedangkan kortikosterid mengurangi inflamasi pada glomerulus. <o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Konsul dokter bila manofesstasi kelebihan cairan menetap atau memburuk terhadap tindakan. Siapkan untuk hemodialisa atau dialisa peritoneal bila dipesankan. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">RASIONAL <o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Dialisa mungkin sementara diperlukan untuk mengeluarkan produk sisa nitrogen dan kelebihan cairan sampai fungsi glomerulus diperbaiki. <o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 1cm; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nutrisi kurang dari kebutuhan tubuh berhubungan dengan faktor anoreksia dan kehilangan protin sekunder terhadap kerusakan glomerulus. </span></b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 60.55pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>Ø<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Batasan karakteristik: penggunaan otot, kelemahan, masukan makanan sedikit, keluhan penurunan napsu makan, proteinuria. <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 60.55pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>Ø<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hasil pasien (kolaboratif): mendemostrasikan tak ada lagi kekurangan nutrisi.<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 60.55pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>Ø<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kriteria evaluasi: berat badan stabil, peningkatan masukan makanan, nilai-nilai laboratorium dalam batas normal. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">INTERVENSI <o:p></o:p></span></b></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pantau: <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hasil albumin, protein, hemoglobin, hematorit, BUN, dan kreatinin serum.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Persentase makanan yang dikomsumsi pada sekali makan. <o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Timbang berat badan setiap minggu. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">RASIONAL <o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengidentifikasi indikasi kemajuan ke arah atau penyimmpangan dari hasil yang diharapkan. Hemoglobin dan hematokrit rendah menyebabkan sedikit oksigen yang tersedia untuk digunakan oleh tubuh, mengakibatkan kelelahan. Peningkatan BUM dan kreatinin serum menandakan insufissiensi ginjal dan kebutuhan dialisa. <o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan lingkungan yang nyaman, bebas bau pada saat makan. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">RASIONAL <o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nyeri dan bau menyebabkan anoreksia. <o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan makanan sedikit dan sering. Berikan permen keras dan es batu bila pasien pada pembatasan cairan mengalami haus. Alokasikan waktu pemmberian cairan sehingga pasien menerima sesuatu untuk diminum saat interval reguler dan pada saat makan dan minum obat. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">RASIONAL <o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Makanan sedikit kemungkinan menyebabkan distensi gaster, sehingga menurunkan mual. Batu es dan cairan melumasi mulut dan mencegah<span> </span>mukosa oral kering. Permen juga membantu memperbaiki rasa pada mulut. <o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rujuk pasien pada ahli diet untuk instruksikan tentang modifikasi diet yang diprogramkan,<span> </span>seperti pembatasan masukan natrium untuk glomerulonefritis akut bila oliguria. Jelaskan bahwa natrium dibatasi untuk membantu menghilangkan retensi cairan . <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">RASIONAL <o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span><span> </span>Ahli diet adalah spesialis dalam bidang nutrisi dan dapat membantu pasien memahami hubungan antara penyakit glomerulus dan pembatasan diet dan memilih makanan yang memenuhi kebutuhan nutrsi relatif terhadap pembatasan diet. Kepatuhan ditingkatkan bila pasien memahami hubungan antara kondisi mereka dan terapi yang diprogramkan. <o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan sumber protein dan kalori optimal pada diet bila albumin serum rendah secara bermakna. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">RASIONAL <o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Diet tinggi protein dapat mencegah keseimbangan nitrogen negatif, yang terjadi pada proteinuria masif. Karbohidrat untuk mengsuplai kalori yang digunakan<span> </span>pada efek pemecahan protein. <o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anjurkan ambulasi dan sosialisasi untuk toleransi.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">RASIONAL<o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Latihan meningkatkan peristaltik yang membantu merangsang nafsu makan. Sosialisasi menghilangkan defresi, yang sering terjadi pada berbagai derajat selama penyakit kronik dan akut. <o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 1cm; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gangguan perfusi jaringan serebral yang berhubungan dengan retensi air dan hipernatremia. </span></b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 74.95pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>Ø<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hasil yang diharapkan: memiliki perfusi jaringan normal yang ditandai oleh tekanan darah normal, penurunan retensi cairan, dan tidak ada tanda hipernatremia. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">INTERVENSI<o:p></o:p></span></b></div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 21.3pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pantau dan catat tekanan darah setiap 1-2 jam selama fase akut.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">RASIONAL <o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Pemantauan sering memungkinkandeteksi dini, dan penanganan segera terhadap perubahan tekanan darah anak. <o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 21.3pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Lakukan tindakan kewaspadaan berikut ini bila terjadi kejang:<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 74.95pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>Ø<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pertahankan jalan napas melalui mulut.<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 74.95pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="IN" style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>Ø<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sematkan tanda di atas temppat tidur dan pada pintu, berisi peringatan tentang status kejang anak ditujukan untuk petugas kesehatan. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">RASIONAL <o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Melakukan tindak kewaspadaan bila terjadi kejang dapat mencegah cedera selama episode serangan kejang. Kendati tidak umum pada glomerulonefritis akut, kejang dapat terjadi akibat kurang perfusi oksigen ke otak. <o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 21.3pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Beri obat anthipertensi, misalnya, hidralazin hidroksida (Aperesline) sesuai program. Ppantau anak untuk adanya efek samping. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">RASIONAL <o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemberian obat antihipertensi dapat diprogramkan, karena hipertensi tidak terkontrol dapat menyebabkan kerusakan ginjal. Kendati penyebab persis hipertensi tidak diketahui, hipertensi mungkin berhubungan dengan kelebihan beban cairan di dalam sistem sirkulasi. <o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 21.3pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pantau status volume cairan anak setiap 1-2 jam. Pantau haluaran urine, haluaran harus 1-22 ml/kg/jam.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 3.3pt; text-align: justify;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">RASIONAL <o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; margin-left: 3.3pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Pemantauan sangat penting dilakukan, karena penambahan volume lebih lanjut akan meningkatkan tekanan darah. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>D.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><!--[endif]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">IMPLEMENTASI<span> </span><o:p></o:p></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: 18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Implementasi dilakukan sesuai dengan intervensi yang ditetapkan dan sesuai dengan masalah prioritas pasien .<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: 18pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 10pt; line-height: 150%;"><span>E.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><!--[endif]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">EVALUASI <o:p></o:p></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Keseimbangan cairan dan elektrolit dapat dipertahankan.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kebutuhan nutrisi klien kembali adekuat.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><!--[endif]--><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Risiko tinggi terhadap infeksi kembali adekuat.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify;"><br />
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</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">DAFTAR PUSTAKA </span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-indent: 36pt;"><span lang="DE-LU" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Salam, Nur. 2008<i>. Asuhan Keperawatan Gangguan Ginjal. </i>Jabar. Salemba medika.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Engram, Barbara. 1994. <i>Rencana Asuhan Keperawatan Medikal-Bedah Vol. 1. </i>Jakarta. EGC.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Smeltzer, Suzanne C. 2002. <i>Keperawatan Medikal-Bedah Vol 2. </i>Jakarta. EGC. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Speer, Kathleen Morgan. 2002. <i>Rencana Asuhan Keperawatan Pediatrik Edisi 3.</i> Jakarta. EGC. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Syaifuddin. 2009. <i>Anatomi Fisiologi Manusia untuk Mahasiswa Keperawatan Edisi 2.</i> Jakarta. Salemba Medika. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-indent: 36pt;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 72pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span><span> </span><o:p></o:p></span></div><div class="MsoNormal"><br />
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<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB I<o:p></o:p></span></div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PENDAHULUAN<o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">LATAR BELAKANG<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Upaya peningkatan derajat kesehatan secara optimal menuntut profesi keperawatan mengembangkan mutu pelayanan yang profesional sesuai dengan tuntutan masyarakat di era globalisasi. Keperawatan menjadi salah satu profesi terdepan bagi tenaga kesehatan dalam upaya menjaga mutu tempat pelayanan kesehatan baik di masyarakat baik negeri maupun swasta. Dokumentasi keperawatan dalam bentuk dokumen asuhan keperawatan merupakan salah satu alat pembuktian atas perbuatan perawat selama menjalankan tugas pelayanan keperawatan. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dokumentasi asuhan keperawatan menjadikan hal yang penting sebagai alat bukti tanggung jawab dan tanggung gugat dari perawat dalam menjalankan tugasnya. Perawat profesional dihadapkan pada suatu tuntutan tanggung jawab yang lebih tinggi dan tanggung gugat setiap tindakan yang dilaksanakan. Artinya intervensi keperawatan yang diberikan kepada klien harus dihindarkan terjadinya kesalahan - kesalahan (negligence) dengan melakukan pendekatan proses kepeerawatan dan pendokumentasian yang akurat dan benar. Untuk mengetahui proses keperawatan akan kami jelaskan di bab- bab berikutnya.<o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">RUMUSAN MASALAH <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Apakah yang di maksud dengan dokumentasi proses keperawatan ?<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagaimanakah proses keperawatan itu ?<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">TUJUAN PENULISAN <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Agar kita dapat mengetahui defenisi dan seluk beluk mengenai dokumentasi proses keperawatan.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Agar kita dapat memahami proses keperawatan.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>D.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">MANFAAT <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">kita dapat mengetahui defenisi dan seluk beluk mengenai dokumentasi proses keperawatan.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">kita dapat memahami proses keperawatan<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: justify;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB II<o:p></o:p></span></div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PEMBAHASAN<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">DEFENISI<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dokumentasi merupakan segala sesuatu yang ditulis atau dicetak , yang dapat dipercaya sebagai bukti kewenangan individu (Edelstein, 1990). Sedangkan proses keperawatan adalah metoda sistematis yang mengarahkan klien dan perawat untuk bersama-sama menetapkan kebutuhan terhadap asuhan, merencanakan dan melaksanakan asuhan, serta mengevaluasi hasil asuhan. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: 18pt;"><span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Proses keperawatan adalah suatu metode yang sistematis dan terorganisasi dalam pemberian asuhan keperawatan, yang difokuskan pada reaksi dan respon untuk individu pada suatu kelompok atau perorangan terhadap gangguan kesehatan yang dialami. Baik aktual maupun potensial proses keperawatan juga dapat diartikan sebagai pendekatan yang digunakan perawat dalam memberikan asuhan keperawatan sehingga kebutuhan dasar klien dapat terpenuhi.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 17.85pt; text-align: justify; text-indent: 17.85pt;"><span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Seiring dengan perkembangan keperawatan, keilmuan dalam praktek keperawatanpun turut berkembang berbagai penelitian berdasarkan fenomena yang ada di dunia pelayanan keperawatan dilakukan. Asuhan keperawatan merupakan tulang punggung pelayanan yang terintegrasi dalam pelayanan kesehatan di rumah sakit. Mutu pelayanan keperawatan ditentukan oleh perawat yang kompeten di bidangnya.<o:p></o:p></span></div><div style="line-height: 150%; margin: 0cm 0cm 0.0001pt 17.85pt; text-align: justify; text-indent: 17.85pt;">Pencatatan proses keperawatan merupakan metode yang tepat umtuk pengambilan keputusan yang sistematis, problem solving, dan riset lebih lanjut. Dokumentasi proses keperawatan mencakup pengkajian, identifikasi masalah, perencanaan, dan tindakan. Perawat kemudian Mengobservasi dan mengevaluasi respon klien terhadap tindakan yang diberikan, dan mengkomunikasikan informasi tersebut kepada tenaga kesehatan lainnya.</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: 18pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PROSES DOKUMENTASI KEPERAWATAN<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PENGKAJIAN KEPERAWATAN<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1) Definisi <o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify; text-indent: 20.7pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengkajian keperawatan suatu kegiatan pemeriksaan dan atau peninjauan terhadap situasi / kondisi yang dialami pasien / klien untuk tujuan perumusan masalah / diagnosa keperawatan <o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; text-align: justify; text-indent: 20.7pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Pengkajian keperawatan : tahap pertama dari proses keperawatan dimana pengumpulan data dilakukan dengan tujuan mengidentifikasi masalah aktual atau potensial / risiko. </span><span lang="FI" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada tahap pengkajian kegiatan yang dilakukan adalah pengumpulan data, seperti riwayat keperawatan, pemeriksaan fisik dan pemeriksaan data sekunder lainnya (catatan hasil pemeriksaan diagnostik dan literatur).dokumentasi proses keperawatan merupakan catan tentang hasil pengkajian yang di laksakan untuk mengumpulkan informasi dari pasien, membuat data dasar tentang klien, dan membuat catan tentang respon kesehatan klien. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2) Kegiatan Dalam Pengkajian <o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Pengumpulan <span> </span>data <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengumpulan data menggunakan berbagai metode seperti observasi( data yang di kumpulkan berasal dari pengamatan) , wawancara ( bertujuan mendapatkan respon dari klien dengan cara tatap muka), konsultasi, pemeriksaan fisik, pemeriksaan laboratorium, ataupun pemeriksaan tambahan. <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Validasi data <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Meyakinkan apakah data yang telah dikumpulkan nyata benar atau meragukan <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Organisasi data <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengelompokan data ke dalam kelompok informasi yang dapat membantu dalam mengidentifikasi pola kesehatan / penyakit <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Identifikasi pola / masalah <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Membuat kesan awal tentang pola informasi dan penambahan data yang diperlukan untuk mengisi kekurangan, dalam upaya menggambarkan masalah keperawatan lebih jelas. <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Koleksi Data <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ruang lingkup koleksi data<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Mengidentifikasi informasi tentang : nama, umur, jenis kelamin, pekerjaan, dll </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Persepsi klien terhadap sakit atau gejala klinis yang dirasakan </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Stressor yang mempengaruhi kesehatan klien dan cara penanganannya <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Gaya hidup dan pengaruh sakit terhadap ADL <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Faktor sosbud yang mempengaruhi kesehatan <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Tingkat perkembangan dan kebutuhan <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ruang Lingkup koleksi data <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">- Kebutuhan dasar fisiologik dan psikologik <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">- Sumber-sumber kekuatan <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">- Kekurangan / kelemahan / keterbatasan fisik <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">- Kemampuan intelektual, motivasi, dan ketermapilan belajar </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">- Harapan klien terhadap perawatan <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">- Pengalamanan yang lalu tentang pelayanan kesehatan<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jenis Data <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1. ) Data Objektif <o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">- <span> </span>Disebut juga tanda (sign) <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">- Diperoleh berdasarkan observasi atau pemeriksaan <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Contoh : hasil pengukuran tanda vital (Td, N, RR, S) Bb pemeriksaan laboratorium <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span><span> </span>2.) Data Subjektif<o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">- Disebut juga gejala (symptom)<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">- Ungkapan atau pernyataan klien / keluarga tentang yang dirasakan </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">- Contoh : klien merasa nyeri, khawatir <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Karakteristik data yang baik <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">- Lengkap <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">- Akurat dan nyata <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">- Relevan<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>g.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengorganisasian Data <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a.) Mengelompokan data berdasarkan kerangka kerja yang dapat membantu mengidentifikasi masalah keperawatan <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b. ) Metode pengorganisasian data :<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">- Berdasarkan hirarki kebutuhan “Maslow” <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">- Berdasarkan pola fungsi kesehatan “Gordon” <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Pola persepsi penanganan kesehatan <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Pola nutrisi metabolisme <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Pola eliminasi <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Pola aktifitas latihan <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Pola istirahat – tidur <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Pola persepsi diri – konsep diri <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Pola hubungan peran <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Pola sexual – reproduksi <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 108pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Pola koping – stress – toleransi <o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 108pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Pola sistem nilai – kepercayaan<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan dokumentasi pengkajian : <o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; line-height: 150%;"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengidentifikasi berbagai kebutuhan dan respon pasien terhadap masalah yang dapat mempengaruhi perawatan<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; line-height: 150%;"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk konsolidasi dan organisasi informasi yang di dapat dari berbagai sumber tentang masalah kesehatan pasien sehingga dapat di analisis dan di identifikasi<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; line-height: 150%;"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk dapat di jadikan sebagai ukuran dalam mencapai atau mendapatkan informasi<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; line-height: 150%;"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengidentifikasi berbagai macam karakteristik serta kondisi pasien dan respon yang akan mempengaruhi perencanaan keperawatan<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; line-height: 150%;"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk menyediakan dasar pemikiran dalam rencana keperawatan. <o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">DIAGNOSA KEPERAWATAN <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Defenisi </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Diagnosa keperawatan adalah struktur dan proses<span> </span>atau<span> </span></span><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pernyataan singkat dan jelas tentang masalah kesehatan pasien. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Struktur diagnosa keperawatan komponennya tergantung pada tipenya, antara lain:</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div style="line-height: 150%; margin-left: 46.35pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><b><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><strong>Diagnosa keperawatan aktual (Actual Nursing Diagnoses).</strong><br />
Diagnosa keperawatan aktual menyajikan keadaan yang secara klinis telah divalidasi melalui batasan karakteristik mayor yang dapat diidentifikasi. Tipe dari diagnosa keperawatan ini mempunyai empat komponen yaitu label, definisi, batasan karakteristik, dan faktor-faktor yang berhubungan (Craven & Hirnle, 2000; Carpenito, 1997).</div><div style="line-height: 150%; margin-left: 46.35pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><b><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><strong>Diagnosa keperawatan risiko dan risiko tinggi (Risk and High-Risk Nursing Diagnoses),</strong> adalah keputusan klinis bahwa individu, keluarga dan masyarakat sangat rentan untuk mengalami masalah bila tidak diantisipasi oleh tenaga keperawatan, dibanding yang lain pada situasi yang sama atau hampir sama (Craven & Hirnle, 2000; Carpenito, 1997).</div><div style="line-height: 150%; margin-left: 46.35pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><b><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><strong>Diagnosa keperawatan kemungkinan (Possible Nursing Diagnoses),</strong> adalah pernyataan tentang masalah-masalah yang diduga masih memerlukan data tambahan. Namun banyak perawat-perawat telah diperkenalkan untuk menghindari sesuatu yang bersifat sementara dan NANDA tidak mengeluarkan diagnosa keperawatan untuk jenis ini (Craven & Hirnle, 2000; Carpenito, 1997).</div><div style="line-height: 150%; margin-left: 46.35pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><b><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><strong>Diagnosa keperawatan sejahtera (Wellness Nursing Diagnoses)</strong>, adalah ketentuan klinis mengenai individu, keluarga dan masyarakat dalam transisi dari tingkat kesehatan khusus ketingkat kesehatan yang lebih baik. Pernyataan diagnostik untuk diagnosa keperawatan sejahtera merupakan bagian dari pernyataan yang berisikan hanya sebuah label. Label ini dimulai dengan “Potensial terhadap peningkatan…….”, diikuti tingkat sejahtera yang lebih tinggi yang dikehendaki oleh individu atau keluarga, misal “Potensial terhadap peningkatan proses keluarga” (Craven & Hirnle, 2000; Carpenito, 1997).</div><div style="line-height: 150%; margin-left: 46.35pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><b><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><!--[endif]--><strong>Diagnosa keperawatan sindroma (Syndrome Nursing Diagnoses)</strong>, terdiri dari sekelompok diagnosa keperawatan aktual atau risiko tinggi yang diduga akan tampak karena suatu kejadian atau situasi tertentu. NANDA telah menyetujui dua diagnosa keperawatan sindrom yaitu “Sindrom trauma perkosaan” dan “Risiko terhadap sindrom disuse” (Carpenito, 1997).</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Proses pemecahaan masalah mencakup : <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Identifikasi masalah, gangguan kesehatan atau kebutuhan pelayanan keperawatan <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mencari dan menentukan penyebab permasalahan <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Menentukan tanda dan gejala dari masalah<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">problem (masalah), etiologi (penyebab), dan sign/symptom (tanda/ gejala).<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><!--[endif]--><strong><span style="font-size: 12pt; line-height: 150%;">Problem (masalah)</span></strong><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">, adalah gambaran keadaan klien dimana tindakan keperawatan dapat diberikan karena adanya kesenjangan atau penyimpangan dari keadaan normal yang seharusnya tidak terjadi.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><!--[endif]--><strong><span style="font-size: 12pt; line-height: 150%;">Etiologi (penyebab),</span></strong><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> adalah keadaan yang menunjukkan penyebab terjadinya problem (masalah).</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><!--[endif]--><strong><span style="font-size: 12pt; line-height: 150%;">Sign/symptom (tanda/ gejala),</span></strong><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> adalah ciri, tanda atau gejala relevan yang muncul sebagai akibat adanya masalah.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Metode dokumentasi diagnose keperawatan :<o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gunakan format PES untuk semua masalah actual dan PE untuk masalah resiko<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Catat diagnose keperawatan risiko dan risiko tinggi ke dalam masalah atau format diagnose keperawatan<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gunakan diagnose keperawatan yang di buat dari diagnose NANDA atau lainnya<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mulai pernyataan diagnose keperawatan ke dalam daftar masalah<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hubungkan setiap diagnose keperwatan ketika menemukan masalah keperawatan<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gunakan diagnose keperawatan sebagai pedoman untuk pengkaj8ian, perencanaa, pelaksanaan dan evaluasi. <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-indent: 36pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Contoh Penulisan Diagnosa :</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 72pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">“Gangguan Nutrisi kurang dari kebutuhan berhubungan dengan mual dan muntah “</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan diagnose keperawatan :<o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Masalah di mana adanya respon klien terhadap status kesehatan atau penyakit<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Factor- factor yang menunjang atau menyebabkan suatu masalah ( etiologis)<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dan kemampuan klie untuk mencegah atau menyelesaikan masalah. <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">INTERVENSI KEPERAWATAN <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 32.2pt; text-align: justify; text-indent: -14.2pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perumusan tujuan : <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Berfokus pada masyarakat <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Jelas dan singkat <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Dapat diukur dan diobservasi <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Realistis <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Ada target waktu <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Melibatkan peran serta masyarakat <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 35.45pt; text-align: justify; text-indent: -21.25pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b. Rencana tindakan <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Tetapkan tehnik dan prosedur yang akan digunakan </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Mengarah pada tujuan yang akan dicapai </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Realistis <o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Disusun berurutan dan ada rasionalnya <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 14.2pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c. Kriteria hasil <o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Menggunakan kata kerja yang tepat <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Dapat dimodifikasi <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Spesifik <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pentingnya dokumentasi rencana asuhan keperawatan :<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1. Berisikan informasi yang penting dan jelas </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2. Sebagai alat komunikasi antara perawat dan perawat</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3. Memudahkan melaaksanakan maslah keperawatan yang bekelanjutan.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">4. Dokumentasi yang ekslusif untuk pencatatan hasil yang diharapkan untuk pasien.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan dokumentasi tahap perencanaan :</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1. Sebagai kerangka kerja dalam implementasi keperawatan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2. Merupakan inti dokumentasi keperawatan yang berorientasi pada maslah</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3. Sebagai referensi dalam melkukan modifikasi rencana keperawatan <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">4. Sarana komunikasi tim keperawatan dalam pendelegasian tugas /instruksi keperawatan<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">5. Sebagai landasan ilmiah yang logis dan sistimatis dalam mengerjakan asuhan keperawatankepada pasien.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">6. Agar semua rencan tindakan dapat dipilih disesuaikan kondisi klien sehingga efektif.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hal-hal yang didokumentasikan pada tahap perencanaan :</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1. Seperangkat tujuan dan kriteria hasil sesuai dengan prioritas masalah.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2. Tindakan keperawatan mandiri diprioritaskan kemudian tindakan keperawatan kolaborasi.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3. Pendidikan kesehatan kepada klien dan atau kepada keluarga.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">4. Rencana tindakan harus logis dan operasional</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">5. Berikan tanda tangan dan nama jelas<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%;"><br />
</div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 18pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">IMPLEMENTASI KEPERAWATAN </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">- Merupakan pelaksanaan rencana intervensi keperawatan <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">- Terdiri semua aktivitas yang dilakukan oleh perawat dan klien untuk merubah efek dari masalah dilakukan oleh : <o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a. Perawat <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b. Perawat dan klien <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c. Perawat dan keluarga <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">d. Perawat, klien dan keluarga <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">e. Tenaga non keperawatan lain <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dan k</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">egiatan yang dilakukan : <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1. Melanjutkan pengumpulan data dan pengkajian.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada saat melakukan kegiatan perawat tetap menjalankan pengkajian dan pengumpulan data. Contoh : Saat melakukan prosedur memandikan pasien ditempat tidur atau saat melakukan backrub, perawat akan memperoleh data tentang status fisik seperti kondisi kulitnya dan kemampouan pergerakannya </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2. Melaksanakan intervensi keperawatan <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3. Mendokumentasikan asuhan keperawatan <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">4. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Memberikan laporan keperawatan secara verbal <o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">5. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mempertahankan rencana asuhan<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-indent: 36pt;"><b><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan Dokumentasi Pelaksanaan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1. Mengevaluasi kondisi kesehatan pasien dalam periode yang singkat (evaluasi formatif) setelah tindakan dilakukan.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2. Mengetahui jumlah tenaga/jenis tenaga kesehatan yang terlihat langsung memberikan pelayanan kesehatan kepada pasien.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -14.15pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3. Mengetahui jenis tindakan keperawatan yang telah diberikan.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -14.15pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">4. Mengetahui pendidikan kesehatan yang telah diberikan.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -14.15pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">5. Dokumentasi legal intervensi keperawatan yang telah diberikan kepada klien dan keluarganya</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-indent: 36pt;"><b><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hal-hal yang perlu didokumentasikan pada tahap implementasi :</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -14.15pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1. Mencatat waktu dan tanggal pelaksanaan.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -14.15pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mencatat diagnosa keperawatan nomor berapa yang dilakukan intervensi tersebut<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -14.15pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3. Mencatat semua jenis intervensi keperawatan termasuk hasilnya<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: 36pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Contoh : Mengornpres luka dengan betadin 5 %</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Flasil : luka tampak bersih, pus tidak ada, tidak berbau<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -14.15pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">4. Berikan tanda tangan dan nama jelas perawat satu tim kesehatan yang telah melakukan intervensi</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-indent: 35.45pt;"><b><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Petunjuk Pendokumentasian Pelaksaaan (Implementasi)</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1. Gunakan ballpoint tertulis jelas, tulis dengan huruf cetak bila tulisan tidak jelas. Bila salah tidak boleh di tipp ex tetapi dicoret saja, dan ditulis kembali diatas atau disamping.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-indent: 36pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Contoh: RR: 24 kali/menit, Seharusnya RR: 42 kali/menit</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 72pt;"><s><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">RR: 24 kali/menit</span></s><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">, RR : 42 kali / menit</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2. Jangan lupa selalu menuliskan waktu, jam pelaksanaan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-indent: 35.45pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Contoh 28 Mei 2008, pukul 18.00, memonitor tanda vital<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-indent: 35.45pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">RR : 42 kali/menit</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-indent: 35.45pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Suhu : 39 C</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-indent: 35.45pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nadi : 98 kali/menit</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-indent: 35.45pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">TD :140/90 mmHg<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3. Jangan membiarkan baris </span><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">kosong</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">, tetapi buatlah garis kesamping untuk mengisi tempat yang tidak digunakan<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-indent: 35.45pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Contoh: Mengukur suhu klien, hasil: suhu 39 C Hartifah, R.N<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">4. Dokumentasikan sesegera mungkin setelah tindakan dilaksanakan guna menghindari kealpaan (lupa)<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">5. Gunakan kata kerja akif, untuk menjelaskan apa yang dikerjakon.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-indent: 36pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Contoh : Memberikan obat tetes mata</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">6. Dokumentasikan bagaimana respon pasien terhadap tindakan yang dilakukan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">7. </span><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dokumentesikan aspek keamanan, kenyamanan dan pengawasan infeksi terhadap klien. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Juga tindakan-tindakan invasive harus dicatat.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-indent: 36pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Contoh : Memberikan kompres betadin pacia lokasi tusukan infus</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">8. Dokumentasikan pula modifikasi lingkungan bila itu merupakan bagian dari tindakan keperawatan.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Contoh : Membatasi pengunjung, agar pasien dapat istirahat<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">9. Dokumentasikan.persetujuan keluarga untuk prosedur khusus dan tindakan invasif yang mempunyai resiko tambahan.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">10.Dokumentasikan semua informasi yang diberikan dan pendidikan kesehatan yang diberikan.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">11.Dokumentasikan dengan jelas, lengkap, bukan berarti semua kalimat harus ditulis, tetapi kata‑kata kunci dan simbol-simbol / lambang-lambang sudah baku/lazim dapat digunakan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-indent: 35.45pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Contoh: IVFD, NGT, dll</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">12. Spesifik hindarkan penggunaan kata yang tidak jelas,bila perlu tuliskan ungkapan klien untuk memperjelas maksud.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-indent: 35.45pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Contoh : Klien nampak cemas (salah)<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-indent: 35.45pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Klien tidak dapat tidur, sering menekuk kaki sebelah</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-indent: 35.45pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">kanannya dah ia mengatakan "ingin bertemu'.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-indent: 35.45pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">suaminya dulu sebelum mati'</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">13.Rujuk ke petunjuk, kebijakan dan prosedur rumah sakit untuk penggunaan format</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-indent: 35.45pt;"><b><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Manfaat Kegunaan Dokumentasi Implementasi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1. Mengkomunikasikan secara nyata tindakan‑tindakan yang telah dilakukan untuk klien. Hal ini penting untuk :</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 72pt; text-indent: -18pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Menghindarkan kesalahan‑kesalahan seperti duplikasi tindakan, yang seharusnya tidak perlu terjadi</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 72pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Contoh : Pemberian obat sudah diberikan, tetapi tidak dicatat Sehingga diberikan obat kembali</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 72pt; text-indent: -18pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Quality Assurance (menjamin mutu ) yang akan menunjukkan apa yang secara nyata telah dilakukan terhadap klien dan bagaimana hubungannya dengan standar yang telah dibuat</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 72pt; text-indent: -18pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Melihat hubungan respon‑respon klien dengan tindakan keperawatan yang sudah diberikan (evaluasi klinis)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2. Menjadi dasor penentuan tugas<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sistem klasifikasi klien didasarkan pada dokumentasi tindakan keperawatan yang sudah ada, untuk selanjutnya digunakan dalam menentukan jurnal perawat yang harus bartugas dalam setiap shift jaga<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3. Memperkuat pelayanan keperawatan<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jalan keluar dari tindakan malpraktek tergantung pada dokumen-dokumen yang ada.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-indent: 36pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Dokumen tentang kondisi klien</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-indent: 36pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Segala sesuatu yang telah dilakukan untuk k1jen</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-indent: 36pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Kejadian‑kejadian atau kondisi klien sebelum dilakukan tindakan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">4. Menjadi dasar perencanaan anggaran pembelanjaan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 35.45pt; text-indent: 21.85pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dokumen tentang penggunaan alat‑alat dan bahan‑bahan akan membpntu perhitungan anggaran biaya suatu rumah sakit</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -18pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Catatan Keperawatan </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -18pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">- Gunakan tinta yang jelas, menulis dengan huruf cetak / bila tulisan tidak jelas </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">- </span><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menulis pada catatan se</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">segera mungkin setelah memberikan askep <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">- Menulis dengan sebenarnya : bagaimana kapan, dimana kegiatan dilakukan <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -18pt;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">- Selalu membuat nama jelas dan paraf </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">- Catatan meliputi : <o:p></o:p></span></div><ol start="3" type="1"><ul type="disc"><li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengkajian <o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi aktivitas <o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Evaluasi respon <o:p></o:p></span></li>
</ul></ol><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Contoh pencatatan implementasi :<o:p></o:p></span></div><table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; width: 619px;"><tbody>
<tr> <td style="border: 1pt solid windowtext; padding: 0cm 5.4pt; width: 25.5pt;" width="34"> <div class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">No<o:p></o:p></span></div></td> <td style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 67.3pt;" width="90"> <div class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hari / tgl<o:p></o:p></span></div></td> <td style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 38.6pt;" width="51"> <div class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jam<o:p></o:p></span></div></td> <td style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 43.35pt;" width="58"> <div class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">No. dx<o:p></o:p></span></div></td> <td style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 217.65pt;" width="290"> <div class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tindakan keperawatan<o:p></o:p></span></div></td> <td style="border-color: windowtext windowtext windowtext -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 72pt;" width="96"> <div class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">TTD<o:p></o:p></span></div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 25.5pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1<o:p></o:p></span></div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 67.3pt;" valign="top" width="90"> <div class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sabtu <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">7-3-1998<o:p></o:p></span></div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 38.6pt;" valign="top" width="51"> <div class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">08.00<o:p></o:p></span></div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 43.35pt;" valign="top" width="58"> <div class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1<o:p></o:p></span></div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 217.65pt;" valign="top" width="290"> <div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">- Membantu pasien memberi makan <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Respon <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pasien makan habis 1 porsi tidak ada muntah <u>________________________ </u><o:p></o:p></span></div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 72pt;" valign="top" width="96"> <div class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">YUNI<o:p></o:p></span></div></td> </tr>
<tr> <td style="border-color: -moz-use-text-color windowtext windowtext; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 25.5pt;" valign="top" width="34"></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 67.3pt;" valign="top" width="90"></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 38.6pt;" valign="top" width="51"> <div class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">09.00<o:p></o:p></span></div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 43.35pt;" valign="top" width="58"> <div class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2<o:p></o:p></span></div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 217.65pt;" valign="top" width="290"> <div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">- Mengukur tanda vital <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Respon / hasil : <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">TD : 150/90 mmHg <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">S : 37.8<sup>o</sup>C <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">RR : 24 x/mnt <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Klien mengeluh pusing ____________<o:p></o:p></span></div></td> <td style="border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 72pt;" valign="top" width="96"> <div class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">YUNI<o:p></o:p></span></div></td> </tr>
</tbody></table><div class="MsoNormal" style="line-height: 150%;"><br />
</div><div class="MsoNormal" style="line-height: 150%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">5.EVALUASI KEPERWATAN<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengertian </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; line-height: 150%;"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Evaluasi adalah membandingkan suatu hasil / perbuatan dengan standar untuk tujuan pengambilan keputusan yang tepat sejauh mana tujuan tercapai<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; line-height: 150%;"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Evaluasi keperawatan : membandingkan efek / hasil suatu tindakan keperawatan dengan normal atau kriteria tujuan yang sudah dibuat <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; line-height: 150%;"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tahap akhir dari proses keperawatan <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; line-height: 150%;"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menilai tujuan dalam rencana perawatan tercapai atau tidak <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; line-height: 150%;"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menilai efektifitas rencana keperawatan atau strategi askep <o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; line-height: 150%;"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menentukan efektif / tidaknya tindakan keperawatan dan perkembangan pasien terhadap masalah kesehatan </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-indent: 18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tahap Dalam Evaluasi </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; line-height: 150%;"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengidentifikasi kriteria hasil standar untuk mengukur keberhasilan <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; line-height: 150%;"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengumpulkan dat asehubungan dengan kriteria hasil yang telah ditetapkan. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Contoh : dalam waktu 1 mg BB naik ½ kg <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; line-height: 150%;"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengevaluasi pencapaian tujuan dengan membandingkan data yang dikumpulkan dengan kriteria. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Contoh: setelah 1 mg perawat menimbang BB naik ¼ kg <o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Courier New"; font-size: 12pt; line-height: 150%;"><span>o<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Modifikasi rencana keperawatan <o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-indent: 18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tahap Dalam Modifikasi Rencana Keperawatan </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><ol start="3" type="1"><ul type="disc"><li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kumpulkan data untuk menentukan apakah timbul masalah baru atau dx tidak tercapai <o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ubah dx keperawatan / masalah kolaboratif yang tidak tepat, kemudian ganti dengan yang baru <o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Cek kembali daftar dx keperawatan baru dan buat prioritas <o:p></o:p></span></li>
</ul></ol><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-indent: 18pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Macam Evaluasi </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1. Evaluasi formatif <o:p></o:p></span></div><ol start="3" type="1"><ul type="disc"><li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hasil observasi dan analisa perawat terhadap respon pasien segera pada saat / setelah dilakukan tindakan keperawatan <o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ditulis pada catatan perawatan <o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Contoh: membantu pasien duduk semifowler, pasien dapat duduk selama 30 menit tanpa pusing <o:p></o:p></span></li>
</ul></ol><div class="MsoNormal" style="line-height: 150%; margin-left: 54pt; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2. Evaluasi Sumatif SOAPIER <o:p></o:p></span></div><ol start="3" type="1"><ul type="disc"><li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="NL" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rekapitulasi dan kesimpulan dari observasi dan analisa status kesehatan sesuai waktu pada tujuan </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ditulis pada catatan perkembangan<o:p></o:p></span></li>
</ul></ol><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan evaluasi keperawatan:<o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengakhiri rencana tindakan keperawatan( klien telah mencapai tujuan)<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Memodifikasi rencana tindakan kepearawatan( klien mengalami kesulitan untuk mencapai tujuan)<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Meneruskana rencana tindakan( klien memetlukan waktu yang lebih lama untuk mencapai tujuan)<o:p></o:p></span></div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center; text-indent: 20.7pt;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center; text-indent: 20.7pt;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center; text-indent: 20.7pt;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center; text-indent: 20.7pt;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center; text-indent: 20.7pt;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center; text-indent: 20.7pt;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center; text-indent: 20.7pt;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center; text-indent: 20.7pt;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center; text-indent: 20.7pt;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center; text-indent: 20.7pt;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center; text-indent: 20.7pt;"><br />
</div><div align="center" class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center; text-indent: 20.7pt;"><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 align="center" class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB III<o:p></o:p></span></div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PENUTUP<o:p></o:p></span></div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center; text-indent: 20.7pt;"><br />
</div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">KESIMPULAN<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-indent: 18pt;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Proses keperawatan adalah metode yang sistematis, dimana perawat dan klien bekerjasama.Dimana proses keperawatan merupakan kerangka kerja dalam proses keperawatan.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 17.85pt; text-indent: 18pt;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dengan proses keperawatan kita mendapatkan asuhan keperawatan yang efektif dan efisien dengan partisipasi aktif dari klien.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 17.85pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 17.85pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">SARAN <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 17.85pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 17.85pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk membuat asuhan keperawatan yang baik dan efektif sebaiknya kita lebih memahami tentang prosedur dalam pembuatan asuhan keperawatan. Setiap melakukan tindakan hendaknya selalu di sertai dengan pendokumentasian agar kelak bisa di pertanggung jawab. <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify;"><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 align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">DAFTAR PUSTAKA<o:p></o:p></span></div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Aziz alimul (2001). PENGANTAR DOKUMENTASI PROSES KEPERAWATAN. Jakarta :EGC<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nursalam (2001). PROSES & DOKUMENTASI KEPERAWATAN KONSEP DAN PRAKTIK.jakarta : salemba medika<o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><a href="http://kti-akbid.blogspot.com/2011/03/makalah-proses-keperawatan.html"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">http://kti-akbid.blogspot.com/2011/03/makalah-proses-keperawatan.html</span></a><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"> di akses tgl : 28/desember/2011<o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Deswari, 2009. Proses Keperawatan dan Berpikir Kritis, Jakarta : Salemba Medika<o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><a href="http://akhtyo.blogspot.com/2009/04/analisa-dokumentasi-keperawatan-pada.html"><b><span style="font-family: "Times New Roman","serif"; font-size: 13.5pt;">http://akhtyo.blogspot.com/2009/04/analisa-dokumentasi-keperawatan-pada.html</span></b></a><b><span style="font-family: "Times New Roman","serif"; font-size: 13.5pt;"> di akses tgl 23 desember </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><o:p></o:p></span></div><div align="center" class="MsoListParagraph" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: center;"><br />
</div>musdalifah sang pemimpinhttp://www.blogger.com/profile/16028724952062600560noreply@blogger.com0