Awie Trans

Senin, 06 Mei 2013

ABORTUS IMMINEN

A. PENGERTIAN ABORTUS IMMINEN Abortus imminen adalah perdarahan bercak yang menunjukkan ancaman terhadap kelangsungan sauatu kehamilan. Dalam kondisi seperti ini kehamilan masih mungkin berlanjut atau dipertahankan. (Syaifudin. Bari Abdul, 2000) Abortus imminen adalah perdarahan pervaginam pada kehamilan kurang dari 20 minggu, tanpa tanda-tanda dilatasi serviks yang meningkat ( Mansjoer, Arif M, 1999) Abortus imminen adalah pengeluaran secret pervaginam yang tampak pada paruh pertama kehamilan ( William Obstetri, 1990) B. ETIOLOGI ABORTUS IMMINEN Abortus dapat terjadi karena beberapa sebab yaitu : Kelainan pertumbuhan hasil konsepsi, biasanya menyebabkan abortus pada kehamilan sebelum usia 8 minggu. Faktor yang menyebabkan kelainan ini adalah : Kelainan kromosom, terutama trimosoma dan monosoma X Lingkungan sekitar tempat impaltasi kurang sempurna Pengaruh teratogen akibat radiasi, virus, obat-obatan temabakau dan alkohol Kelainan pada plasenta, misalnya endarteritis vili korialis karena hipertensi menahun Faktor maternal seperti pneumonia, typus, anemia berat, keracunan dan toksoplasmosis. Kelainan traktus genetalia, seperti inkompetensi serviks (untuk abortus pada trimester kedua), retroversi uteri, mioma uteri dan kelainan bawaan uterus. C. GAMBARAN KLINIS ABORTUS IMMINEN Terlambat haid atau amenorhe kurang dari 20 minggu Pada pemeriksaan fisik : keadaan umum tampak lemah kesadaran menurun, tekanan darah normal atau menurun, denyut nadi normal atau cepat dan kecil, suhu badan normal atau meningkat Perdarahan pervaginam mungkin disertai dengan keluarnya jaringan hasil konsepsi Rasa mulas atau kram perut, didaerah atas simfisis, sering nyeri pingang akibat kontraksi uterus Pemeriksaan ginekologi : Inspeksi Vulva : perdarahan pervaginam ada atau tidak jaringan hasil konsepsi, tercium bau busuk dari vulva Inspekulo : perdarahan dari cavum uteri, osteum uteri terbuka atau sudah tertutup, ada atau tidak jaringan keluar dari ostium, ada atau tidak cairan atau jaringan berbau busuk dari ostium. Colok vagina : porsio masih terbuka atau sudah tertutup, teraba atau tidak jaringan dalam cavum uteri, besar uterus sesuai atau lebih kecil dari usia kehamilan, tidak nyeri saat porsio digoyang, tidak nyeri pada perabaan adneksa, cavum douglas tidak menonjol dan tidak nyeri. D. PATOFISIOLOGI ABORTUS IMMINEN Pada awal abortus terjadi perdarahan desiduabasalis, diikuti dengan nerkrosis jaringan sekitar yang menyebabkan hasil konsepsi terlepas dan dianggap benda asing dalam uterus. Kemudian uterus berkontraksi untuk mengeluarkan benda asing tersebut. Pada kehamilan kurang dari 8 minggu, villi korialis belum menembus desidua secara dalam jadi hasil konsepsi dapat dikeluarkan seluruhnya. Pada kehamilan 8 sampai 14 minggu, penembusan sudah lebih dalam hingga plasenta tidak dilepaskan sempurna dan menimbulkan banyak perdarahan. Pada kehamilan lebih dari 14 minggu janin dikeluarkan terlebih dahulu daripada plasenta hasil konsepsi keluar dalam bentuk seperti kantong kosong amnion atau benda kecil yang tidak jelas bentuknya (blightes ovum),janin lahir mati, janin masih hidup, mola kruenta, fetus kompresus, maserasi atau fetus papiraseus. Komplikasi : Perdarahan, perforasi syok dan infeksi Pada missed abortion dengan retensi lama hasil konsepsi dapat terjadi kelainan pembekuan darah. E. PATHWAY ABORTUS IMMINEN Download Pathway Abortus Imminen Via Ziddu Download Pathway Abortus Imminen Via Mediafire F. PEMERIKSAAN PENUNJANG ABORTUS IMMINEN Tes kehamilan positif jika janin masih hidup dan negatif bila janin sudah mati Pemeriksaan Dopler atau USG untuk menentukan apakah janin masih hidup Pemeriksaan fibrinogen dalam darah pada missed abortion Data laboratorium Tes urine Hemoglobin dan hematokrit Menghitung trombosit Kultur darah dan urine G. MASALAH KEPERAWATAN ABORTUS IMMINEN Kecemasan Intoleransi aktifitas Gangguan rasa nyaman dan nyeri Defisit volume cairan H. DIAGNOSA KEPERAWATAN ABORTUS IMMINEN Cemas berhubungan dengan pengeluaran konsepsi Tujuan : Mengurangi atau menghilangkan kecemasan Intervensi : Siapkan klien untuk reaksi atas kehilangan Beri informasi yang jelas dengan cara yang tepat Nyeri berhubungan dengan kontraksi uterus Tujuan : Mengurangi atau menghilangkan rasa sakit Intervensi : Menetapkan laporan dan tanda-tanda yang lain. Panggil pasien dengan nama lengkap. Jangan tinggalkan pasien tanpa pengawasan dalam waktu yang lama Rasa sakit dan karakteristik, termasuk kualitas waktu lokasi dan intensitas Melakukan tindakan yang membuat klien merasa nyaman seperti ganti posisi, teknik relaksasi serta kolaburasi obat analgetik Resiko tinggi defisit volume cairan berhubungan dengan perdarahan Tujuan : Mencegah terjadinya defisit cairan Intervensi : Kaji perdarahan pada pasien, setiap jam atau dalam masa pengawasan Kaji perdarahan Vagina : warna, jumlah pembalut yang digunakan, derajat aliran dan banyakny Kaji adanya gumpalan Kaji adanya tanda-tanda gelisah, taki kardia, hipertensi dan kepucatan Monitor nilai HB dan Hematokrit Kehilangan berhubungan dengan pengeluaran hasil konsepsi Tujuan : Mengurangi atau meminimalkan rasa kehilangan atau duka cita Intervensi : Pasien menerima kenyataan kehilangan dengan tenang tidak dengan cara menghakimi Jika diminta bisa juga dilakukan perawatan janin Menganjurkan pada pasien untuk mendekatkan diri pada Tuhan YME Intoleransi aktivitas berhubungan dengan nyeri Tujuan : Klien dapat melakukan aktifitas sesuai dengan toleransinya Intervensi : Menganjurkan pasien agar tiduran Tidak melakukan hubungan seksual

Asuhan Keperawatan Pada Pasien Abortus,

Asuhan Keperawatan Pada Pasien Abortus, Asuhan Keperawatan Pada Klien Abortus, askep arbotus, askep Abortus Inkomplit, asuhan keperawatan maternitas abortus, asuhan kebidanan (askeb) abortus,Asuhan Keperawatan pada Klien dengan aborsi, laporan pendahuluan LP askep abortus, contoh kasus askep abortus, diagnosa keperawatan askep abortus, kumpulan askep, pengertian/definisi abortus informasi mengenai abortus atau aborsi akan dijelaskan berikut ini: A. Pengertian Abortus adalah keluarnya janin sebelum mencapai viabilitas. Dimana masa gestasi belum mencapai usia 22 minggu dan beratnya kurang dari 500gr (Derek liewollyn&Jones, 2002). B. Klasifikasi Abortus spontanea (abortus yangberlangsung tanpa tindakan) Abortus imminens : Peristiwa terjadinya perdarahan dari uterus pada kehamilan sebelum 20 minggu, dimana hasil konsepsi masih dalam uterus, dan tanpa adanya dilatasi serviks. Abortus insipiens : Peristiwa perdarahan uterus pada kehamilan sebelum 20 minggu dengan adanya dilatasi serviks uteri yang meningkat, tetapi hasil konsepsi masih dalam uterus. Abortus inkompletus : Pengeluaran sebagian hasil konsepsi pada kehamilan sebelum 20 minggu dengan masih ada sisa tertinggal dalam uterus. Abortus kompletus : Semua hasil konsepsi sudah dikeluarkan. Abortus provokatus (abortus yang sengaja dibuat) Menghentikan kehamilan sebelum janin dapat hidup di luar tubuh ibu. Pada umumnya dianggap bayi belum dapat hidup diluar kandungan apabila kehamilan belum mencapai umur 28 minggu, atau berat badanbayi belum 1000 gram, walaupun terdapat kasus bahwa bayi dibawah 1000 gram dapat terus hidup. C. Etiologi Kelainan Ovum Abortus spontan yang disebabkan oleh karena kelainan dari ovum berkurang kemungkinannya kalau kehamilan sudah lebih dari satu bulan,artinya makin muda kehamilan saat terjadinya abortus makin besar kemungkinan disebabkan oleh kelainan ovum. Kelainan genetalia ibu Anomali congenital (hipoplasia uteri,uterus bikornis dan lain-lain). Kelainan letak dari uterus seperti retrofleksi uteri fiksata. Tidak sempurnanya persiapan uterus dalam menanti nidasi dari ovum yang sudah dibuahi,seperti kurangnya progesterone atau astrogen,endometritis,mioma sub mukosa. Uterus terlalu cepat meregang (kehamilan ganda,mola). Distosia uterus missal karena terdorong oleh tumor pelvis. Gangguan sirkulasi plasenta Dijumpai pada ibu yang menderita penyakit nefrisis,hipertensi,toksemia gravidarum,anomaly plasenta. D. Patofisiologi Pada awal abortus terjadi perdarahan desiduabasalis, diikuti dengan nerkrosis jaringan sekitar yang menyebabkan hasil konsepsi terlepas dan dianggap benda asing dalam uterus. Kemudian uterus berkontraksi untuk mengeluarkan benda asing tersebut. Pada kehamilan kurang dari 8 minggu, villi korialis belum menembus desidua secara dalam jadi hasil konsepsi dapat dikeluarkan seluruhnya. Pada kehamilan 8 sampai 14 minggu, penembusan sudah lebih dalam hingga plasenta tidak dilepaskan sempurna dan menimbulkan banyak perdarahan. Pada kehamilan lebih dari 14 minggu janin dikeluarkan terlebih dahulu daripada plasenta hasil konsepsi keluar dalam bentuk seperti kantong kosong amnion atau benda kecil yang tidak jelas bentuknya (blightes ovum),janin lahir mati, janin masih hidup, mola kruenta, fetus kompresus, maserasi atau fetus papiraseus. F. Manifestasi Klinis Terlambat haid atau amenorhe kurang dari 20 minggu. Pada pemeriksaan fisik : keadaan umum tampak lemah kesadaran menurun, tekanan darah normal atau menurun, denyut nadi normal atau cepat dan kecil, suhu badan normal atau meningkat. Perdarahan pervaginam mungkin disertai dengan keluarnya jaringan hasil konsepsi. Rasa mulas atau kram perut, didaerah atas simfisis, sering nyeri pingang akibat kontraksi uterus. Pemeriksaan ginekologi : Inspeksi Vulva : perdarahan pervaginam ada atau tidak jaringan hasil konsepsi, tercium bau busuk dari vulva. Inspekulo : perdarahan dari cavum uteri, osteum uteri terbuka atau sudah tertutup, ada atau tidak jaringan keluar dari ostium, ada atau tidak cairan atau jaringan berbau busuk dari ostium. Colok vagina : porsio masih terbuka atau sudah tertutup, teraba atau tidak jaringan dalam cavum uteri, besar uterus sesuai atau lebih kecil dari usia kehamilan, tidak nyeri saat porsio digoyang, tidak nyeri pada perabaan adneksa, cavum douglas tidak menonjol dan tidak nyeri. Asuhan Keperawatan pada Pasien dengan Abortus A. Pengkajian Pengkajian dasar data pasien Tinjauan ulang catatan prenatal sampai adanya terjadi abortus. Sirkulasi Kehilangan darah selama terjadi perdarahan karena abortus. Integritas Ego Dapat menunjukkan labilitas emosional dari kegembiraan sampai ketakutan, marah atau menarik diri klien/ pasangan dapat memiliki pertanyaan atau salah terima peran dalam pengalaman kelahiran. Mungkin mengekpresikan ketidak mampuan untuk menghadapi suasana baru. Eliminasi Kateter urinarius mungkin terpasang : urin jernih pusat, bising usus tidak ada. Makanan/ cairan Abdomen lunak dengan tidak ada distensi pada awal. Neurosensorik Kerusakan gerakan pada sensori dibawah tindak anestesi spinal epidural. Nyeri/ kenyamanan Mungkin mengeluh ketidaknyamanan dari berbagai sumber : misal nyeri penyerta, distensi kandung kemih/ abdomen, efek-efek anestesi : mulut mungkin kering. Pernapasan Bunyi paru jelas dan vesikuler. Keamanan Jalur parenteral bila digunakan resiko terkena infeksi karena pemasangan infus dan nyeri tekan. Seksualitas Fundus kontraksi kuat dan terletak di umbilikus. Pemeriksaan Diagnostik Jumlah darah lengkap, hemoglobin/ hematokrit (Hb/Ht). Mengkaji perubahan dari kadar efek kehilangan darah pada pembedahan urinalisis, kultur urine, darah vaginalm, dan lokhea : Pemeriksaan tambahan didasarkan pada kebutuhan individual. (Doengoes, MZ, & Mary P.M., 2001). B. Diagnosa Keperawatan Devisit Volume Cairan s.d perdarahan Gangguan Aktivitas s.d kelemahan, penurunan sirkulasi Gangguan rasa nyaman: Nyeri s.d kerusakan jaringan intrauteri C. Intervensi Devisit Volume Cairan s.d Perdarahan Tujuan : Tidak terjadi devisit volume cairan, seimbang antara intake dan output baik jumlah maupun kualitas. Intervensi : Kaji kondisi status hemodinamika R : Pengeluaran cairan pervaginal sebagai akibat abortus memiliki karekteristik bervariasi Ukur pengeluaran harian R : Jumlah cairan ditentukan dari jumlah kebutuhan harian ditambah dengan jumlah cairan yang hilang pervaginal Berikan sejumlah cairan pengganti harian R : Tranfusi mungkin diperlukan pada kondisi perdarahan masif Evaluasi status hemodinamika R : Penilaian dapat dilakukan secara harian melalui pemeriksaan fisik Gangguan Aktivitas s.d kelemahan, penurunan sirkulasi Tujuan : Kllien dapat melakukan aktivitas tanpa adanya komplikasi Intervensi : Kaji tingkat kemampuan klien untuk beraktivitas R : Mungkin klien tidak mengalami perubahan berarti, tetapi perdarahan masif perlu diwaspadai untuk menccegah kondisi klien lebih buruk Kaji pengaruh aktivitas terhadap kondisi uterus/kandungan R : Aktivitas merangsang peningkatan vaskularisasi dan pulsasi organ reproduksi Bantu klien untuk memenuhi kebutuhan aktivitas sehari-hari R : Mengistiratkan klilen secara optimal Bantu klien untuk melakukan tindakan sesuai dengan kemampuan/kondisi klien R : Mengoptimalkan kondisi klien, pada abortus imminens, istirahat mutlak sangat diperlukan Evaluasi perkembangan kemampuan klien melakukan aktivitas R : Menilai kondisi umum klien Gangguan rasa nyaman : Nyeri s.d Kerusakan jaringan intrauteri Tujuan : Klien dapat beradaptasi dengan nyeri yang dialami Intervensi : Kaji kondisi nyeri yang dialami klien R : Pengukuran nilai ambang nyeri dapat dilakukan dengan skala maupun dsekripsi. Terangkan nyeri yang diderita klien dan penyebabnya R : Meningkatkan koping klien dalam melakukan guidance mengatasi nyeri Kolaborasi pemberian analgetika R : Mengurangi onset terjadinya nyeri dapat dilakukan dengan pemberian analgetika oral maupun sistemik dalam spectrum luas/spesifik

Jumat, 03 Mei 2013

Caring and Compassion, Leadership Essentials

RoAnna Kingman The vision of Nurse Leader at its inception was to communicate with, guide, share with, and inform nurses in management. However, over time, I recognized that leadership is about far more than that expected of those in management roles. Clinicians who choose to become experts in their field demonstrate the key components of what leadership is about in action. These characteristics have been discussed in numerous articles, research, and the literature. One critical asset is a cognitive recognition of the nursing profession's mission to provide caring and compassionate care. As nurse leaders, it is also our responsibility to ensure that this is practiced and valued in all roles. During the process of writing this editorial, I had the pleasure of teaching a leadership development class to novice nurses sponsored by hospitals in conjunction with Florida Atlantic University. My experience that day led me to believe that I could take a different approach for this editorial and publish one student's paper that said so much more than I could about the importance of maintaining compassion regardless of the circumstances. Her essay is such a powerful example of practicing a necessary leadership trait that not only could I not paraphrase it, I could never do it the justice it deserves. I requested the author's permission to print her paper as a part of my editorial. It is my pleasure to introduce one of our newest nurse leaders, RoAnna Kingman. Back to Article Outline A Reflection on Caring RoAnna Kingman Though I have been a registered nurse for a very short period of time, I feel that my understanding and expression of caring has grown immensely. I certainly was not aware of all the ways that caring can be expressed. I did not really correlate a kind word or a gentle smile with caring. I just thought that this was the way a nurse was supposed to be. The growth that I have sustained over the past 6 months is expressed in the story below. This nursing situation still brings tears to my eyes when I think of it. Mr. Jones, unfortunately, has a terminal condition. He has inoperable throat cancer. The tumor is pressing against his esophagus and his larynx. He is unable to speak to convey his thoughts. He has a tracheostomy to enable him to breathe and a percutaneous endoscopic gastrostomy tube for feeding. He has copious amounts of slimy, smelly, greenish secretions that constantly flow from his nose and mouth. His tracheostomy also consistently leaks thick, malodorous secretions. A nurse could stay at the bedside all day with the suction Yankauer and have a full-time job collecting secretions from Mr. Jones's face, neck, and trach site. Because of his illness, Mr. Jones is rail thin and extremely weak. Despite his frailty, he has managed to remove his tracheostomy tube 5 times; therefore, he is in soft restraints. As you can imagine, Mr. Jones is a high-maintenance patient. He requires a lot of time and patience that many nurses not only do not have but may not want to give. The first time I encountered him, we had just received him in telemetry from the step-down unit. We were told he was stable. We quickly found out that there was a little more going on. Within the first 10 minutes of his arrival, he had removed his trach tube, stood up out of bed, and defecated all over the bed, himself, and the floor. He then proceeded to smear the feces all over his body with his then-unrestrained hands. As you can imagine, touching him at that time was one of the last things I wanted to do. However, there was no choice in the matter since his airway was compromised and his safety was a prime concern. A rapid response was called. We were unable to locate the obturator at that time (later, we saw it taped to the side of the bed). His oxygen saturation had dropped to 42%. Respiratory responded with the team and managed to reinsert the trach tube. After he was stable, we were told not to bathe him because he did not need any extra stimulation at this time. I felt a strong twinge in my stomach at that point. This man was covered in feces from head to toe. It was disgusting! I could not imagine leaving my dog like that, and now I had to leave a human being in this predicament. I gently cleaned him the best that I could without causing him too much stress, but he was still filthy. As I left the unit that morning 2 hours after my shift ended, I felt horrible. I felt as if I had not fulfilled my duty as a caregiver. I returned a few nights later to find that I was to take care of Mr. Jones during my shift. I was a little nervous because I knew that he was not only a lot of work but also quite unstable. With the other six patients that I had to care for that night, I was not sure that I would be able to give him the care that he needed. By this time, Mr. Jones was now on contact precautions, so the extra time had to be taken to don gown, gloves, and mask before entering the room. During report, I found myself becoming a little irritated and upset that I had such a difficult patient load. Little did I know it, but fortunately this attitude would soon change as the night progressed. According to Brilowski and Wendler,1 a positive attitude is necessary to be considered caring. As I began my rounds into my patients' rooms, I really focused on trying to appear caring and joyful. I saved Mr. Jones for last because I knew that his extensive care would take the longest. As I approached his room, I could smell a horrible odor emitting from his body, similar to rotting flesh. My nose cringed in disgust as I donned gown, gloves, and mask. When I came in, Mr. Jones was wide awake, with copious, greenish-yellow, slimy secretions pouring out of his nose and mouth. He looked miserable and pathetic as he lay restrained with soft bilateral wrist restraints. I immediately felt a rush of empathy for this poor man who was completely helpless. Through this empathy, I was able to provide nursing care that was effective and satisfying for him.2 I completely forgot about my overwhelming patient load and focused on what I could do to make this man a little more comfortable. What this man would not give to be in my position! Shame on me for grumbling about the fortunate situation that I was in! I began to clean Mr. Jones, first by suctioning him so that he could breathe a little more effortlessly. I then wiped all of the loose secretions from his face and neck. Though he was not fond of my efforts, I spoke softly to him and explained that I was trying to clean him and make him a little more comfortable. It was the moment when he peered into my eyes with a look of gratitude that I realized he really appreciated me taking the time to help him. It really is the little things that mean the most to everyone involved.1 After I finished bathing him, I stood next to him and began to talk to him. I told him that I realized he was in a lot of pain. I began to gently rub his head as I spoke softly to him. In that instant, he closed his eyes and appeared completely relaxed. His body melted as I gently stroked him. I asked him if he liked it, and he nodded his head yes several times. My presence and communication with Mr. Jones conveyed my interest in him.1 Though he could not speak, we were fully engaged in conversation. Tears began to well up in my eyes as I wondered how long it had been since he had felt that way. Here was this man who most people would think was utterly gross and disgusting, when in reality, he is a man suffering a terminal illness who possesses the same basic needs as all of us. I came to see and accept him as a human being.1 I felt that this nursing situation is one that signifies the meaning of caring to me. I went into the room just wanting to “get the job done and get it over with” and came out of it knowing that I had not only done my job but had possibly given this dying man a little comfort. According to Brilowski and Wendler,1 there are five attributes of caring within nursing: relationship, action, attitude, acceptance, and variability. I feel that my relationship with Mr. Jones existed because I identified a need in him and I was motivated to act.3 I feel that I created a trusting relationship with Mr. Jones by being sincere and patient with him. I also felt an overwhelming responsibility to preserve and enhance his well-being. The care that I provided was predicated on his specific needs and changed as I was in the room.1 I feel that I grow as a caring nurse every day. When I enter the hospital, I focus on preparing myself to care for each patient individually. When I leave the hospital, I reflect on my shift and the positive and negative aspects of every situation. This interaction with Mr. Jones has taught me that there are many ways to be caring and that everyone deserves to be treated with empathy and kindness. I am so thankful that I was able to have the opportunity to care for and give him well-deserved personal attention. This is what we are about! Back to Article Outline References Brilowski GA , Wendler MC . An evolutionary concept analysis of caring . J Adv Nurs . 2005;56:641–650 View In Article Carper BA . Fundamental patterns of knowing in nursing . Adv Nurs Sci . 1978;1:13–24 View In Article Fealy G . Professional caring: the moral dimension . J Adv Nurs . 1995;22:1135–1140 View In Article MEDLINE CrossRef

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