Senin, 22 Maret 2010
MIDWIFE
MIDWIFE
Midwifery is a health care profession in which providers offer care to childbearing women during their pregnancy, labour and birth, and during the postpartum period. They also care for the newborn through to six weeks of age, including assisting the mother with breastfeeding. Midwives may also offer interconceptional care including well-woman care.
A practitioner of midwifery is known as a midwife, a term used in reference to both women and men. (The etymology of midwife is Middle English: mid = with and Old English: wif = woman). In the United States, nurse-midwives are advance practice nurses (nurse practitioners]). In addition to giving care to women in connection with pregnancy and birth, they also provide primary care to women, well-woman care (gynecological annual exams), family planning, and menopause care.
Midwives are autonomous practitioners who are specialists in low-risk pregnancy, childbirth, and postpartum. They generally strive to help women to have a healthy pregnancy and natural birth experience. Midwives are trained to recognize and deal with deviations from the norm. Obstetricians, in contrast, are specialists in illness related to childbearing and in surgery. The two professions can be complementary, but often are at odds because obstetricians are taught to "actively manage" labor, while midwives are taught not to intervene unless necessary.
Midwives refer women to general practitioners or obstetricians when a pregnant woman requires care beyond the midwives' area of expertise. In many jurisdictions, these professions work together to provide care to childbearing women. In others, only the midwife is available to provide care. Midwives are trained to handle certain situations that may be described as normal variations or may be considered abnormal, including breech births, twin births and births where the baby is in a posterior position, using non-invasive techniques.
Definition
According to the International Confederation of Midwives (a definition that has also been adopted by the World Health Organization and the International Federation of Gynecology and Obstetrics):
A midwife is a person who, having been regularly admitted to a midwifery educational program that is duly recognized in the country in which it is located, has successfully completed the prescribed course of studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery. The educational program may be an apprenticeship, a formal university program, or a combination.
The midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife's own responsibility and to provide care for the infant. This care includes preventive measures, the promotion of normal birth, the detection of complications in mother and child, accessing of medical or other appropriate assistance and the carrying out of emergency measures.
The midwife has an important task in health counseling and education, not only for the woman, but also within the family and community. This work should involve antenatal education and preparation for parenthood and may extend to womens health, sexual or reproductive health and childcare, and to gain the knowledge to counteract the lack of pain relivers and antiseptics.
A midwife may practice in any setting including in the home, the community, hospitals, clinics or health units.
Early historical perspective
In ancient Egypt, midwifery was a recognized female occupation, as attested by the Ebers papyrus which dates from 1900 to 1550 BCE. Five columns of this papyrus deal with obstetrics and gynecology, especially concerning the acceleration of parturition and the birth prognosis of the newborn. The Westcar papyrus, dated to 1700 BCE, includes instructions for calculating the expected date of confinement and describes different styles of birth chairs. Bas reliefs in the royal birth rooms at Luxor and other temples also attest to the heavy presence of midwifery in this culture.
Midwifery in Greco-Roman antiquity covered a wide range of women, including old women who continued folk medical traditions in the villages of the Roman Empire, trained midwives who garnered their knowledge from a variety of sources, and highly trained women who were considered female physicians. However, there were certain characteristics desired in a “good” midwife, as described by the physician Soranus of Ephesus in the second century. He states in his work, Gynecology, that “a suitable person will be literate, with her wits about her, possessed of a good memory, loving work, respectable and generally not unduly handicapped as regards her senses i.e., sight, smell, hearing], sound of limb, robust, and, according to some people, endowed with long slim fingers and short nails at her fingertips.” Soranus also recommends that the midwife be of sympathetic disposition (although she need not have borne a child herself) and that she keep her hands soft for the comfort of both mother and child. Pliny, another physician from this time, valued nobility and a quiet and inconspicuous disposition in a midwife. A woman who possessed this combination of physique, virtue, skill, and education must have been difficult to find in antiquity. Consequently, there appears to have been three “grades” of midwives present in ancient times. The first was technically proficient; the second may have read some of the texts on obstetrics and gynecology; but the third was highly trained and reasonably considered a medical specialist with a concentration in midwifery.
Midwives were known by many different titles in antiquity, ranging from iatrinē, maia, obstetrix, and medica. It appears as though midwifery was treated differently in the Eastern end of the Mediterranean basin as opposed to the West. In the East, some women advanced beyond the profession of midwife (maia) to that of obstetrician (iatros gynaikeios), for which formal training was required. Also, there were some gynecological tracts circulating in the medical and educated circles of the East that were written by women with Greek names, although these women were few in number. Based on these facts, it would appear that midwifery in the East was a respectable profession in which respectable women could earn their livelihoods and enough esteem to publish works read and cited by male physicians. In fact, a number of Roman legal provisions strongly suggest that midwives enjoyed status and remuneration comparable to that of male doctors. One example of such a midwife is Salpe of Lemnos, who wrote on women’s diseases and was mentioned several times in the works of Pliny.
However, in the Roman West, our knowledge of practicing midwives comes mainly from funerary epitaphs. Two hypotheses are suggested by looking at a small sample of these epitaphs. The first is the midwifery was not a profession to which freeborn women of families that had enjoyed free status of several generations were attracted; therefore it seems that most midwives were of servile origin. Second, since most of these funeral epitaphs describe the women as freed, it can be proposed that midwives were generally valued enough, and earned enough income, to be able to gain their freedom. It is not known from these epitaphs how certain slave women were selected for training as midwives. Slave girls may have been apprenticed, and it is most likely that mothers taught their daughters.
The actual duties of the midwife in antiquity consisted mainly of assisting in the birthing process, although they may also have helped with other medical problems relating to women when needed. Often, the midwife would call for the assistance of a physician when a more difficult birth was anticipated. In many cases the midwife brought along two or three assistants. In antiquity, it was believed by both midwives and physicians that a normal delivery was made easier when a woman sat upright. Therefore, during parturition, midwives brought a stool to the home where the delivery was to take place. In the seat of the birthstool was a crescent-shaped hole through which the baby would be delivered. The birthstool or chair often had armrests for the mother to grasp during the delivery. Most birthstools or chairs had backs which the patient could press against, but Soranus suggests that in some cases the chairs were backless and an assistant would stand behind the mother to support her. The midwife sat facing the mother, encouraging and supporting her through the birth, perhaps offering instruction on breathing and pushing, sometimes massaging her vaginal opening, and supporting her perineum during the delivery of the baby. The assistants may have helped by pushing downwards on the top of the mother's abdomen. Finally, the midwife received the infant, placed it in pieces of cloth, cut the umbilical cord, and cleansed the baby. The child was sprinkled with “fine and powdery salt, or natron or aphronitre” to soak up the birth residue, rinsed, and then powdered and rinsed again. Next, the midwives cleared away any and all mucus present from the nose, mouth, ears, or anus. Midwives were encouraged by Soranus to put olive oil in the baby’s eyes to cleanse away any birth residue, and to place a piece of wool soaked in olive oil over the umbilical cord. After the delivery, the midwife made the initial call on whether or not an infant was healthy and fit to rear. She inspected the newborn for congenital deformities and testing its cry to hear whether or not it was robust and hearty. Ultimately, midwives made a determination about the chances for an infant’s survival and likely recommended that a newborn with any severe deformities be exposed.
A second-century terracotta relief from the Ostian tomb of Scribonia Attice, wife of physician-surgeon M. Ulpius Amerimnus, details a childbirth scene. Scribonia was a midwife and the relief shows her in the midst of a delivery. A patient sits in the birthing chair, gripping the handles and the midwife’s assistant stands behind her providing support. Scribonia sits on a low stool in front of the woman, modestly looking away while also assisting the delivery by dilating and massaging the vagina, as encouraged by Soranus.
The services of a midwife were not inexpensive; this fact that suggests poorer women who could not afford the services of a professional midwife often had to make do with female relatives. Many wealthier families had their own midwives. However, the vast majority of women in the Greco-Roman world very likely received their maternity care from hired midwives. They may have been highly trained or only possessed a rudimentary knowledge of obstetrics. Also, many families had a choice of whether or not they wanted to employ a midwife who practiced the traditional folk medicine or the newer methods of professional parturition. Like a lot of other factors in antiquity, quality gynecological care often depended heavily on the socioeconomic status of the patient.
During the Christian era in Europe, midwives became important to the church due to their role in emergency baptisms, and found themselves regulated by Roman Catholic canon law. In Medieval times, childbirth was considered so deadly that the Christian Church told pregnant women to prepare their shrouds and confess their sins in case of death. The Church pointed to Genesis 3:16 as the basis for pain in childbirth, where Eve's punishment for her role in disobeying God was that he would "multiply thy sorrows, and thy conceptions: in sorrow shalt thou bring forth children." A popular medieval saying was, "The better the witch; the better the midwife"; to guard against witchcraft, the Church required midwives to be licensed by a bishop and swear an oath not to use magic when assisting women through labour.
Later historical perspective
In the 18th century, a division between surgeons and midwives arose, as medical men began to assert that their modern scientific processes were better for mothers and infants than the folk-medical midwives.
At the outset of the 18th century in England, most babies were caught by a midwife, but by the onset of the 19th century, the majority of those babies born to persons of means had a surgeon involved. A number of excellent full length studies of this historical shift have been written.
German social scientists Gunnar Heinsohn and Otto Steiger have put forward the theory that midwifery became a target of persecution and repression by public authorities because midwives not only possessed highly specialized knowledge and skills regarding assisting birth, but also regarding contraception and abortion. According to Heinsohn and Steiger's theory, the modern state persecuted the midwives as witches in an effort to repopulate the European continent which had suffered severe loss of manpower as a result of the bubonic plague (also known as the black death) which had swept over the continent in waves, starting in 1348.
They thus interpret the witch hunts as attacking midwifery and knowledge about birth control with a demographic goal in mind. Indeed, after the witch hunts, the number of children per mother rose sharply, giving rise to what has been called the "European population explosion" of modern times, producing an enormous youth bulge that enabled Europe to colonize large parts of the rest of the world.
While historians specializing in the history of the witch hunts have generally remained critical of this macroeconomic approach and continue to favor micro level perspectives and explanations, prominent historian of birth control John M. Riddle has expressed agreement.
United States
There are two main divisions of modern midwifery in the US: nurse-midwives and direct-entry midwives.
Nurse-midwives
Nurse-midwives were introduced in the United States in 1925 by Mary Breckinridge for use in the Frontier Nursing Service (FNS). Mrs. Breckinridge chose the nurse-midwifery model used in England and Scotland because she expected these nurse-midwives on horseback to serve the health care needs of the families living in the remote hills of eastern Kentucky. This combination of nurse and midwife was very successful. The Metropolitan Life Insurance Company studied the first seven years of the FNS, and reported a substantially lower maternal and infant mortality rate than for the rest of the country. The report concluded that if this type of care was available to other women in the USA thousands of lives would be saved, and suggested nurse-midwife training should be done in the USA. Mrs. Breckinridge opened the Frontier Graduate School of Midwifery in 1939 the first nurse-midwifery education program in the USA. The Frontier School is still educating nurse-midwives today but in a new way. In 1989 the program became the first distance option for nurses to become nurse-midwives without leaving their home communities. The students do their academic work on-line with the Frontier School of Midwifery and Family Nursing faculty members and they do their clinical practice with a nurse-midwife in their community who is credentialed by Frontier as a clinical faculty member. This community based model has graduated over 1200 nurse-midwives.
In the United States, nurse-midwives are variably licenced depending on the state as advanced practice nurses, midwives or nurse-midwives. Certified Nurse-Midwives are educated in both nursing and midwifery and provide gynecological and midwifery care of relatively healthy women. In addition to licensure, many nurse-midwives have a master's degree in nursing, public health, or midwifery. Nurse-midwives practice in hospitals, medical clinics and private offices and may deliver babies in hospitals, birth centers and at home. They are able to prescribe medications in all 50 states. Nurse-midwives provide care to women from puberty through menopause. Nurse-midwives may work closely with obstetricians, who provide consultation and assistance to patients who develop complications. Often, women with high risk pregnancies can receive the benefits of midwifery care from a nurse-midwife in collaboration with a physician. Currently, 2% of nurse-midwives are men. The American College of Nurse-Midwives accredits nurse-midwifery/midwifery education programs and serves as the national professional society for the nation's certified nurse-midwives and certified midwives. Upon graduation from these programs, graduates sit for a certification exam administered by the American Midwifery Certification Board.
Direct-entry midwives
A direct-entry midwife is educated in the discipline of midwifery in a program or path that does not require prior education as a nurse. Direct-entry midwives learn midwifery through self-study, apprenticeship, a private midwifery school, or a college- or university-based program distinct from the discipline of nursing. A direct-entry midwife is trained to provide the Midwives Model of Care to healthy women and newborns throughout the childbearing cycle primarily in out-of-hospital settings.
Under the umbrella of "direct-entry midwife" are several types of midwives:
A Certified Professional Midwife (CPM) is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the midwives model of care. The CPM is the only US credential that requires knowledge about and experience in out-of-hospital settings. At present, there are approximately 900 CPMs practicing in the US.
A Licensed Midwife is a midwife who is licensed to practice in a particular state. Currently, licensure for direct-entry midwives is available in 24 states.
The term "Lay Midwife" has been used to designate an uncertified or unlicensed midwife who was educated through informal routes such as self-study or apprenticeship rather than through a formal program. This term does not necessarily mean a low level of education, just that the midwife either chose not to become certified or licensed, or there was no certification available for her type of education (as was the fact before the Certified Professional Midwife (CPM) credential was available).
The American College of Nurse-Midwives (ACNM) also provides accreditation to non-nurse midwife programs, as well as colleges that graduate nurse-midwives. This credential, called the Certified Midwife, is currently recognized in only three states (New York, New Jersey, and Rhode Island). All CMs must pass the same certifying exam administered by the American Midwifery Certification Board for CNMs.
The North American Registry of Midwives (NARM) is a certification agency whose mission is to establish and administer certification for the credential "Certified Professional Midwife" (CPM). The CPM certification process validates entry-level knowledge, skills, and experience vital to responsible midwifery practice. This certification process encompasses multiple educational routes of entry including apprenticeship, self-study, private midwifery schools, college- and university-based midwifery programs, and nurse-midwifery. Created in 1987 by the Midwives' Alliance of North America (MANA), NARM is committed to identifying standards and practices that reflect the excellence and diversity of the independent midwifery community in order to set the standard for North American midwifery.
Practice
Midwives work with women and their families in any number of settings. While the majority of nurse-midwives work in hospitals, some nurse-midwives and many non-nurse-midwives work within the community or home. In many states, midwives form birthing centers where a group of midwives work together. Midwives generally support and encourage natural childbirth in all practice settings. Laws regarding who can practice midwifery and in what circumstances vary from state to state.
United Kingdom
Midwives are practitioners in their own right in the United Kingdom, and take responsibility for the antenatal, intrapartum and postnatal care of women, up until 28 days after the birth, or as required thereafter. Midwives are the lead health care professional attending the majority of births, mostly in a hospital setting, although home birth is a perfectly safe option for many births. There are a variety of routes to qualifying as a midwife. Most midwives now qualify via a direct entry course, which refers to a three- or four-year course undertaken at university that leads to either a degree or a diploma of higher education in midwifery and entitles them to apply for admission to the register. Following completion of nurse training, a nurse may become a registered midwife by completing an eighteen-month post-registration course (leading to a degree qualification), however this route is only available to adult branch nurses, and any child, mental health, or learning disability branch nurse must complete the full three-year course to qualify as a midwife. Midwifery students do not pay tuition fees and are eligible for financial support for living costs while training. Funding varies depending on which country within the UK the student is located and whether they are taking a degree or diploma course. Midwifery degrees are paid for by the National Health Service (NHS). Some students may also be eligible for NHS bursaries.
All practising midwives must be registered with the Nursing and Midwifery Council and also must have a Supervisor of Midwives through their local supervising authority. Most midwives work within the National Health Service, providing both hospital and community care, but a significant proportion work independently, providing total care for their clients within a community setting. However, recent government proposals to require insurance for all health professionals is threatening independent midwifery in England.
Midwives are at all times responsible for the woman for whom they are caring, to know when to refer complications to medical staff, to act as the woman's advocate, and to ensure the mother retains choice and control over her childbirth experience. Many midwives are opposed to the "medicalisation" of childbirth, preferring a more approach to care, ensuring a satisfactory outcome for mother and baby.
Midwifery Training
Midwifery training is considered one of the most challenging and competitive courses amongst other healthcare subjects. Most midwives undergo a 32 month vocational training program, or an 18 month nurse conversion course (on top of the 32 month nurse training course). Thus midwives potentially could have had up to 5 years of total training. Midwifery training consists of classroom based learning provided by select Universities in conjunction with hospital and community based training placements at NHS Trusts.
Midwives may train to be community Health Visitors (as may Nurses).
Community Midwives
Many midwives also work in the community. The role of community midwives include the initial appointments with pregnant women, managingclinics, postnatal care in the home, and attending home births.
Diposkan oleh Catatanku di 23:18 0 komentar
Minggu, 21 Maret 2010
HOSPITAL
A hospital is an institution for health care providing patient treatment by specialized staff and equipment, and often, but not always providing for longer-term patient stays.
Today, hospitals usually are funded by the public sector, by health organizations, (for profit or nonprofit), health insurance companies or charities, including by direct charitable donations. In history, however, hospitals often were founded and funded by religious orders or charitable individuals and leaders. Similarly, modern-day hospitals are largely staffed by professional physicians, surgeons, and nurses, whereas in history, this work usually was performed by the founding religious orders or by volunteers.
Etymology
During the Middle Ages the hospital could serve other functions, such as almshouse for the poor, hostel for pilgrims, or hospital school. The name comes from Latin hospes (host), which also is the root for the English words hospice, hotel, hostel, and hospitality. The modern word hotel derives from the French word hostel, which featured a silent s, eventually removed from the word to leave a circumflex on modern French hôtel. The word also is related to the German word 'Spital'.
Grammar of the word differs slightly depending on the dialect. In the U.S., hospital usually requires an article; in Britain and elsewhere, the word normally is used without an article when it is the object of a preposition and when referring to a patient ("in/to the hospital" vs. "in/to hospital"); in Canada, both uses are found.
Types
Some patients go to a hospital just for diagnosis, treatment, or therapy and then leave ('outpatients') without staying overnight; while others are 'admitted' and stay overnight or for several weeks or months ('inpatients'). Hospitals usually are distinguished from other types of medical facilities by their ability to admit and care for inpatients and the others often are described as a clinic.
General
The best-known type of hospital is the general hospital, which is set up to deal with many kinds of disease and injury, and typically has an emergency department to deal with immediate and urgent threats to health. A general hospital typically is the major health care facility in its region, with large numbers of beds for intensive care and long-term care; and specialized facilities for surgery, plastic surgery, childbirth, bioassay laboratories, and so forth. Larger cities may have several hospitals of varying sizes and facilities. Some hospitals, especially in the United States, have their own ambulance service.
Specialized
Types of specialized hospitals include trauma centers, rehabilitation hospitals, children's hospitals, seniors' (geriatric) hospitals, and hospitals for dealing with specific medical needs such as psychiatric problems (see psychiatric hospital), certain disease categories, and so forth.
A hospital may be a single building or a number of buildings on a campus. Many hospitals with pre-twentieth-century origins began as one building and evolved into campuses. Some hospitals are affiliated with universities for medical research and the training of medical personnel such as physicians and nurses, often called teaching hospitals. Worldwide, most hospitals are run on a nonprofit basis by governments or charities. Within the United States, most hospitals are nonprofit.
Teaching
A teaching hospital combines assistance to patients with teaching to medical students and nurses and often is linked to a medical school or nursing school. Some of these are associated with universities
Clinics
A medical facility smaller than a hospital is generally called a clinic, and often is run by a government agency for health services or a private partnership of physicians (in nations where private practice is allowed). Clinics generally provide only outpatient services.
Departments
Resuscitation room bed after a trauma intervention, showing the highly technical equipment of modern hospitals
See also: Category:Hospital departments
Hospitals vary widely in the services they offer and therefore, in the departments they have. They may have acute services such as an emergency department or specialist trauma centre, burn unit, surgery, or urgent care. These may then be backed up by more specialist units such as cardiology or coronary care unit, intensive care unit, neurology, cancer center, and obstetrics and gynecology.
Some hospitals will have outpatient departments and some will have chronic treatment units such as behavioral health services, dentistry, dermatology, psychiatric ward, rehabilitation services, and physical therapy.
Common support units include a dispensary or pharmacy, pathology, and radiology, and on the non-medical side, there often are medical records departments and/or release of information department.
History
Early examples
In ancient cultures, religion and medicine were linked. The earliest documented institutions aiming to provide cures were Egyptian temples. In ancient Greece, temples dedicated to the healer-god Asclepius, known as Asclepieia (Greek: Ασκληπιεία, sing. Asclepieion Ασκληπιείον), functioned as centers of medical advice, prognosis, and healing.[1] At these shrines, patients would enter a dream-like state of induced sleep known as "enkoimesis" (Greek: ενκοίμησις) not unlike anesthesia, in which they either received guidance from the deity in a dream or were cured by surgery.[2] Asclepeia provided carefully controlled spaces conducive to healing and fulfilled several of the requirements of institutions created for healing.[3] In the Asclepieion of Epidaurus, three large marble boards dated to 350 BC preserve the names, case histories, complaints, and cures of about 70 patients who came to the temple with a problem and shed it there. Some of the surgical cures listed, such as the opening of an abdominal abscess or the removal of traumatic foreign material, are realistic enough to have taken place, but with the patient in a state of enkoimesis induced with the help of soporific substances such as opium.[4] The worship of Asclepius was adopted by the Romans. Under his Roman name Æsculapius, he was provided with a temple (291 BC) on an island in the Tiber in Rome, where similar rites were performed.
According to the Mahavamsa, the ancient chronicle of Sinhalese royalty, written in the sixth century A.D., King Pandukabhaya (fourth century B.C.) had lying-in-homes and hospitals (Sivikasotthi-Sala) built in various parts of the country. This is the earliest documentary evidence we have of institutions specifically dedicated to the care of the sick anywhere in the world.[6][7] Mihintale Hospital is the oldest in the world.[8] Ruins of ancient hospitals in Sri Lanka are still in existence in Mihintale, Anuradhapura, and Medirigiriya.
Institutions created specifically to care for the ill also appeared early in India. King Ashoka is said to have founded at least eighteen hospitals ca. 230 B.C., with physicians and nursing staff, the expense being borne by the royal treasury.[10] Stanley Finger (2001) in his book, Origins of Neuroscience: A History of Explorations Into Brain Function, cites an Ashokan edict translated as: "Everywhere King Piyadasi (Asoka) erected two kinds of hospitals, hospitals for people and hospitals for animals. Where there were no healing herbs for people and animals, he ordered that they be bought and planted."[11] However Dominik Wujastyk of the University College London disputes this, arguing that the edict indicates that Ashoka built rest houses (for travellers) instead of hospitals, and that this was misinterpreted due to the reference to medical herbs.
The first teaching hospital where students were authorized to practice methodically on patients under the supervision of physicians as part of their education, was the Academy of Gundishapur in the Persian Empire. One expert has argued that "to a very large extent, the credit for the whole hospital system must be given to Persia".
Roman Empire
The Romans created valetudinaria for the care of sick slaves, gladiators, and soldiers around 100 B.C., and many were identified by later archeology. While their existence is considered proven, there is some doubt as to whether they were as widespread as was once thought, as many were identified only according to the layout of building remains, and not by means of surviving records or finds of medical tools.
The adoption of Christianity as the state religion of the Roman Empire drove an expansion of the provision of care. The First Council of Nicaea in 325 A.D. urged the church to provide for the poor, sick, widows, and strangers. It ordered the construction of a hospital in every cathedral town. Among the earliest were those built by the physician Saint Sampson in Constantinople and by Basil, bishop of Caesarea. The latter was attached to a monastery and provided lodgings for poor and travelers, as well as treating the sick and infirm. There was a separate section for lepers.
Medieval Islamic world
Main article: Bimaristan
Further information: Medicine in medieval Islam
In the medieval Islamic world, the word "bimaristan" was used to indicate a hospital establishment where the ill were welcomed, cared for and treated by qualified staff. In this way medieval Islamic physicians distinguished between a hospital and earlier ancient establishments such as a healing temple, sleep temple, hospice, asylum, lazaret, or leper-house, all of which were common in antiquity and more concerned with isolating the sick and the mad (insane) from society than offering them a true cure. Some thus consider the medieval Bimaristan hospitals as "the first hospitals" in the modern sense of the word.
The first free public hospital in Baghdad was opened during the Abbasid Caliphate of Harun al-Rashid in the 8th century.[17] The first hospital in Egypt was opened in 872 and thereafter public hospitals sprang up all over the empire from Islamic Spain and the Maghrib to Persia. As the system developed, physicians and surgeons were appointed who gave lectures to medical students and issued diplomas to those who were considered qualified to practice, an early parallel to modern medical schools.[18][17] The first psychiatric hospital was built in Baghdad in 705. Many other Islamic hospitals also often had their own wards dedicated to mental health.
Between the eighth and twelfth centuries CE Muslim hospitals developed a high standard of care. Hospitals in Baghdad in the ninth and tenth centuries employed up to twenty-five staff physicians and had separate wards for different conditions. Al-Qairawan hospital and mosque, in Tunisia, were built under the Aghlabid rule in 830 CE and was simple, but adequately equipped with halls organized into waiting rooms, a mosque, and a special bath. The hospital employed female nurses, including nurses from Sudan.[20] In addition to regular physicians who attended the sick, there were Fuqaha al-Badan, a kind of religious physio-therapists, group of religious scholars whose medical services included bloodletting, bone setting, and cauterisation. During Ottoman rule, when hospitals reached a particular distinction, Sultan Bayazid II built a psychiatric hospital and medical madrasa in Edirne, and a number of other early hospitals also were built in Turkey.
Medieval Europe
Medieval hospitals in Europe followed a similar pattern to the Byzantine. They were religious communities, with care provided by monks and nuns. (An old French term for hospital is hôtel-Dieu, "hostel of God.") Some were attached to monasteries; others were independent and had their own endowments, usually of property, which provided income for their support. Some hospitals were multi-functional while others were founded for specific purposes such as leper hospitals, or as refuges for the poor, or for pilgrims: not all cared for the sick. The first Spanish hospital, founded by the Catholic Visigoth bishop Masona in 580 at Mérida, was a xenodochium designed as an inn for travellers (mostly pilgrims to the shrine of Eulalia of Mérida) as well as a hospital for citizens and local farmers. The hospital's endowment consisted of farms to feed its patients and guests.
Colonial America
The first hospital founded in the Americas was the Hospital San Nicolás de Bari [Calle Hostos] in Santo Domingo, Distrito Nacional Dominican Republic. Fray Nicolas de Ovando, Spanish governor and colonial administrator from 1502–1509, authorized its construction on December 29, 1503. This hospital apparently incorporated a church. The first phase of its construction was completed in 1519, and it was rebuilt in 1552.[22] Abandoned in the mid-eighteenth century, the hospital now lies in ruins near the Cathedral in Santo Domingo.
Conquistador Hernán Cortés founded the two earliest hospitals in North America: the Immaculate Conception Hospital and the Saint Lazarus Hospital. The oldest was the Immaculate Conception, now the Hospital de Jesús Nazareno in Mexico City, founded in 1524 to care for the poor.
The first hospital north of Mexico was the Hôtel-Dieu de Québec. It was established in New France in 1639 by three Augustinians from l'Hôtel-Dieu de Dieppe in France. The project, begun by the niece of Cardinal de Richelieu was granted a royal charter by King Louis XIII and staffed by colonial physician Robert Giffard de Moncel.
Modern era
In Europe the medieval concept of Christian care evolved during the sixteenth and seventeenth centuries into a secular one, but it was in the eighteenth century that the modern hospital began to appear, serving only medical needs and staffed with physicians and surgeons. The Charité (founded in Berlin in 1710) is an early example.
Guy's Hospital was founded in London in 1724 from a bequest by the wealthy merchant, Thomas Guy. Other hospitals sprang up in London and other British cities over the century, many paid for by private subscriptions. In the British American colonies the Pennsylvania General Hospital was chartered in Philadelphia in 1751, after £2,000 from private subscription was matched by funds from the Assembly.
When the Vienna General Hospital opened in 1784 (instantly becoming the world's largest hospital), physicians acquired a new facility that gradually developed into the most important research center. During the nineteenth century, the Second Viennese Medical School emerged with the contributions of physicians such as Carl Freiherr von Rokitansky, Josef Škoda, Ferdinand Ritter von Hebra, and Ignaz Philipp Semmelweis. Basic medical science expanded and specialization advanced. Furthermore, the first dermatology, eye, as well as ear, nose, and throat clinics in the world were founded in Vienna, being considered as the birth of specialized medicine.
By the mid-nineteenth century most of Europe and the United States had established a variety of public and private hospital systems. In continental Europe the new hospitals generally were built and run from public funds. The National Health Service, the principle provider of health care in the United Kingdom, was founded in 1948.
In the United States the traditional hospital is a non-profit hospital, usually sponsored by a religious denomination. One of the earliest of these "almshouses" in what would become the United States was started by William Penn in Philadelphia in 1713. These hospitals are tax-exempt due to their charitable purpose, but provide only a minimum of charitable medical care. They are supplemented by large public hospitals in major cities and research hospitals often affiliated with a medical school. The largest public hospital system in America is the New York City Health and Hospitals Corporation, which includes Bellevue Hospital, the oldest U.S. hospital, affiliated with New York University Medical School. In the late twentieth century, chains of for-profit hospitals arose in the USA.
Criticism
While hospitals, by concentrating equipment, skilled staff and other resources in one place, clearly provide important help to patients with serious or rare health problems, hospitals also are criticised for a number of faults, some of which are endemic to the system, others which develop from what some consider wrong approaches to health care.
One criticism often voiced is the 'industrialised' nature of care, with constantly shifting treatment staff, which dehumanises the patient and prevents more effective care as doctors and nurses rarely are intimately familiar with the patient. The high working pressures often put on the staff exacerbate such rushed and impersonal treatment. The architecture and setup of modern hospitals often is voiced as a contributing factor to the feelings of faceless treatment many people complain about.
Another criticism is that hospitals are in themselves dangerous places for patients, who are often suffering from weakened immune systems - either due to their body having to undergo substantial surgery or because of the illness which placed them in the hospital itself. Most of these criticisms stem from the pre-Listerian era. However, even in modern hospitals, hospital-acquired infections can be an important cause of hospital related morbidity, and sometimes mortality.
Funding
In the modern era, hospitals are, broadly, either funded by the government of the country in which they are situated, or survive financially by competing in the private sector (a number of hospitals also are still supported by the historical type of charitable or religious associations).
In the United Kingdom for example, a relatively comprehensive, "free at the point of delivery" health care system exists, funded by the state. Hospital care is thus relatively easily available to all legal residents (although as hospitals prioritize their limited resources, there is a tendency for 'waiting lists' for non-emergency treatment in countries with such systems, and those who can afford it, often take out private health care to get treatment more quickly). On the other hand, many countries, including for example the USA, have in the twentieth century followed a largely private-based, for-profit-approach to providing hospital care, with few state-money supported 'charity' hospitals remaining today.[26] Where for-profit hospitals in such countries admit uninsured patients in emergency situations (such as during and after Hurricane Katrina in the USA), they incur direct financial losses, ensuring that there is a clear disincentive to admit such patients.
As quality of health care has increasingly become an issue around the world, hospitals have increasingly had to pay serious attention to this. Independent external assessment of quality is one of the most powerful ways of assessing the quality of health care, and hospital accreditation is one means by which this is achieved. In many parts of the world such accreditation is sourced from other countries, a phenomenon known as international health care accreditation, by groups such as Accreditation Canada from Canada, the Joint Commission from the USA, the Trent Accreditation Scheme from Great Britain, and Haute Authorité de santé (HAS) from France.
Buildings
Architecture
Modern hospital buildings are designed to minimize the effort of medical personnel and the possibility of contamination while maximizing the efficiency of the whole system. Travel time for personnel within the hospital and the transportation of patients between units is facilitated and minimized. The building also should be built to accommodate heavy departments such as radiology and operating rooms while space for special wiring, plumbing, and waste disposal must be allowed for in the design.
However, the reality is that many hospitals, even those considered 'modern', are the product of continual and often badly managed growth over decades or even centuries, with utilitarian new sections added on as needs and finances dictate. As a result, Dutch architectural historian Cor Wagenaar has called many hospitals:
"... built catastrophes, anonymous institutional complexes run by vast bureaucracies, and totally unfit for the purpose they have been designed for ... They are hardly ever functional, and instead of making patients feel at home, they produce stress and anxiety."
Some newer hospital designs now try to reestablish design that takes the patient's psychological needs into account, such as providing for more air, better views, and more pleasant color schemes. These ideas hearken back to the late eighteenth century, when the concept of providing fresh air and access to the 'healing powers of nature' were first employed by hospital architects in improving their buildings.
Another major change which is still ongoing in many parts of the world is the change from a ward-based system (where patients are treated and accommodated in communal rooms, separated at best by movable partitions) to a room-based environment, where patients are accommodated in private rooms. The ward-based system has been described as very efficient, especially for the medical staff, but is considered to be more stressful for patients and detrimental to their privacy. A major constraint on providing all patients with their own rooms is however found in the higher cost of building and operating such a hospital, which causes some hospitals to charge for the privilege of private rooms.
Ninewells Hospital, Dundee, Scotland is currently one of the largest hospitals in the world, it also is one of the largest teaching hospitals. Ninewells also contains the first building in Britain designed by architect Frank Gehry, in conjunction with James F Stephen. The design was commissioned by Maggie's centres, the cancer support organisation, for their third centre at the hospital and was officially opened on 25 September 2003 by Bob Geldof. Also Ten million pounds has been spent redesigning and overhauling the paediatric department of the hospital and, in June 2006, it was opened officially under the name Tayside Children's Hospital.
Department of hospital:
1.Acute assessment unit
2.Coronary care unit
3.Emergency department
4.Geriatric intensive-care unit
5.Intensive-care unit
6.Neonatal intensive-care unit
7.Norfolk Regional Center
8.Nursing unit
9.On-call room
10.Pediatric intensive-care unit
11.Physical therapy
12.P cont.
13.Post anesthesia care unit
14.Psychiatric hospital
15.Release of information department
16.Trauma center
17.Urgent care
Some vocabularies for giving direction:
1.Go ahead = Jalan terus
2.Turn right = Belok kanan
3.Turn left = Belok kiri
4.Go upstair = Naik tangga
5.Go downstair = Turun tangga
6.Way = Jalan
7.Junction = Pertigaan
8.Crossway/road = Perempatan
9.Turning = Belokan
10.Sign = Tanda
Diposkan oleh Catatanku di 22:03 0 komentar
Kamis, 18 Maret 2010
nurse
Nurse
A nurse is a healthcare professional who, in collaboration with other members of a health care team, is responsible for: treatment, safety, and recovery of acutely or chronically ill individuals; health promotion and maintenance within families, communities and populations; and, treatment of life-threatening emergencies in a wide range of health care settings. Nurses perform a wide range of clinical and non-clinical functions necessary to the delivery of health care, and may also be involved in medical and nursing research.
Both Nursing roles and education were first defined by Florence Nightingale, following her experiences caring for the wounded in the Crimean War. Prior to this, nursing was thought to be a trade with few common practices or documented standards. Nightingale's concepts were used as a guide for establishing nursing schools at the beginning of the twentieth century, which were mostly hospital-based training programs emphasizing the development of a set of clinical skills. The profession's early utilization of a general, hospital-based education is sometimes credited for the wide range of roles nurses have assumed within health care, and this is contrasted with present-day nursing education, which is increasingly specialized and typically offered at post-secondary institutions.
Practice as a nurse is often defined by state, provincial or territorial governments. As an example, the province of Ontario classifies nurses into the roles of Registered Practical Nurse, Registered Nurse (general class), and Registered Nurse (extended class).In this respect, the title "nurse" is protected by law within the province, and regulated by legislative statute.Some regions have legislated different or expanded roles for nurses, generating many potential nurse careers.
Around the world, nurses are often female. However, in Francophone Africa, which includes the countries of Benin, Burkino Faso, Cameroon, Chad, Congo, Côte d'Ivoire, the Democratic Republic of Congo, Djibouti, Guinea, Gabon, Mali, Mauritania, Niger, Rwanda, Senegal, and Togo, there are more male than female nurses.In Europe, in countries such as Spain, Portugal, Czechoslovakia, and Italy, over 20% of nurses are male.
Currently, a nursing shortage exists within the United Kingdom, United States, Canada, and a number of other developed countries. The majority of analysis refers to a shortage of Registered Nurse staff. The Canadian Registered Nurse shortage has been linked to longer wait times for hospital-based procedures, increased adverse events for patients, and more stressful work environments. As the shortage of Registered Nurses increases, it is expected that there will be an increasing move towards utilizing unregulated healthcare workers to meet demands for basic nursing care within hospitals and the community.
Etymology
The English word nurse also refers to the act of breastfeeding. A wet nurse is considered someone who provides her own breast-milk to infants. In other languages, the word for nurse comes from the same etymology as the word infirmary, such as in French (infirmier), or Italian (infermiere).
Education
Typically, nurses are distinguished from one another by the area they work in (critical care, perioperative, oncology, nephrology, pediatrics, adult acute care, geriatrics, psychiatric, community, occupational health, etc.). Bodies such as the American Nurses Association and the Canadian Nurses Association have both supported a move towards the creation of national specialty certifications, in order to support more specialized nursing roles. As nursing roles and specialties are continually changing, the International Council of Nurses states that nursing education should always include continuing education activities; while educational preparation is expected to vary between countries, all nursing jurisdictions are encouraged to promote continuing education as an important form of professional education.
Nursing education varies widely, and continues to produce an array of options as nursing roles evolve and also expand in scope. Educational preparation as a nurse may include certificate, diploma, associates, bachelors, masters or doctoral preparation.
Sabtu, 27 Maret 2010
Kamis, 18 Maret 2010
Minggu, 14 Februari 2010
DEPRESI
• MASALAH UTAMA Gangguan alam perasaan: depresi.
• PROSES TERJADINYA MASALAH
Depresi adalah suatu jenis alam perasaan atau emosi yang disertai komponen psikologik : rasa susah, murung, sedih, putus asa -dan tidak bahagia, serta komponen somatik: anoreksia, konstipasi, kulit lembab (rasa dingin), tekanan darah dan denyut nadi sedikit menurun.
Depresi merupakan gangguan alam perasaan yang berat dan dimanifestasikan dengan gangguan fungsi social dan fungsi fisik yang hebat, lama dan menetap pada individu yang bersangkutan.
Depresi disebabkan oleh banyak faktor antara lain : faktor heriditer dan genetik, faktor konstitusi, faktor kepribadian pramorbid, faktor fisik, faktor psikobiologi, faktor neurologik, faktor biokimia dalam tubuh, faktor keseimbangan elektrolit dan sebagainya.
Depresi biasanya dicetuskan oleh trauma fisik seperti penyakit infeksi, pembedahan, kecelakaan, persalinan dan sebagainya, serta faktor psikik seperti kehilangan kasih sayang atau harga diri dan akibat kerja keras.
Depresi merupakan reaksi yang normal bila berlangsung dalam waktu yang pendek dengan adanya faktor pencetus yang jelas, lama dan dalamnya depresi sesuai dengan faktor pencetusnya. Depresi merupakan gejala psikotik bila keluhan yang bersangkutan tidak sesuai lagi dengan realitas, tidak dapat menilai realitas dan tidak dapat dimengerti oleh orang lain.
MASALAH KEPERAWATAN DAN DATA YANG PERLU DIKAJI
• Gangguan alam perasaan: depresi
• Data subyektif:
Tidak mampu mengutarakan pendapat dan malas berbicara.Sering mengemukakan keluhan somatic seperti ; nyeri abdomen dan dada, anoreksia, sakit punggung,pusing. Merasa dirinya sudah tidak berguna lagi, tidak berarti, tidak ada tujuan hidup, merasa putus asa dan cenderung bunuh diri. Pasien mudah tersinggung dan ketidakmampuan untuk konsentrasi.
• Data obyektif:
Gerakan tubuh yang terhambat, tubuh yang melengkung dan bila duduk dengan sikap yang merosot, ekspresi wajah murung, gaya jalan yang lambat dengan langkah yang diseret.Kadang-kadang dapat terjadi stupor. Pasien tampak malas, lelah, tidak ada nafsu makan, sukar tidur dan sering menangis. Proses berpikir terlambat, seolah-olah pikirannya kosong, konsentrasi terganggu, tidak mempunyai minat, tidak dapat berpikir, tidak mempunyai daya khayal Pada pasien psikosa depresif terdapat perasaan bersalah yang mendalam, tidak masuk akal (irasional), waham dosa, depersonalisasi dan halusinasi. Kadang-kadang pasien suka menunjukkan sikap bermusuhan (hostility), mudah tersinggung (irritable) dan tidak suka diganggu. Pada pasien depresi juga mengalami kebersihan diri kurang dan keterbelakangan psikomotor.
• Koping maladaptif
• DS : Menyatakan putus asa dan tak berdaya, tidak bahagia, tak ada harapan.
• DO : Nampak sedih, mudah marah, gelisah, tidak dapat mengontrol impuls.
Mekanisme koping yang digunakan adalah denial dan supresi yang berlebihan .
• DIAGNOSA KEPERAWATAN
• Resiko mencederai diri berhubungan dengan depresi.
• Gangguan lam perasaan: depresi berhubungan dengan koping maladaptif.
• RENCANA TINDAKAN KEPERAWATAN
• Tujuan umum: Klien tidak mencederai diri.
• Tujuan khusus
• Klien dapat membina hubungan saling percaya
Tindakan:
• Perkenalkan diri dengan klien dengan cara menyapa klien dengan ramah, baik verbal dan non verbal, selalu kontak mata selama interaksi dan perhatikan kebutuhan dasar klien.
• Lakukan interaksi dengan pasien sesering mungkin dengan sikap empati
• Dengarkan pemyataan pasien dengan sikap sabar empati dan lebih banyak memakai bahasa non verbal. Misalnya: memberikan sentuhan, anggukan.
• Perhatikan pembicaraan pasien serta beri respons sesuai dengan keinginannya
• Bicara dengan nada suara yang rendah, jelas, singkat, sederhana dan mudah dimengerti
• Terima pasien apa adanya tanpa membandingkan dengan orang lain.
• Klien dapat menggunakan koping adaptif
• Beri dorongan untuk mengungkapkan perasaannya dan mengatakan bahwa perawat memahami apa yang dirasakan pasien.
• Tanyakan kepada pasien cara yang biasa dilakukan mengatasi perasaan sedih/menyakitkan
• Diskusikan dengan pasien manfaat dari koping yang biasa digunakan
• Bersama pasien mencari berbagai alternatif koping.
• Beri dorongan kepada pasien untuk memilih koping yang paling tepat dan dapat diterima
• Beri dorongan kepada pasien untuk mencoba koping yang telah dipilih
• Anjurkan pasien untuk mencoba alternatif lain dalam menyelesaikan masalah.
• Klien terlindung dari perilaku mencederai diri
Tindakan:
• Pantau dengan seksama resiko bunuh diri/melukai diri sendiri.
• Jauhkan dan simpan alat-alat yang dapat digunakan olch pasien untuk mencederai dirinya/orang lain, ditempat yang aman dan terkunci.
• Jauhkan bahan alat yang membahayakan pasien.
• Awasi dan tempatkan pasien di ruang yang mudah dipantau oleh peramat/petugas.
4. Klien dapat meningkatkan harga diri
Tindakan:
4.1. Bantu untuk memahami bahwa klien dapat mengatasi keputusasaannya.
4.2. Kaji dan kerahkan sumber-sumber internal individu.
4.3. Bantu mengidentifikasi sumber-sumber harapan (misal: hubungan antar sesama, k eyakinan, hal-hal untuk diselesaikan).
5. Klien dapat menggunakan dukungan sosial
Tindakan:
5.1. Kaji dan manfaatkan sumber-sumber ekstemal individu (orang-orang terdekat, tim pelayanan kesehatan, kelompok pendukung, agama yang dianut).
5.2. Kaji sistem pendukung keyakinan (nilai, pengalaman masa lalu, aktivitas keagamaan, kepercayaan agama).
5.3. Lakukan rujukan sesuai indikasi (misal : konseling pemuka agama).
• Klien dapat menggunakan obat dengan benar dan tepat
Tindakan:
6.1. Diskusikan tentang obat (nama, dosis, frekuensi, efek dan efek samping minum obat).
6.2. Bantu menggunakan obat dengan prinsip 5 benar (benar pasien, obat, dosis, cara, waktu).
6.3. Anjurkan membicarakan efek dan efek samping yang dirasakan.
6.4. Beri reinforcement positif bila menggunakan obat dengan benar
• PROSES TERJADINYA MASALAH
Depresi adalah suatu jenis alam perasaan atau emosi yang disertai komponen psikologik : rasa susah, murung, sedih, putus asa -dan tidak bahagia, serta komponen somatik: anoreksia, konstipasi, kulit lembab (rasa dingin), tekanan darah dan denyut nadi sedikit menurun.
Depresi merupakan gangguan alam perasaan yang berat dan dimanifestasikan dengan gangguan fungsi social dan fungsi fisik yang hebat, lama dan menetap pada individu yang bersangkutan.
Depresi disebabkan oleh banyak faktor antara lain : faktor heriditer dan genetik, faktor konstitusi, faktor kepribadian pramorbid, faktor fisik, faktor psikobiologi, faktor neurologik, faktor biokimia dalam tubuh, faktor keseimbangan elektrolit dan sebagainya.
Depresi biasanya dicetuskan oleh trauma fisik seperti penyakit infeksi, pembedahan, kecelakaan, persalinan dan sebagainya, serta faktor psikik seperti kehilangan kasih sayang atau harga diri dan akibat kerja keras.
Depresi merupakan reaksi yang normal bila berlangsung dalam waktu yang pendek dengan adanya faktor pencetus yang jelas, lama dan dalamnya depresi sesuai dengan faktor pencetusnya. Depresi merupakan gejala psikotik bila keluhan yang bersangkutan tidak sesuai lagi dengan realitas, tidak dapat menilai realitas dan tidak dapat dimengerti oleh orang lain.
MASALAH KEPERAWATAN DAN DATA YANG PERLU DIKAJI
• Gangguan alam perasaan: depresi
• Data subyektif:
Tidak mampu mengutarakan pendapat dan malas berbicara.Sering mengemukakan keluhan somatic seperti ; nyeri abdomen dan dada, anoreksia, sakit punggung,pusing. Merasa dirinya sudah tidak berguna lagi, tidak berarti, tidak ada tujuan hidup, merasa putus asa dan cenderung bunuh diri. Pasien mudah tersinggung dan ketidakmampuan untuk konsentrasi.
• Data obyektif:
Gerakan tubuh yang terhambat, tubuh yang melengkung dan bila duduk dengan sikap yang merosot, ekspresi wajah murung, gaya jalan yang lambat dengan langkah yang diseret.Kadang-kadang dapat terjadi stupor. Pasien tampak malas, lelah, tidak ada nafsu makan, sukar tidur dan sering menangis. Proses berpikir terlambat, seolah-olah pikirannya kosong, konsentrasi terganggu, tidak mempunyai minat, tidak dapat berpikir, tidak mempunyai daya khayal Pada pasien psikosa depresif terdapat perasaan bersalah yang mendalam, tidak masuk akal (irasional), waham dosa, depersonalisasi dan halusinasi. Kadang-kadang pasien suka menunjukkan sikap bermusuhan (hostility), mudah tersinggung (irritable) dan tidak suka diganggu. Pada pasien depresi juga mengalami kebersihan diri kurang dan keterbelakangan psikomotor.
• Koping maladaptif
• DS : Menyatakan putus asa dan tak berdaya, tidak bahagia, tak ada harapan.
• DO : Nampak sedih, mudah marah, gelisah, tidak dapat mengontrol impuls.
Mekanisme koping yang digunakan adalah denial dan supresi yang berlebihan .
• DIAGNOSA KEPERAWATAN
• Resiko mencederai diri berhubungan dengan depresi.
• Gangguan lam perasaan: depresi berhubungan dengan koping maladaptif.
• RENCANA TINDAKAN KEPERAWATAN
• Tujuan umum: Klien tidak mencederai diri.
• Tujuan khusus
• Klien dapat membina hubungan saling percaya
Tindakan:
• Perkenalkan diri dengan klien dengan cara menyapa klien dengan ramah, baik verbal dan non verbal, selalu kontak mata selama interaksi dan perhatikan kebutuhan dasar klien.
• Lakukan interaksi dengan pasien sesering mungkin dengan sikap empati
• Dengarkan pemyataan pasien dengan sikap sabar empati dan lebih banyak memakai bahasa non verbal. Misalnya: memberikan sentuhan, anggukan.
• Perhatikan pembicaraan pasien serta beri respons sesuai dengan keinginannya
• Bicara dengan nada suara yang rendah, jelas, singkat, sederhana dan mudah dimengerti
• Terima pasien apa adanya tanpa membandingkan dengan orang lain.
• Klien dapat menggunakan koping adaptif
• Beri dorongan untuk mengungkapkan perasaannya dan mengatakan bahwa perawat memahami apa yang dirasakan pasien.
• Tanyakan kepada pasien cara yang biasa dilakukan mengatasi perasaan sedih/menyakitkan
• Diskusikan dengan pasien manfaat dari koping yang biasa digunakan
• Bersama pasien mencari berbagai alternatif koping.
• Beri dorongan kepada pasien untuk memilih koping yang paling tepat dan dapat diterima
• Beri dorongan kepada pasien untuk mencoba koping yang telah dipilih
• Anjurkan pasien untuk mencoba alternatif lain dalam menyelesaikan masalah.
• Klien terlindung dari perilaku mencederai diri
Tindakan:
• Pantau dengan seksama resiko bunuh diri/melukai diri sendiri.
• Jauhkan dan simpan alat-alat yang dapat digunakan olch pasien untuk mencederai dirinya/orang lain, ditempat yang aman dan terkunci.
• Jauhkan bahan alat yang membahayakan pasien.
• Awasi dan tempatkan pasien di ruang yang mudah dipantau oleh peramat/petugas.
4. Klien dapat meningkatkan harga diri
Tindakan:
4.1. Bantu untuk memahami bahwa klien dapat mengatasi keputusasaannya.
4.2. Kaji dan kerahkan sumber-sumber internal individu.
4.3. Bantu mengidentifikasi sumber-sumber harapan (misal: hubungan antar sesama, k eyakinan, hal-hal untuk diselesaikan).
5. Klien dapat menggunakan dukungan sosial
Tindakan:
5.1. Kaji dan manfaatkan sumber-sumber ekstemal individu (orang-orang terdekat, tim pelayanan kesehatan, kelompok pendukung, agama yang dianut).
5.2. Kaji sistem pendukung keyakinan (nilai, pengalaman masa lalu, aktivitas keagamaan, kepercayaan agama).
5.3. Lakukan rujukan sesuai indikasi (misal : konseling pemuka agama).
• Klien dapat menggunakan obat dengan benar dan tepat
Tindakan:
6.1. Diskusikan tentang obat (nama, dosis, frekuensi, efek dan efek samping minum obat).
6.2. Bantu menggunakan obat dengan prinsip 5 benar (benar pasien, obat, dosis, cara, waktu).
6.3. Anjurkan membicarakan efek dan efek samping yang dirasakan.
6.4. Beri reinforcement positif bila menggunakan obat dengan benar
ASUHAN KEPERAWATAN PADA PASIEN DENGAN GAGAL NAFAS
I. PENGERTIAN
• Gagal nafas adalah ketidakmampuan sistem pernafasan untuk mempertahankan oksigenasi darah normal (PaO2), eliminasi karbon dioksida (PaCO2) dan pH yang adekuat disebabkanoleh masalah ventilasi difusi atau perfusi (Susan Martin T, 1997)
• Gagal nafas adalah kegagalan sistem pernafasan untuk mempertahankan pertukaran oksigen dankarbondioksida dalam jumlah yangdapat mengakibatkan gangguan pada kehidupan (RS Jantung “Harapan Kita”, 2001)
• Gagal nafas terjadi bilamana pertukaran oksigen terhadap karbondioksida dalam paru-paru tidak dapat memelihara laju komsumsioksigen dan pembentukan karbon dioksida dalam sel-sel tubuh. Sehingga menyebabkan tegangan oksigen kurang dari 50 mmHg (Hipoksemia) dan peningkatan tekanan karbondioksida lebih besar dari 45 mmHg (hiperkapnia). (Brunner & Sudarth, 2001)
II. PATOFISIOLOGI
Gagal nafas ada dua macam yaitu gagal nafas akut dan gagal nafas kronik dimana masing masing mempunyai pengertian yang bebrbeda. Gagal nafas akut adalah gagal nafas yang timbul pada pasien yang parunyanormal secara struktural maupun fungsional sebelum awitan penyakit timbul. Sedangkan gagal nafas kronik adalah terjadi pada pasien dengan penyakit paru kronik seperti bronkitis kronik, emfisema dan penyakit paru hitam (penyakit penambang batubara).Pasien mengalalmi toleransi terhadap hipoksia dan hiperkapnia yang memburuk secara bertahap. Setelah gagal nafas akut biasanya paru-paru kembali kekeasaan asalnya. Pada gagal nafas kronik struktur paru alami kerusakan yang ireversibel.
Indikator gagal nafas telah frekuensi pernafasan dan kapasitas vital, frekuensi penapasan normal ialah 16-20 x/mnt. Bila lebih dari20x/mnt tindakan yang dilakukan memberi bantuan ventilator karena “kerja pernafasan” menjadi tinggi sehingga timbul kelelahan. Kapasitasvital adalah ukuran ventilasi (normal 10-20 ml/kg).
Gagal nafas penyebab terpenting adalah ventilasi yang tidak adekuatdimana terjadi obstruksi jalan nafas atas. Pusat pernafasan yang mengendalikan pernapasan terletak di bawah batang otak (pons dan medulla). Pada kasus pasien dengan anestesi, cidera kepala, stroke, tumor otak, ensefalitis, meningitis, hipoksia dan hiperkapnia mempunyai kemampuan menekan pusat pernafasan. Sehingga pernafasan menjadi lambat dan dangkal. Pada periode postoperatif dengan anestesi bisa terjadi pernafasan tidak adekuat karena terdapat agen menekan pernafasan denganefek yang dikeluarkanatau dengan meningkatkan efek dari analgetik opiood. Pnemonia atau dengan penyakit paru-paru dapat mengarah ke gagal nafas akut.
PATHWAYS
III. ETIOLOGI
1. Depresi Sistem saraf pusat
Mengakibatkan gagal nafas karena ventilasi tidak adekuat. Pusat pernafasan yang menngendalikan pernapasan, terletak dibawah batang otak (pons dan medulla) sehingga pernafasan lambat dan dangkal.
2. Kelainan neurologis primer
Akan memperngaruhi fungsi pernapasan. Impuls yang timbul dalam pusat pernafasan menjalar melalui saraf yang membentang dari batang otak terus ke saraf spinal ke reseptor pada otot-otot pernafasan. Penyakit pada saraf seperti gangguan medulla spinalis, otot-otot pernapasan atau pertemuan neuromuslular yang terjadi pada pernapasan akan sangatmempengaruhiventilasi.
3. Efusi pleura, hemotoraks dan pneumothoraks
Merupakan kondisi yang mengganggu ventilasi melalui penghambatan ekspansi paru. Kondisi ini biasanya diakibatkan penyakti paru yang mendasari, penyakit pleura atau trauma dan cedera dan dapat menyebabkan gagal nafas.
4. Trauma
Disebabkan oleh kendaraan bermotor dapat menjadi penyebab gagal nafas. Kecelakaan yang mengakibatkan cidera kepala, ketidaksadaran dan perdarahan dari hidung dan mulut dapat mnegarah pada obstruksi jalan nafas atas dan depresi pernapasan. Hemothoraks, pnemothoraks dan fraktur tulang iga dapat terjadi dan mungkin meyebabkan gagal nafas. Flail chest dapat terjadi dan dapat mengarah pada gagal nafas. Pengobatannya adalah untuk memperbaiki patologi yang mendasar
5. Penyakit akut paru
Pnemonia disebabkan oleh bakteri dan virus. Pnemonia kimiawi atau pnemonia diakibatkan oleh mengaspirasi uap yang mengritasi dan materi lambung yang bersifat asam. Asma bronkial, atelektasis, embolisme paru dan edema paru adalah beberapa kondisi lain yang menyababkan gagal nafas.
IV. TANDA DAN GEJALA
A. Tanda
Gagal nafas total
• Aliran udara di mulut, hidung tidak dapat didengar/dirasakan.
• Pada gerakan nafas spontan terlihat retraksi supra klavikuladan sela iga serta tidak ada pengembangan dada pada inspirasi
• Adanya kesulitasn inflasi parudalam usaha memberikan ventilasi buatan
Gagal nafas parsial
• Terdenganr suara nafas tambahan gargling, snoring, Growing dan whizing.
• Ada retraksi dada
B. Gejala
• Hiperkapnia yaitu penurunan kesadaran (PCO2)
• Hipoksemia yaitu takikardia, gelisah, berkeringat atau sianosis (PO2 menurun)
V. PEMERIKSAAN PENUNJANG
• Pemerikasan gas-gas darah arteri
Hipoksemia
Ringan : PaO2 < 80 mmHg
Sedang : PaO2 < 60 mmHg
Berat : PaO2 < 40 mmHg
• Pemeriksaan rontgen dada
Melihat keadaan patologik dan atau kemajuan proses penyakit yang tidak diketahui
• Hemodinamik
Tipe I : peningkatan PCWP
• EKG
Mungkin memperlihatkan bukti-bukti regangan jantung di sisi kanan
Disritmia
VI. PENGKAJIAN
Pengkajian Primer
1. Airway
• Peningkatan sekresi pernapasan
• Bunyi nafas krekels, ronki dan mengi
2. Breathing
• Distress pernapasan : pernapasan cuping hidung, takipneu/bradipneu, retraksi.
• Menggunakan otot aksesori pernapasan
• Kesulitan bernafas : lapar udara, diaforesis, sianosis
3. Circulation
• Penurunan curah jantung : gelisah, letargi, takikardia
• Sakit kepala
• Gangguan tingkat kesadaran : ansietas, gelisah, kacau mental, mengantuk
• Papiledema
• Penurunan haluaran urine
VII. PENTALAKSANAAN MEDIS
• Terapi oksigen
Pemberian oksigen kecepatan rendah : masker Venturi atau nasal prong
• Ventilator mekanik dengan tekanan jalan nafas positif kontinu (CPAP) atau PEEP
• Inhalasi nebuliser
• Fisioterapi dada
• Pemantauan hemodinamik/jantung
• Pengobatan
Brokodilator
Steroid
• Dukungan nutrisi sesuai kebutuhan
VIII. DIAGNOSA KEPERAWATAN
1. Pola nafas tidak efektif b.d. penurunan ekspansi paru
Tujuan :
Setelah dilakukan tindakan keperawatan pasien dapat mempertahankan pola pernapasan yang efektif
Kriteria Hasil :
Pasien menunjukkan
• Frekuensi, irama dan kedalaman pernapasan normal
• Adanya penurunan dispneu
• Gas-gas darah dalam batas normal
Intervensi :
• Kaji frekuensi, kedalaman dan kualitas pernapasan serta pola pernapasan.
• Kaji tanda vital dan tingkat kesasdaran setaiap jam dan prn
• Monitor pemberian trakeostomi bila PaCo2 50 mmHg atau PaO2< 60 mmHg
• Berikan oksigen dalam bantuan ventilasi dan humidifier sesuai dengan pesanan
• Pantau dan catat gas-gas darah sesuai indikasi : kaji kecenderungan kenaikan PaCO2 atau kecendurungan penurunan PaO2
• Auskultasi dada untuk mendengarkan bunyi nafas setiap 1 jam
• Pertahankan tirah baring dengan kepala tempat tidur ditinggikan 30 sampai 45 derajat untuk mengoptimalkan pernapasan
• Berikan dorongan utnuk batuk dan napas dalam, bantu pasien untuk mebebat dada selama batuk
• Instruksikan pasien untuk melakukan pernapasan diagpragma atau bibir
• Berikan bantuan ventilasi mekanik bila PaCO > 60 mmHg. PaO2 dan PCO2 meningkat dengan frekuensi 5 mmHg/jam. PaO2 tidak dapat dipertahankan pada 60 mmHg atau lebih, atau pasien memperlihatkan keletihan atau depresi mental atau sekresi menjadi sulit untuk diatasi.
2. Gangguan pertukaran gas berhubungan dengan abnormalitas ventilasi-perfusi sekunder terhadap hipoventilasi
Tujuan :
Setelah diberikan tindakan keperawatan pasien dapat mempertahankan pertukaran gas yang adekuat
Kriteria Hasil :
Pasien mampu menunjukkan :
• Bunyi paru bersih
• Warna kulit normal
• Gas-gas darah dalam batas normal untuk usia yang diperkirakan
Intervensi :
• Kaji terhadap tanda dan gejala hipoksia dan hiperkapnia
• Kaji TD, nadi apikal dan tingkat kesadaran setiap[ jam dan prn, laporkan perubahan tinmgkat kesadaran pada dokter.
• Pantau dan catat pemeriksaan gas darah, kaji adanya kecenderungan kenaikan dalam PaCO2 atau penurunan dalam PaO2
• Bantu dengan pemberian ventilasi mekanik sesuai indikasi, kaji perlunya CPAP atau PEEP.
• Auskultasi dada untuk mendengarkan bunyi nafas setiap jam
• Tinjau kembali pemeriksaan sinar X dada harian, perhatikan peningkatan atau penyimpangan
• Pantau irama jantung
• Berikan cairan parenteral sesuai pesanan
• Berikan obat-obatan sesuai pesanan : bronkodilator, antibiotik, steroid.
• Evaluasi AKS dalam hubungannya dengan penurunan kebutuhan oksigen.
3. Kelebihan volume cairan b.d. edema pulmo
Tujuan :
Setelah diberikan tindakan perawatan pasien tidak terjadi kelebihan volume cairan
Kriteria Hasil :
Pasien mampu menunjukkan:
• TTV normal
• Balance cairan dalam batas normal
• Tidak terjadi edema
Intervensi :
• Timbang BB tiap hari
• Monitor input dan output pasien tiap 1 jam
• Kaji tanda dan gejala penurunan curah jantung
• Kaji tanda-tanda kelebihan volume : edema, BB , CVP
• Monitor parameter hemodinamik
• Kolaburasi untuk pemberian cairandan elektrolit
4. Gangguan perfusi jaringan b.d. penurunan curah jantung
Tujuan :
Setelah dilakukan tindakan keperawatan pasien mampu mempertahankan perfusi jaringan.
Kriteria Hasil :
Pasien mampu menunjukkan
• Status hemodinamik dalam bata normal
• TTV normal
Intervensi :
• Kaji tingkat kesadaran
• Kaji penurunan perfusi jaringan
• Kaji status hemodinamik
• Kaji irama EKG
• Kaji sistem gastrointestinal
Daftar pustaka
Hudak and Gallo, (1994), Critical Care Nursing, A Holistic Approach, JB Lippincott company, Philadelpia.
Marilynn E Doengoes, et all, alih bahasa Kariasa IM, (2000), Rencana Asuhan Keperawatan, pedoman untuk perencanaan dan pendokumentasian perawatan pasien, EGC, Jakarta.
Reksoprodjo Soelarto, (1995), Kumpulan Kuliah Ilmu Bedah, Binarupa Aksara, Jakarta.
Suddarth Doris Smith, (1991), The lippincott Manual of Nursing Practice, fifth edition, JB Lippincott Company, Philadelphia.
• Gagal nafas adalah ketidakmampuan sistem pernafasan untuk mempertahankan oksigenasi darah normal (PaO2), eliminasi karbon dioksida (PaCO2) dan pH yang adekuat disebabkanoleh masalah ventilasi difusi atau perfusi (Susan Martin T, 1997)
• Gagal nafas adalah kegagalan sistem pernafasan untuk mempertahankan pertukaran oksigen dankarbondioksida dalam jumlah yangdapat mengakibatkan gangguan pada kehidupan (RS Jantung “Harapan Kita”, 2001)
• Gagal nafas terjadi bilamana pertukaran oksigen terhadap karbondioksida dalam paru-paru tidak dapat memelihara laju komsumsioksigen dan pembentukan karbon dioksida dalam sel-sel tubuh. Sehingga menyebabkan tegangan oksigen kurang dari 50 mmHg (Hipoksemia) dan peningkatan tekanan karbondioksida lebih besar dari 45 mmHg (hiperkapnia). (Brunner & Sudarth, 2001)
II. PATOFISIOLOGI
Gagal nafas ada dua macam yaitu gagal nafas akut dan gagal nafas kronik dimana masing masing mempunyai pengertian yang bebrbeda. Gagal nafas akut adalah gagal nafas yang timbul pada pasien yang parunyanormal secara struktural maupun fungsional sebelum awitan penyakit timbul. Sedangkan gagal nafas kronik adalah terjadi pada pasien dengan penyakit paru kronik seperti bronkitis kronik, emfisema dan penyakit paru hitam (penyakit penambang batubara).Pasien mengalalmi toleransi terhadap hipoksia dan hiperkapnia yang memburuk secara bertahap. Setelah gagal nafas akut biasanya paru-paru kembali kekeasaan asalnya. Pada gagal nafas kronik struktur paru alami kerusakan yang ireversibel.
Indikator gagal nafas telah frekuensi pernafasan dan kapasitas vital, frekuensi penapasan normal ialah 16-20 x/mnt. Bila lebih dari20x/mnt tindakan yang dilakukan memberi bantuan ventilator karena “kerja pernafasan” menjadi tinggi sehingga timbul kelelahan. Kapasitasvital adalah ukuran ventilasi (normal 10-20 ml/kg).
Gagal nafas penyebab terpenting adalah ventilasi yang tidak adekuatdimana terjadi obstruksi jalan nafas atas. Pusat pernafasan yang mengendalikan pernapasan terletak di bawah batang otak (pons dan medulla). Pada kasus pasien dengan anestesi, cidera kepala, stroke, tumor otak, ensefalitis, meningitis, hipoksia dan hiperkapnia mempunyai kemampuan menekan pusat pernafasan. Sehingga pernafasan menjadi lambat dan dangkal. Pada periode postoperatif dengan anestesi bisa terjadi pernafasan tidak adekuat karena terdapat agen menekan pernafasan denganefek yang dikeluarkanatau dengan meningkatkan efek dari analgetik opiood. Pnemonia atau dengan penyakit paru-paru dapat mengarah ke gagal nafas akut.
PATHWAYS
III. ETIOLOGI
1. Depresi Sistem saraf pusat
Mengakibatkan gagal nafas karena ventilasi tidak adekuat. Pusat pernafasan yang menngendalikan pernapasan, terletak dibawah batang otak (pons dan medulla) sehingga pernafasan lambat dan dangkal.
2. Kelainan neurologis primer
Akan memperngaruhi fungsi pernapasan. Impuls yang timbul dalam pusat pernafasan menjalar melalui saraf yang membentang dari batang otak terus ke saraf spinal ke reseptor pada otot-otot pernafasan. Penyakit pada saraf seperti gangguan medulla spinalis, otot-otot pernapasan atau pertemuan neuromuslular yang terjadi pada pernapasan akan sangatmempengaruhiventilasi.
3. Efusi pleura, hemotoraks dan pneumothoraks
Merupakan kondisi yang mengganggu ventilasi melalui penghambatan ekspansi paru. Kondisi ini biasanya diakibatkan penyakti paru yang mendasari, penyakit pleura atau trauma dan cedera dan dapat menyebabkan gagal nafas.
4. Trauma
Disebabkan oleh kendaraan bermotor dapat menjadi penyebab gagal nafas. Kecelakaan yang mengakibatkan cidera kepala, ketidaksadaran dan perdarahan dari hidung dan mulut dapat mnegarah pada obstruksi jalan nafas atas dan depresi pernapasan. Hemothoraks, pnemothoraks dan fraktur tulang iga dapat terjadi dan mungkin meyebabkan gagal nafas. Flail chest dapat terjadi dan dapat mengarah pada gagal nafas. Pengobatannya adalah untuk memperbaiki patologi yang mendasar
5. Penyakit akut paru
Pnemonia disebabkan oleh bakteri dan virus. Pnemonia kimiawi atau pnemonia diakibatkan oleh mengaspirasi uap yang mengritasi dan materi lambung yang bersifat asam. Asma bronkial, atelektasis, embolisme paru dan edema paru adalah beberapa kondisi lain yang menyababkan gagal nafas.
IV. TANDA DAN GEJALA
A. Tanda
Gagal nafas total
• Aliran udara di mulut, hidung tidak dapat didengar/dirasakan.
• Pada gerakan nafas spontan terlihat retraksi supra klavikuladan sela iga serta tidak ada pengembangan dada pada inspirasi
• Adanya kesulitasn inflasi parudalam usaha memberikan ventilasi buatan
Gagal nafas parsial
• Terdenganr suara nafas tambahan gargling, snoring, Growing dan whizing.
• Ada retraksi dada
B. Gejala
• Hiperkapnia yaitu penurunan kesadaran (PCO2)
• Hipoksemia yaitu takikardia, gelisah, berkeringat atau sianosis (PO2 menurun)
V. PEMERIKSAAN PENUNJANG
• Pemerikasan gas-gas darah arteri
Hipoksemia
Ringan : PaO2 < 80 mmHg
Sedang : PaO2 < 60 mmHg
Berat : PaO2 < 40 mmHg
• Pemeriksaan rontgen dada
Melihat keadaan patologik dan atau kemajuan proses penyakit yang tidak diketahui
• Hemodinamik
Tipe I : peningkatan PCWP
• EKG
Mungkin memperlihatkan bukti-bukti regangan jantung di sisi kanan
Disritmia
VI. PENGKAJIAN
Pengkajian Primer
1. Airway
• Peningkatan sekresi pernapasan
• Bunyi nafas krekels, ronki dan mengi
2. Breathing
• Distress pernapasan : pernapasan cuping hidung, takipneu/bradipneu, retraksi.
• Menggunakan otot aksesori pernapasan
• Kesulitan bernafas : lapar udara, diaforesis, sianosis
3. Circulation
• Penurunan curah jantung : gelisah, letargi, takikardia
• Sakit kepala
• Gangguan tingkat kesadaran : ansietas, gelisah, kacau mental, mengantuk
• Papiledema
• Penurunan haluaran urine
VII. PENTALAKSANAAN MEDIS
• Terapi oksigen
Pemberian oksigen kecepatan rendah : masker Venturi atau nasal prong
• Ventilator mekanik dengan tekanan jalan nafas positif kontinu (CPAP) atau PEEP
• Inhalasi nebuliser
• Fisioterapi dada
• Pemantauan hemodinamik/jantung
• Pengobatan
Brokodilator
Steroid
• Dukungan nutrisi sesuai kebutuhan
VIII. DIAGNOSA KEPERAWATAN
1. Pola nafas tidak efektif b.d. penurunan ekspansi paru
Tujuan :
Setelah dilakukan tindakan keperawatan pasien dapat mempertahankan pola pernapasan yang efektif
Kriteria Hasil :
Pasien menunjukkan
• Frekuensi, irama dan kedalaman pernapasan normal
• Adanya penurunan dispneu
• Gas-gas darah dalam batas normal
Intervensi :
• Kaji frekuensi, kedalaman dan kualitas pernapasan serta pola pernapasan.
• Kaji tanda vital dan tingkat kesasdaran setaiap jam dan prn
• Monitor pemberian trakeostomi bila PaCo2 50 mmHg atau PaO2< 60 mmHg
• Berikan oksigen dalam bantuan ventilasi dan humidifier sesuai dengan pesanan
• Pantau dan catat gas-gas darah sesuai indikasi : kaji kecenderungan kenaikan PaCO2 atau kecendurungan penurunan PaO2
• Auskultasi dada untuk mendengarkan bunyi nafas setiap 1 jam
• Pertahankan tirah baring dengan kepala tempat tidur ditinggikan 30 sampai 45 derajat untuk mengoptimalkan pernapasan
• Berikan dorongan utnuk batuk dan napas dalam, bantu pasien untuk mebebat dada selama batuk
• Instruksikan pasien untuk melakukan pernapasan diagpragma atau bibir
• Berikan bantuan ventilasi mekanik bila PaCO > 60 mmHg. PaO2 dan PCO2 meningkat dengan frekuensi 5 mmHg/jam. PaO2 tidak dapat dipertahankan pada 60 mmHg atau lebih, atau pasien memperlihatkan keletihan atau depresi mental atau sekresi menjadi sulit untuk diatasi.
2. Gangguan pertukaran gas berhubungan dengan abnormalitas ventilasi-perfusi sekunder terhadap hipoventilasi
Tujuan :
Setelah diberikan tindakan keperawatan pasien dapat mempertahankan pertukaran gas yang adekuat
Kriteria Hasil :
Pasien mampu menunjukkan :
• Bunyi paru bersih
• Warna kulit normal
• Gas-gas darah dalam batas normal untuk usia yang diperkirakan
Intervensi :
• Kaji terhadap tanda dan gejala hipoksia dan hiperkapnia
• Kaji TD, nadi apikal dan tingkat kesadaran setiap[ jam dan prn, laporkan perubahan tinmgkat kesadaran pada dokter.
• Pantau dan catat pemeriksaan gas darah, kaji adanya kecenderungan kenaikan dalam PaCO2 atau penurunan dalam PaO2
• Bantu dengan pemberian ventilasi mekanik sesuai indikasi, kaji perlunya CPAP atau PEEP.
• Auskultasi dada untuk mendengarkan bunyi nafas setiap jam
• Tinjau kembali pemeriksaan sinar X dada harian, perhatikan peningkatan atau penyimpangan
• Pantau irama jantung
• Berikan cairan parenteral sesuai pesanan
• Berikan obat-obatan sesuai pesanan : bronkodilator, antibiotik, steroid.
• Evaluasi AKS dalam hubungannya dengan penurunan kebutuhan oksigen.
3. Kelebihan volume cairan b.d. edema pulmo
Tujuan :
Setelah diberikan tindakan perawatan pasien tidak terjadi kelebihan volume cairan
Kriteria Hasil :
Pasien mampu menunjukkan:
• TTV normal
• Balance cairan dalam batas normal
• Tidak terjadi edema
Intervensi :
• Timbang BB tiap hari
• Monitor input dan output pasien tiap 1 jam
• Kaji tanda dan gejala penurunan curah jantung
• Kaji tanda-tanda kelebihan volume : edema, BB , CVP
• Monitor parameter hemodinamik
• Kolaburasi untuk pemberian cairandan elektrolit
4. Gangguan perfusi jaringan b.d. penurunan curah jantung
Tujuan :
Setelah dilakukan tindakan keperawatan pasien mampu mempertahankan perfusi jaringan.
Kriteria Hasil :
Pasien mampu menunjukkan
• Status hemodinamik dalam bata normal
• TTV normal
Intervensi :
• Kaji tingkat kesadaran
• Kaji penurunan perfusi jaringan
• Kaji status hemodinamik
• Kaji irama EKG
• Kaji sistem gastrointestinal
Daftar pustaka
Hudak and Gallo, (1994), Critical Care Nursing, A Holistic Approach, JB Lippincott company, Philadelpia.
Marilynn E Doengoes, et all, alih bahasa Kariasa IM, (2000), Rencana Asuhan Keperawatan, pedoman untuk perencanaan dan pendokumentasian perawatan pasien, EGC, Jakarta.
Reksoprodjo Soelarto, (1995), Kumpulan Kuliah Ilmu Bedah, Binarupa Aksara, Jakarta.
Suddarth Doris Smith, (1991), The lippincott Manual of Nursing Practice, fifth edition, JB Lippincott Company, Philadelphia.
ASKEP GADAR
A. PERDARAHAN
Definisi
Perdarahan terjadi jika pembuluh darah putus atau pecah.
Perdarahan luar
Perdarahan dalam
Perdarahan hebat, dapat membahayakan shock hipovolemik
Klafisikasi : perdarahan kapiler, perdarahan arteri, perdarahan vena.
Asuhan Keperawatan
Pengkajian
Pengkajian ABCD, pucat, kulit dingin dan lembab, tekanan darah turun, nadi cepat tapi lemah, nafas dalam dan cepat, menurunnya produksi urine.
Diagnosa keperawatan
Kurang volume cairan tubuh berhubungan dengan kehilangan darah aktif.
Penurunan kardiak output berhubungan dengan penurunan preload, kehilangan darah.
Perubahan perfusi jaringan berhubungan dengan kehilangan darah.
Perubahan persepsi sensori berhubungan dengan penurunan perfusi otak.
Tujuan keperawatan
Mengontrol perdarahan.
Mempertahankan volume darah sirkulasiadekuat untuk oksigenasi.
Mencegah shock.
Penatalaksanaan kedaruratan
Potong baju pasien untuk mengidentifikasi area perdarahan dan lakukan pengkajian fisik dengan cepat.
Beri penekanan pada area perdarahan.
• Penekanan langsung
Tekan langsung area perdarahan dengan telapak tangan atau menggunakan pembalut atau kainyang bersih selama kurang lebih 15 menit, dan pasang balutan tekanan kuat.
• Penekanan arteri
Penekanan dilakukan pada ujung arteri yang sesuai (ujung dimana arteri ditekan melawan tulang yang berada dibawahnya).
Enam titik utama penekanan
Arteri temporalis : pada daerah depan masing-masing telinga dan dapat ditekan pada tulang tengkorak.
Arteri fasialis : terletak dibawah dagu dan 2,5 cm sebelah dalam dagu.
Arteri karotis komunis : pada sisi samping trachea. Saat dilakukan tekanan observasi pernapasan pasien dan tidak boleh pada kedua arteri karotis dalam waktu bersamaan.
Arteri subklavia : terletak dibawah kedua sisi klavikula (tulang collar). Penekanan harus dilakukan pada posisi melintang dibelakang dan kira – kira setengah panjang klavikula.
Arteri brakhialis : pada pertengahan antara siku dan bahu, terletak pada daerah yang lebih dalam dari lengan atas antara otot biseps dan triseps.
Arteri femoralis : dapat dirasakan pada lipat paha.
• Torniket
Pemasanagan torniket pada ekstremitas hanya sebagai upaya terakhir ketika perdarahan tidak dapat dikontrol dengan metode lain.
Torniket dipasang tepat proksimal dengan luka ; torniket cukup kencang untuk mengontrol aliran darah arteri.
Berikan tanda pada kulit pasien dengan pulpen atau plester dengan tanda T, menyatakan lokasi dan waktu pemasangan torniket.
Longgarkan torniket sesuai petunjuk untuk mencegah kerusakan vascular atau neurologik. Bila sudah tidak ada perdarahan arteri, lepasakan torniket dan coba lagi balut dengan tekanan.
Pada kejadian amputasi traumatic, jangan lepaskan torniket sampai pasien masuk ruang operasi.
Tinggikan atau elevasikan bagian yang luka untuk memperlambat mengalirnya darah.
Baringkan korban untuk mengurangi derasnya darah keluar.
Berikan cairan pengganti sesuai saran, meliputi cairan elektrolit isotonic, plasma atau protein plasma, atau terapi komponen darah (bergantung perkiraan tipe dan volume cairan yang hilang).
• Darah segar diberikan bila ada kehilangan darah massif.
• Tamabahan trombosit dan factor pembekuan darah diberikan ketika jumlah darah yang besar diperlukan karena darah penggantian kekurangan factor pembekuan.
Lakukan pemeriksaan darah arteri untuk menentukan gas darah dan memantau tekanan hemodinamik.
Awasi tanda – tanda shock atau gagal jantung karena hipovolemia dan anoksia.
REFERENSI
Brunner and Suddarth. 2001. Keperawatan Medikal Bedah, Ed.8 Vol.3. EGC : Jakarta.
Hudak, Carolyn M. 1996. Keperawatan Kritis-Pendekatan holistic, Ed. 6. Vol. 2. EGC : Jakarta.
Pusponegoro, A.D. Dkk . (……). Buku Panduan Penanggulangan Penderita gawat Darurat. Ambulance 118 : Jakarta.
Skeet, Muriel. 1995. Tindakan paramedic Terrhadap Kegawatan dan Pertolongan Pertama, Ed. 2. EGC : Jakarta.
Definisi
Perdarahan terjadi jika pembuluh darah putus atau pecah.
Perdarahan luar
Perdarahan dalam
Perdarahan hebat, dapat membahayakan shock hipovolemik
Klafisikasi : perdarahan kapiler, perdarahan arteri, perdarahan vena.
Asuhan Keperawatan
Pengkajian
Pengkajian ABCD, pucat, kulit dingin dan lembab, tekanan darah turun, nadi cepat tapi lemah, nafas dalam dan cepat, menurunnya produksi urine.
Diagnosa keperawatan
Kurang volume cairan tubuh berhubungan dengan kehilangan darah aktif.
Penurunan kardiak output berhubungan dengan penurunan preload, kehilangan darah.
Perubahan perfusi jaringan berhubungan dengan kehilangan darah.
Perubahan persepsi sensori berhubungan dengan penurunan perfusi otak.
Tujuan keperawatan
Mengontrol perdarahan.
Mempertahankan volume darah sirkulasiadekuat untuk oksigenasi.
Mencegah shock.
Penatalaksanaan kedaruratan
Potong baju pasien untuk mengidentifikasi area perdarahan dan lakukan pengkajian fisik dengan cepat.
Beri penekanan pada area perdarahan.
• Penekanan langsung
Tekan langsung area perdarahan dengan telapak tangan atau menggunakan pembalut atau kainyang bersih selama kurang lebih 15 menit, dan pasang balutan tekanan kuat.
• Penekanan arteri
Penekanan dilakukan pada ujung arteri yang sesuai (ujung dimana arteri ditekan melawan tulang yang berada dibawahnya).
Enam titik utama penekanan
Arteri temporalis : pada daerah depan masing-masing telinga dan dapat ditekan pada tulang tengkorak.
Arteri fasialis : terletak dibawah dagu dan 2,5 cm sebelah dalam dagu.
Arteri karotis komunis : pada sisi samping trachea. Saat dilakukan tekanan observasi pernapasan pasien dan tidak boleh pada kedua arteri karotis dalam waktu bersamaan.
Arteri subklavia : terletak dibawah kedua sisi klavikula (tulang collar). Penekanan harus dilakukan pada posisi melintang dibelakang dan kira – kira setengah panjang klavikula.
Arteri brakhialis : pada pertengahan antara siku dan bahu, terletak pada daerah yang lebih dalam dari lengan atas antara otot biseps dan triseps.
Arteri femoralis : dapat dirasakan pada lipat paha.
• Torniket
Pemasanagan torniket pada ekstremitas hanya sebagai upaya terakhir ketika perdarahan tidak dapat dikontrol dengan metode lain.
Torniket dipasang tepat proksimal dengan luka ; torniket cukup kencang untuk mengontrol aliran darah arteri.
Berikan tanda pada kulit pasien dengan pulpen atau plester dengan tanda T, menyatakan lokasi dan waktu pemasangan torniket.
Longgarkan torniket sesuai petunjuk untuk mencegah kerusakan vascular atau neurologik. Bila sudah tidak ada perdarahan arteri, lepasakan torniket dan coba lagi balut dengan tekanan.
Pada kejadian amputasi traumatic, jangan lepaskan torniket sampai pasien masuk ruang operasi.
Tinggikan atau elevasikan bagian yang luka untuk memperlambat mengalirnya darah.
Baringkan korban untuk mengurangi derasnya darah keluar.
Berikan cairan pengganti sesuai saran, meliputi cairan elektrolit isotonic, plasma atau protein plasma, atau terapi komponen darah (bergantung perkiraan tipe dan volume cairan yang hilang).
• Darah segar diberikan bila ada kehilangan darah massif.
• Tamabahan trombosit dan factor pembekuan darah diberikan ketika jumlah darah yang besar diperlukan karena darah penggantian kekurangan factor pembekuan.
Lakukan pemeriksaan darah arteri untuk menentukan gas darah dan memantau tekanan hemodinamik.
Awasi tanda – tanda shock atau gagal jantung karena hipovolemia dan anoksia.
REFERENSI
Brunner and Suddarth. 2001. Keperawatan Medikal Bedah, Ed.8 Vol.3. EGC : Jakarta.
Hudak, Carolyn M. 1996. Keperawatan Kritis-Pendekatan holistic, Ed. 6. Vol. 2. EGC : Jakarta.
Pusponegoro, A.D. Dkk . (……). Buku Panduan Penanggulangan Penderita gawat Darurat. Ambulance 118 : Jakarta.
Skeet, Muriel. 1995. Tindakan paramedic Terrhadap Kegawatan dan Pertolongan Pertama, Ed. 2. EGC : Jakarta.
Meningitis
A. Pengertian
Meningitis adalah radang pada meningen (membran yang mengelilingi otak dan medula spinalis) dan disebabkan oleh virus, bakteri atau organ-organ jamur(Smeltzer, 2001).
Meningitis merupakan infeksi akut dari meninges, biasanya ditimbulkan oleh salah satu dari mikroorganisme pneumokok, Meningokok, Stafilokok, Streptokok, Hemophilus influenza dan bahan aseptis (virus) (Long, 1996).
Meningitis adalah peradangan pada selaput meningen, cairan serebrospinal dan spinal column yang menyebabkan proses infeksi pada sistem saraf pusat (Suriadi & Rita, 2001).
B. Etiologi
Bakteri : Mycobacterium tuberculosa, Diplococcus pneumoniae (pneumokok), Neisseria meningitis (meningokok), Streptococus haemolyticuss, Staphylococcus aureus, Haemophilus influenzae, Escherichia coli, Klebsiella pneumoniae, Peudomonas aeruginosa.
Penyebab lainnya lues, Virus, Toxoplasma gondhii dan Ricketsia.
Faktor predisposisi : jenis kelamin lakilaki lebih sering dibandingkan dengan wanita.
Faktor maternal : ruptur membran fetal, infeksi maternal pada minggu terakhir kehamilan.
Faktor imunologi : defisiensi mekanisme imun, defisiensi imunoglobulin.
Kelainan sistem saraf pusat, pembedahan atau injury yang berhubungan dengan sistem persarafan.
C. Klasifikasi
Meningitis dibagi menjadi 2 golongan berdasarkan perubahan yang terjadi pada cairan otak, yaitu :
Meningitis serosa
Adalah radang selaput otak araknoid dan piameter yang disertai cairan otak yang jernih. Penyebab terseringnya adalah Mycobacterium tuberculosa. Penyebab lainnya lues, Virus, Toxoplasma gondhii dan Ricketsia.
Meningitis purulenta
Adalah radang bernanah arakhnoid dan piameter yang meliputi otak dan medula spinalis. Penyebabnya antara lain : Diplococcus pneumoniae (pneumokok), Neisseria meningitis (meningokok), Streptococus haemolyticuss, Staphylococcus aureus, Haemophilus influenzae, Escherichia coli, Klebsiella pneumoniae, Peudomonas aeruginosa.
D. Patofisiologi
Meningitis bakteri dimulai sebagai infeksi dari oroaring dan diikuti dengan septikemia, yang menyebar ke meningen otak dan medula spinalis bagian atas.
Faktor predisposisi mencakup infeksi jalan nafas bagian atas, otitis media, mastoiditis, anemia sel sabit dan hemoglobinopatis lain, prosedur bedah saraf baru, trauma kepala dan pengaruh imunologis. Saluran vena yang melalui nasofaring posterior, telinga bagian tengah dan saluran mastoid menuju otak dan dekat saluran vena-vena meningen; semuanya ini penghubung yang menyokong perkembangan bakteri.
Organisme masuk ke dalam aliran darah dan menyebabkan reaksi radang di dalam meningen dan di bawah korteks, yang dapat menyebabkan trombus dan penurunan aliran darah serebral. Jaringan serebral mengalami gangguan metabolisme akibat eksudat meningen, vaskulitis dan hipoperfusi. Eksudat purulen dapat menyebar sampai dasar otak dan medula spinalis. Radang juga menyebar ke dinding membran ventrikel serebral. Meningitis bakteri dihubungkan dengan perubahan fisiologis intrakranial, yang terdiri dari peningkatan permeabilitas pada darah, daerah pertahanan otak (barier oak), edema serebral dan peningkatan TIK.
Pada infeksi akut pasien meninggal akibat toksin bakteri sebelum terjadi meningitis. Infeksi terbanyak dari pasien ini dengan kerusakan adrenal, kolaps sirkulasi dan dihubungkan dengan meluasnya hemoragi (pada sindromWaterhouse-Friderichssen) sebagai akibat terjadinya kerusakan endotel dan nekrosis pembuluh darah yang disebabkan oleh meningokokus.
E. Manifestasi klinis
Gejala meningitis diakibatkan dari infeksi dan peningkatan TIK :
Sakit kepala dan demam (gejala awal yang sering)
Perubahan pada tingkat kesadaran dapat terjadi letargik, tidak responsif, dan koma.
Iritasi meningen mengakibatkan sejumlah tanda sbb :
Rigiditas nukal (kaku leher). Upaya untuk fleksi kepala mengalami kesukaran karena adanya spasme otot-otot leher.
Tanda kernik positip: ketika pasien dibaringkan dengan paha dalam keadan fleksi kearah abdomen, kaki tidak dapat di ekstensikan sempurna.
Tanda brudzinki : bila leher pasien di fleksikan maka dihasilkan fleksi lutut dan pinggul. Bila dilakukan fleksi pasif pada ekstremitas bawah pada salah satu sisi maka gerakan yang sama terlihat peda sisi ektremita yang berlawanan.
Mengalami foto fobia, atau sensitif yang berlebihan pada cahaya.
Kejang akibat area fokal kortikal yang peka dan peningkatan TIK akibat eksudat purulen dan edema serebral dengan tanda-tanda perubahan karakteristik tanda-tanda vital(melebarnya tekanan pulsa dan bradikardi), pernafasan tidak teratur, sakit kepala, muntah dan penurunan tingkat kesadaran.
Adanya ruam merupakan ciri menyolok pada meningitis meningokokal.
Infeksi fulminating dengan tanda-tanda septikimia : demam tinggi tiba-tiba muncul, lesi purpura yang menyebar, syok dan tanda koagulopati intravaskuler diseminata.
F. Pemeriksaan Diagnostik
Analisis CSS dari fungsi lumbal :
Meningitis bakterial : tekanan meningkat, cairan keruh/berkabut, jumlah sel darah putih dan protein meningkat glukosa meningkat, kultur positip terhadap beberapa jenis bakteri.
Meningitis virus : tekanan bervariasi, cairan CSS biasanya jernih, sel darah putih meningkat, glukosa dan protein biasanya normal, kultur biasanya negatif, kultur virus biasanya dengan prosedur khusus.
Glukosa serum : meningkat (meningitis)
LDH serum : meningkat (meningitis bakteri)
Sel darah putih : sedikit meningkat dengan peningkatan neutrofil (infeksi bakteri)
Elektrolit darah : Abnormal.
Kultur darah/ hidung/ tenggorokan/ urine : dapat mengindikasikan daerah pusat infeksi atau mengindikasikan tipe penyebab infeksi.
MRI/ skan CT : dapat membantu dalam melokalisasi lesi, melihat ukuran/letak ventrikel; hematom daerah serebral, hemoragik atau tumor.
Rontgen dada/kepala/ sinus ; mungkin ada indikasi sumber infeksi intra kranial.
G. Komplikasi
Hidrosefalus obstruktif
MeningococcL Septicemia (mengingocemia)
Sindrome water-friderichen (septik syok, DIC,perdarahan adrenal bilateral)
SIADH (Syndrome Inappropriate Antidiuretic hormone)
Efusi subdural
Kejang
Edema dan herniasi serebral
Cerebral palsy
Gangguan mental
Gangguan belajar
Attention deficit disorder.
Download Askep Meningitis di sini
Asuhan Keperawatan Pada Pasien Dengan Meningitis
A. Pengkajian
Biodata klien.
Riwayat kesehatan yang lalu
Apakah pernah menderita penyait ISPA dan TBC ?
Apakah pernah jatuh atau trauma kepala ?
Pernahkah operasi daerah kepala ?
Riwayat kesehatan sekarang
Aktivitas
Gejala : Perasaan tidak enak (malaise). Tanda : ataksia, kelumpuhan, gerakan involunter.
Sirkulasi
Gejala : Adanya riwayat kardiopatologi : endokarditis dan PJK. Tanda : tekanan darah meningkat, nadi menurun, dan tekanan nadi berat, taikardi, disritmia.
Eliminasi
Tanda : Inkontinensi dan atau retensi.
Makanan/cairan
Gejala : Kehilangan nafsu makan, sulit menelan. Tanda : anoreksia, muntah, turgor kulit jelek dan membran mukosa kering.
Higiene
Tanda : Ketergantungan terhadap semua kebutuhan perawatan diri.
Neurosensori
Gejala : Sakit kepala, parestesia, terasa kaku pada persarafan yang terkena, kehilangan sensasi, hiperalgesia, kejang, diplopia, fotofobia, ketulian dan halusinasi penciuman. Tanda : letargi sampai kebingungan berat hingga koma, delusi dan halusinasi, kehilangan memori, afasia,anisokor, nistagmus,ptosis, kejang umum/lokal, hemiparese, tanda brudzinki positif dan atau kernig positif, rigiditas nukal, babinski positif,reflek abdominal menurun dan reflek kremastetik hilang pada laki-laki.
Nyeri/keamanan
Gejala : sakit kepala(berdenyut hebat, frontal). Tanda : gelisah, menangis.
Pernafasan
Gejala : riwayat infeksi sinus atau paru. Tanda : peningkatan kerja pernafasan.
B. Diagnosa Keperawatan
Resiko tinggi terhadap penyebaran infeksi sehubungan dengan diseminata hematogen dari patogen.
Risiko tinggi terhadap perubahan serebral dan perfusi jaringan sehubungan dengan edema serebral, hipovolemia.
Risisko tinggi terhadap trauma sehubungan dengan kejang umum/fokal, kelemahan umum, vertigo.
Nyeri (akut) sehubungan dengan proses inflamasi, toksin dalam sirkulasi.
Kerusakan mobilitas fisik sehubungan dengan kerusakan neuromuskular, penurunan kekuatan
Anxietas berhubungan dengan krisis situasi, ancaman kematian.
C. Intervensi
Resiko tinggi terhadap penyebaran infeksi sehubungan dengan diseminata hematogen dari patogen.
Mandiri :
Beri tindakan isolasi sebagai pencegahan
Pertahan kan teknik aseptik dan teknik cuci tangan yang tepat.
Pantau suhu secara teratur
Kaji keluhan nyeri dada, nadi yang tidak teratur demam yang terus menerus
Auskultasi suara nafas ubah posisi pasien secara teratur, dianjurkan nafas dalam
Cacat karakteristik urine (warna, kejernihan dan bau)
Kolaborasi :
Berikan terapi antibiotik iv: penisilin G, ampisilin, klorampenikol, gentamisin.
Resiko tinggi terhadap perubahan cerebral dan perfusi jaringan sehubungan dengan edema serebral, hipovolemia.
Mandiri :
Tirah baring dengan posisi kepala datar.
Pantau status neurologis.
Kaji regiditas nukal, peka rangsang dan kejang.
Pantau tanda vital dan frekuensi jantung, penafasan, suhu, masukan dan haluaran.
Bantu berkemih, membatasi batuk, muntah mengejan.
Kolaborasi :
Tinggikan kepala tempat tidur 15-45 derajat.
Berikan cairan iv (larutan hipertonik, elektrolit).
Pantau BGA.
erikan obat : steoid, clorpomasin, asetaminofen.
Resiko tinggi terhadap trauma sehubungan dengan kejang umum/vokal, kelemahan umum vertigo.
Mandiri :
Pantau adanya kejang
Pertahankan penghalang tempat tidur tetap terpasang dan pasang jalan nafas buatan.
Tirah baring selama fase akut kolaborasi berikan obat : venitoin, diaepam, venobarbital.
Nyeri (akut ) sehubungan dengan proses infeksi, toksin dalam sirkulasi.
Mandiri :
Letakkan kantung es pada kepala, pakaian dingin di atas mata, berikan posisi yang nyaman kepala agak tinggi sedikit, latihan rentang gerak aktif atau pasif dan masage otot leher.
Dukung untuk menemukan posisi yang nyaman(kepala agak tingi)
Berikan latihan rentang gerak aktif/pasif.
Gunakan pelembab hangat pada nyeri leher atau pinggul.
Kolaborasi :
Berikan anal getik, asetaminofen, codein
Kerusakan mobilitas fisik sehubungan dengan kerusakan neuromuskuler.
Kaji derajat imobilisasi pasien.
Bantu latihan rentang gerak.
Berikan perawatan kulit, masase dengan pelembab.
Periksa daerah yang mengalami nyeri tekan, berikan matras udsra atau air perhatikan kesejajaran tubuh secara fumgsional.
Berikan program latihan dan penggunaan alat mobiluisasi.
Perubahan persepsi sensori sehubungan dengan defisit neurologis
Pantau perubahan orientasi, kemamapuan berbicara,alam perasaaan, sensorik dan proses pikir.
Kaji kesadara sensorik : sentuhan, panas, dingin.
Observasi respons perilaku.
Hilangkan suara bising yang berlebihan.
Validasi persepsi pasien dan berikan umpan balik.
Beri kessempatan untuk berkomunikasi dan beraktivitas.
Kolaborasi ahli fisioterapi, terapi okupasi,wicara dan kognitif.
Ansietas sehubungan dengan krisis situasi, ancaman kematian.
Kaji status mental dan tingkat ansietasnya.
Berikan penjelasan tentang penyakitnya dan sebelum tindakan prosedur.
Beri kesempatan untuk mengungkapkan perasaan.
Libatkan keluarga/pasien dalam perawatan dan beri dukungan serta petunjuk sumber penyokong.
H. Evaluasi
Hasil yang diharapkan :
Mencapai masa penyembuhan tepat waktu, tanpa bukti penyebaran infeksi endogen atau keterlibatan orang lain.
Mempertahankan tingkat kesadaran biasanya/membaik dan fungsi motorik/sensorik, mendemonstrasikan tanda-tanda vital stabil.
Tidak mengalami kejang/penyerta atau cedera lain.
Melaporkan nyeri hilang/terkontrol dan menunjukkan postur rileks dan mampu tidur/istirahat dengan tepat.
Mencapai kembali atau mempertahankan posisi fungsional optimal dan kekuatan.
Meningkatkan tingkat kesadaran biasanya dan fungsi persepsi.
Tampak rileks dan melaporkan ansietas berkurang dan mengungkapkan keakuratan pengetahuan tentang situasi.
DAFTAR PUSTAKA
Doenges, Marilyn E, dkk.(1999).Rencana Asuhan Keperawatan : Pedoman untuk Perencanaan dan Pendokumentasian Perawatan Pasien. Alih Bahasa, I Made Kariasa, N Made Sumarwati. Editor edisi bahasa Indonesia, Monica Ester, Yasmin asih. Ed.3. Jakarta : EGC.
Harsono.(1996).Buku Ajar Neurologi Klinis.Ed.I.Yogyakarta : Gajah Mada University Press.
Smeltzer, Suzanne C & Bare,Brenda G.(2001).Buku Ajar Keperawatan Medikal Bedah Brunner & Suddarth.Alih bahasa, Agung Waluyo,dkk.Editor edisi bahasa Indonesia, Monica Ester.Ed.8.Jakarta : EGC.
Tucker, Susan Martin et al. Patient care Standards : Nursing Process, diagnosis, And Outcome. Alih bahasa Yasmin asih. Ed. 5. Jakarta : EGC; 1998.
Price, Sylvia Anderson. Pathophysiology : Clinical Concepts Of Disease Processes. Alih Bahasa Peter Anugrah. Ed. 4. Jakarta : EGC; 1994.
Long, Barbara C. perawatan Medikal Bedah : Suatu Pendekatan Proses Keperawatan. Bandung : yayasan Ikatan Alumni Pendidikan Keperawatan; 1996.
Cara Melangsikan Tubuh
Ada banyak cara menurunkan berat badan, mulai dari bermacam metode diet, olahraga, operasi sedot lemak, tusuk jarum, sampai minum obat pelangsing. Manakah yang aman dan efektif ?
Merujuk pada badan kesehatan dunia, WHO, disebutkan bahwa penurunan berat badan yang baik tidak dapat dilakukan secara instan, tetapi merupakan terapi jangka panjang. Yang dibutuhkan untuk mengurangi berat badan bukan sekadar mengurangi porsi makan, tetapi juga diperlukan bimbingan dari ahli gizi sebelum melakukan perubahan pola makan, disertai aktivitas fisik serta terapi perilaku.
Untuk mencari tahu cara pelangsingan mana yang sehat, aman, sekaligus efektif, bacalah uraian berikut sampai tuntas.
Sedot lemak
Cara membuang lemak yang kini sedang tren adalah operasi liposuction dan tummy-tuck. Operasi ini banyak dipilih karena berat badan bisa turun secara drastis tanpa perlu capek berolahraga dan melakukan diet, hal itu dibuktikan oleh kesaksian seorang artis ternama. Tapi mengapa ya meski lemaknya sudah dibuang, badannya masih juga melar ?
Pada dasarnya liposuction adalah operasi untuk mengeluarkan lemak di bawah kulit, dan dilakukan untuk mencapai keserasian bentuk tubuh, bukan untuk menurunkan berat badan. Sedangkan tummy-tuck adalah proses pembuangan jaringan lemak yang berlebih dan kulit di atasnya untuk membentuk tubuh lebih estetis. Lemak yang dikurangi pun tak boleh lebih dari 3-5 kg sekali operasi
Menurut dokter spesialis gizi, dr.Johanes Chandrawinata, MND,SpGK, kedua jenis operasi tersebut biasa dilakukan dokter terhadap pasien yang memiliki tubuh bergelambir setelah berat badan tubuhnya susut. Jadi, menurunkan berat dulu baru dioperasi, bukan operasi untuk menurunkan berat karena setelah 3 bulan tubuh akan gemuk kembali.
Gastric binding & gastric by-pass
Tindakan ini dipilih jika dengan metode pelangsingan apa pun tidak berhasil. Gastric binding adalah pemasangan alat "pengikat lambung" yang menyebabkan kantung lambung lebih kecil sehingga kita tidak akan makan terlalu banyak karena tubuh lebih cepat merasa kenyang. Melalui tindakan ini berat badan dapat berkurang 35-60 persen dalam 12 bulan.
Berbeda dengan gastric binding yang bersifat sementara, gastric by-pass bersifat permanen, dokter akan membuat ’jalan’ penghubung antara pangkal lambung dengan usus halus sehingga makanan tidak melalui lambung namun langsung ke usus halus. Dengan gastric by-pass, berat badan dapat dikurangi sampai 80 persen. Untuk melakukan kedua jenis tindakan tersebut, pasien harus berusia di atas 35 tahun.
Akunpuntur
Sampai saat ini metode akunpuntur belum dapat dibuktikan secara ilmiah dapat menurunkan berat badan. Umumnya para pasien pun berhenti di tengah jalan karena tak kunjung mendapatkan berat ideal yang diharapkan.
Obat dan suplemen pelangsing
Sebelum percaya oleh iming-iming iklan, sebaiknya teliti lebih dahulu kandungan obat-obatan dan suplemen tersebut. Badan pengawasan obat dan makanan AS (FDA) bahkan melarang konsumsi suplemen pelangsing yang mengandung kandungan akftif E.sinica atau efedrin karena memiliki efek samping gejala psikiatrik, mengganggu saluran cerna serta membuat jantung berdebar-debar.
Meski menyebutkan mampu menurunkan kadar lemak, tak sedikit obat pelangsing yang hanya mampu mengurangi berat tubuh 1,2 kg selama 6-14 minggu, setara dengan diet redah kalori sebesar 1250/hari pada kurun waktu 0.5 minggu tanpa obat apa pun.
Diet popular
Diet popular sering disebut sebagai "Fad Diets", memiliki karateristik antara lain ; menjanjikan penurunan badan yang cepat, dapat menyembuhkan berbagai penyakit, menganjurkan penggunaan suplemen, makan berdasarkan waktu tertentu, membatasi atau melarang makanan tertentu dan hanya untuk jangka pandang.
Yang dapat digolongkan ke dalam fad diets misalnya diet rendah karbohidrat, food combining, diet berdasar golongan darah, mayo clinic diet. Karena banyaknya larangan untuk memakan jenis makanan tertentu, biasanya kebutuhan tubuh akan gizi tidak terpenuhi karena kekurangan vitamin, zat besi, serta serat.
Dari segi ilmu gizi, setiap waktu makan (pagi, siang dan malam) dianjurkan memakan makanan yang bervariasi dalam jumlah seimbang, karena tubuh membutuhkan berbagai macam zat gizi sekaligus.
Menurunkan berat badan secara sehat
Meskipun belum ada jawaban pasti diet mana yang paling tepat untuk menurunkan berat badan, namun dr. Johanes merekomendasikan pola diet yang dilakukan oleh National Weight Control Registry (NWCR) di AS. NWCR adalah kumpulan data orang (ada 4000 orang) yang telah berhasil menurunkan berat badan lebih dari 13 kg dan tetap bertahan selama lebih dari 5 tahun.
Karateristik pola makannya adalah rendah lemak (24 persen asupan kalori), asupan karbohidrat cukup tinggi, rendah kalori (1300-1500 kcal/hari). Karena kita tidak mungkin mengetahui berapa kalori yang dikandung dalam makanan, dr.Johanes menyarankan untuk mengurangi asupan lebih kecil dari porsi biasa.
"Untuk mengurangi 500 kalori setiap hari mudah kok, misalnya jika makan gado-gado, kurangi bumbu kacang dan kerupuknya, lebih memilih nasi putih daripada nasi goreng, dan sebagainya", saran dokter yang yang berpraktek di RS. St.Boromeus, Bandung ini.
Dijelaskan oleh dr.Johanes, mayoritas anggota yang terdaftar dalam NWCR melakukan makan pagi secara rutin, memantau berat badan sendiri secara berkala serta melakukan olahraga. Dengan pola makan rendah lemak rendah kalori seperti ini telah terbukti mampu menurunkan berat badan lebih dari 13 kg dan bisa dipertahankan lebih dari 5 tahun.
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