tag:blogger.com,1999:blog-10444797762425649422024-02-19T23:35:07.247-08:00whateverIsma Octavianihttp://www.blogger.com/profile/15581531620650172904noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-1044479776242564942.post-69442304512730043802012-01-07T20:50:00.000-08:002012-01-07T20:55:39.953-08:00ASKEP Open Pneumotoraks<div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif;"><link href="file:///C:%5CUsers%5CISMA_G%7E1%5CAppData%5CLocal%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_filelist.xml" rel="File-List"></link><link href="file:///C:%5CUsers%5CISMA_G%7E1%5CAppData%5CLocal%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_themedata.thmx" rel="themeData"></link><link href="file:///C:%5CUsers%5CISMA_G%7E1%5CAppData%5CLocal%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_colorschememapping.xml" rel="colorSchemeMapping"></link> <span style="font-size: small;"><m:smallfrac m:val="off"> <m:dispdef> <m:lmargin m:val="0"> <m:rmargin m:val="0"> <m:defjc m:val="centerGroup"> <m:wrapindent m:val="1440"> <m:intlim m:val="subSup"> <m:narylim m:val="undOvr"> </m:narylim></m:intlim> </m:wrapindent><style>
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</style> </m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac></span></div><div align="center" class="MsoListParagraphCxSpFirst" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: center;"><span style="font-size: small;"><b><span lang="EN-US" style="line-height: 150%;">BAB 1<o:p></o:p></span></b></span></div><div align="center" class="MsoListParagraphCxSpLast" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: center;"><span style="font-size: small;"><b><span lang="EN-US" style="line-height: 150%;">PENDAHULUAN<o:p></o:p></span></b></span></div><div class="MsoNormal" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%;"><span style="font-size: small;"><br />
</span></div><div class="MsoListParagraph" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt; text-indent: -18pt;"><span style="font-size: small;"><b><span lang="EN-US" style="line-height: 150%;">1.1<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span lang="EN-US" style="line-height: 150%;">LATAR BELAKANG<o:p></o:p></span></b></span></div><div class="MsoNormal" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 54pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">Pada trauma (luka tusuk di dada), biasanya disebabkan oleh benda tajam bila tidak mengenai jantung biasanya dapat menembus rongga paru-paru. Mekanisme penyebabnya bisa satu tusukan kuat ataupun satu gerakan mendadak yang hebat.<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 54pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">Akibatnya selain terjadi pendarahan dari rongga paru-paru, udara juga akan masuk kedalam rongga paru-paru oleh karena itu paru-paru pada sisi yang luka akan mengempis. Penderita Nampak kesakitan ketika bernafas dan mendadak merasa sesak dan gerakan iga disisi yang luka menjadi berkurang (Kartono, M. 1991)<o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt;"><span style="font-size: small;"><br />
</span></div><div class="MsoListParagraphCxSpLast" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt; text-indent: -18pt;"><span style="font-size: small;"><b><span lang="EN-US" style="line-height: 150%;">1.2<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span lang="EN-US" style="line-height: 150%;">TUJUAN PENULISAN<o:p></o:p></span></b></span></div><div class="MsoNormal" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 18pt; text-indent: 36pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">Tujuan umum :<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 54pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">Untuk memperoleh informasi mengenai penyakit OPEN PNEUMOTORAKS pada pasien dengan gawat darurat<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 18pt; text-indent: 36pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">Tujuan khusus :<o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt; text-indent: -18pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">a.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small; line-height: 150%;">Untuk mengetahui proses timbulnya penyakit OPEN PNEUMOTORAKS<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt; text-indent: -18pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">b.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small; line-height: 150%;">Untuk mengetahui cara penanganan secara darurat pada pasien dengan OPEN PNEUMOTORAKS<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt; text-indent: -18pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">c.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small; line-height: 150%;">Untuk mengetahui hal-hal apa saja yang ditimbulkan jika tidak ditangani secara segera pada pasien OPEN PNEUMOTORAKS<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt;"><span style="font-size: small;"><br />
</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt;"><span style="font-size: small;"><br />
</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt;"><span style="font-size: small;"><br />
</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt;"><span style="font-size: small;"><br />
</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt; text-indent: -18pt;"><span style="font-size: small;"><b><span lang="EN-US" style="line-height: 150%;">1.3<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span lang="EN-US" style="line-height: 150%;">METODE PENULISAN<o:p></o:p></span></b></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt;"><span style="font-size: small;"><br />
</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 54pt;"><span style="font-size: small;"><b><span lang="EN-US" style="line-height: 150%;">SISTEMATIKA PENULISAN</span></b></span><span lang="EN-US" style="font-size: small; line-height: 150%;"> Dalam penulisan makalah asuhan keperawatan terhadap penyakit hipertensi pada lansia ini penulis menggunakan metode:<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 54pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">1.Studi pustaka<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 54pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">Mempelajari literature-literatur yang brkaitan dengan trauma dada dari buku- buku.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 54pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">2. Internet<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 54pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">Mengumpulkan data-data terbaru tentang trauma dada dan asuhan keperawatan yang dibutuhkan.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt;"><span style="font-size: small;"><br />
</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 54pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">Penulisan makalah ini disusun secara sistematis dalam 4 bab, yaitu:<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 54pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">Bab 1 : Pendahuluan yang berisi: latar belakang, tujuan penulisan, metode penulisan, dan sistematika penulisan.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 54pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">Bab 2 : Tinjauan teoritis yang terdiri dari; pengertian, etiologi, patofisiologi manifestasi klinik, penatalaksanaan medic dan pemeriksaan diagnostik. Asuhan keperawatan yang terdiri dari; pengkajian, diagnose keperawatan, intervensi, discharge pleaning dan evaluasi<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 54pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">Bab 3: Penutup yang berisi kesimpulan dan saran.<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 36pt;"><span style="font-size: small;"><br />
</span></div><div align="center" class="MsoListParagraphCxSpFirst" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt; text-align: center;"><span style="font-size: small;"><b><span lang="EN-US" style="line-height: 150%;">BAB II<o:p></o:p></span></b></span></div><div align="center" class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt; text-align: center;"><span style="font-size: small;"><b><span lang="EN-US" style="line-height: 150%;">TINJAUAN TEORITIS<o:p></o:p></span></b></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt;"><span style="font-size: small;"><br />
</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 54pt; text-indent: -18pt;"><span style="font-size: small;"><b><span lang="EN-US">A.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span lang="EN-US">KONSEP DASAR MEDIK<o:p></o:p></span></b></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 54pt;"><span style="font-size: small;"><br />
</span></div><div class="MsoListParagraphCxSpLast" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 54pt; text-indent: -18pt;"><span style="font-size: small;"><b><span lang="EN-US">1.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span lang="EN-US">PENGERTIAN<o:p></o:p></span></b></span></div><div class="MsoNormal" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; text-indent: 36pt;"><span lang="EN-US" style="font-size: small;">OPEN PNEUMOTORAKS</span></div><div class="MsoListParagraphCxSpFirst" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 76.5pt; text-indent: -18pt;"><span lang="EN-US" style="font-size: small;">A.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small;">Adalah pneumotoraks yang terjadi akibat terdapatnya hubungan antara rongga pleura dengan bronkus yang merupakan bagian dari luar. Perubahan tekanan ini sesuai dengan perubahan tekanan gerakan pernapasan, pada saat inspirasi tekanan menjadi negative dan pada saat ekspirasi tekanan menjadi positif.</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 76.5pt; text-indent: -18pt;"><span lang="EN-US" style="font-size: small;">B.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small;">Open pneumotoraks adalah adanya trauma tembus pada dinding dada dimana udara yang masuk diruang pleura lebih banyak berasal dari paru-paru yang rusak dari pada defek dinding dada. Jika dinding dada cukup lebar udara dapat masuk dan keluar dari ruang pleura pada setiap pernafasan sehingga mnyebabkan paru didalamnya kolaps.</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 54pt;"><span style="font-size: small;"><br />
</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 54pt; text-indent: -18pt;"><span style="font-size: small;"><b><span lang="EN-US">2.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span lang="EN-US">ANATOMI FISIOLOGI<o:p></o:p></span></b></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt; text-indent: -18pt;"><span lang="EN-US" style="font-size: small;">a.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small;">Anatomi</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt;"><span lang="EN-US" style="font-size: small;">Dinding thorax </span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt;"><span lang="EN-US" style="font-size: small;">Dinding thorax terdiri atas kulit, fascia, saraf, otot, dan tulang. Kerangka dinding thorax membentuk sangkar dada osteokartilaginous yang melindungi jantung, paru-paru, dan beberapa organ rongga abdomen. Kerangka thorax terdiri dari vertebra thoracica dan discus entervertebralis, kostae dan cartilago costalis, serta sternum. Beberapa otot pernapasan yang melekat pada dinding dada antara lain: </span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 108pt; text-indent: -18pt;"><span style="font-size: small;">o<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small;">Otot-otot respirasi : M. intercostalis externus, M. levator costae, M. serratus posterior superior dan M. scalenus</span></div><div class="MsoListParagraphCxSpLast" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 108pt; text-indent: -18pt;"><span style="font-size: small;">o<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small;">Otot ekspirasi : M. intercostalis internus, M. transversus thoracis, M. serratus posterior inferior, M. subcostalis.</span></div><div class="MsoNormalCxSpFirst" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt;"><span lang="EN-US" style="font-size: small;">Traktus respiratorius</span></div><div class="MsoNormalCxSpLast" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt;"><span lang="EN-US" style="font-size: small;">Traktus respiratorius dibedakan menjadi dua yaitu traktus respiratorius bagian atas dan bagian bawah. Traktus respiratorius bagian atas terdiri dari cavum nasi, nasofaring, hingga orofaring. Sementara itu, traktus respiratorius bagian bawah terdiri atas laring, trachea, broncus (primaries, sekundus dan tertius), bronchiolus, bronchiolus respiratorius, duktus alveolaris dan alveolus. Paru- paru kanan terdiri atas tiga lobus (anterior, superior, inferior) sementara paru-paru kiri terdiri atas du lobus (superor dan inverior). Masing-masing paru diliputi oleh kantung pleura yang terdiri dari dua selaput serosa yang disebut pleura, yaitu pleura parietalis dan visceralis. Pleura visceralis meliputi paru-paru termasuk permukaannya dalam visuran sementara pleura parietalis melekat pada dinding thorax, mediastinum dan diafragma. Kavum pleura merupakan ruang potensial antara kedua lapis pleura dan berisi sedikit cairan pleura yang berfungsi melumasi permukaan pleura sehingga memungkinkan gesekan kedua lapisan tersebut pada saat pernapasan.</span></div><div class="MsoListParagraphCxSpFirst" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt; text-indent: -18pt;"><span lang="EN-US" style="font-size: small;">b.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small;">Fisiologi</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt;"><span lang="EN-US" style="font-size: small;">Proses inspirasi terjadi bila tekanan paru lebih kecil dari tekanan atmosfer. Tekanan paru dapat lebih kecil jika volumenya diperbesar. Membesarnya volume paru diakibatkan oleh pembesaran rongga dada. Pembesaran rongga dada terjadi akibat dua factor yaitu factor thoraca dan abdominal. Faktor thoraca (gerakan otot-otot pernapasan pada dinding dada) akan memperbesar rongga dada kearah tranversal dan anterior superior sedangkan factor abdominal (kontraksi diafragma) akan memperbesar ventrikel rongga dada. Akibat membesarnya rongga dada dan tekanan negative pada cavum pleura paru-paru menjaidi terhisap sehingga mengembang dan volumenya membesar, tekanan intrapulmoner menurun. Oleh karena itu udara yang kaya O2 akan bergerak dari lingkungan luar ke alveolus. Di alveolus O2 akan berdifusi masuk ke kapiler sementara CO2 akan berdifusi dari kapiler ke alveolus. Sebaliknya proses ekspirasi terjadi bbila tekanan intra pulmonal lebih besar dari tekanan atmosfir . kerja otot-otot respirasi dan relaksasi diaphragm akan mengakibatkan rongga dada kemballi keukuran semula sehingga tekanan pada cavum pleura menjadi lebih positif dan mendesak paru-paru. Akibatnya tekanan intra pulmoner akan meningkat sehingga udara yang kaya CO2 akan keluar dari paru-paru ke atmosfir.</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 108pt;"><span style="font-size: small;"><br />
</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 108pt;"><span style="font-size: small;"><br />
</span></div><div class="MsoListParagraphCxSpLast" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 54pt; text-indent: -18pt;"><span style="font-size: small;"><b><span lang="EN-US">3.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span lang="EN-US">ETIOLOGI<o:p></o:p></span></b></span></div><div class="MsoNormal" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 36pt;"><span lang="EN-US" style="font-size: small;">Open pneumotoraks disebabkan oleh trauma tembus dada. Berdasarkan kecepatannya, trauma tembus dada dapat dikelompokkan menjadi 2 berdasarkan kecepatannya, yaitu :<br />
- Luka tusuk<br />
Umumnya dianggap kecepatan rendah karena senjata (benda yang menusuk atau mengenai dada) menghancurkan area kecil di sekitar luka. Kebanyakan luka tusuk disebabkan oleh tusukan pisau. Namun, selain itu pada kasus kecelakaan yang mengakibatkan perlukaan dada, dapat juga terjadi ujung iga yang patah (fraktur iga) mengarah ke dalam sehingga merobek pleura parientalis dan viseralis sehingga dapat mengakibatkan open pneumotoraks.<br />
- Luka tembak<br />
Luka tembak pada dada dapat dikelompokkan sebagai kecepatan rendah, sedang, atau tinggi. Faktor yang menentukan kecepatan dan mengakibatkan keluasan kerusakan termasuk jarak darimana senjata ditembakkan, kaliber senjata, dan konstruksi serta ukuran peluru. Peluru yang mengenai dada dapat menembus dada sehingga memungkinkan udara mengalir bebas keluar dan masuk rongga toraks.<br />
<br />
</span></div><div class="MsoListParagraph" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 54pt; text-indent: -18pt;"><span style="font-size: small;"><b><span lang="EN-US">4.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span lang="EN-US">PATOFISIOLOGI<o:p></o:p></span></b></span></div><div class="MsoNormal" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 36pt;"><span lang="EN-US" style="font-size: small;">Pada manusia normal tekanan dalam rongga pleura adalah negatif. Tekanan negatif disebabkan karena kecenderungan paru untuk kolaps (elastic recoil) dan dinding dada yang cenderung<br />
mengembang. Bilamana terjadi hubungan antara alveol atau ruang udara intrapulmoner lainnya (kavitas, bulla) dengan rongga pleura oleh sebab apapun, maka udara akan mengalir dari alveol<br />
ke rongga pleura sampai terjadi keseimbangan tekanan atau hubungan tersebut tertutup. Serupa dengan mekanisme di atas, maka bila ada hubungan antara udara luar dengan rongga pleura melalui dinding dada, udara akan masuk ke rongga pleura sampai perbedaan tekanan menghilang atau hubungan menutup.<br />
Perubahan patofisiologi yang terjadi pada dasarnya adalah akibat dari :<br />
1. Kegagalan ventilasi<br />
2. Kegagalan pertukaran gas pada tingkat alveolar.<br />
3. Kegagalan sirkulasi karena perubahan hemodinamik.<br />
Ketiga faktor diatas dapat menyebabkan hipoksia. <b><br />
<br />
<o:p></o:p></b></span></div><div class="MsoNormal" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 36pt;"><span style="font-size: small;"><b><span lang="EN-US">4 MANIFESTASI KLINIK<o:p></o:p></span></b></span></div><div class="MsoNormal" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 36pt;"><span lang="EN-US" style="font-size: small;">Gejala-gejalanya sangat bervariasi, tergantung kepada jumlah udara yang masuk ke dalam rongga pleura dan luasnya paru-paru yang mengalami kolaps (mengempis).<br />
Gejalanya bisa berupa:<br />
Nyeri dada tajam yang timbul secara tiba-tiba, dan semakin nyeri jika penderita menarik nafas dalam atau terbatuk<br />
- Sesak nafas<br />
- Dada terasa sempit<br />
- Mudah lelah<br />
- Denyut jantung yang cepat<br />
- Warna kulit menjadi kebiruan akibat kekurangan oksigen.<br />
Gejala-gejala tersebut mungkin timbul pada saat istirahat atau tidur.Gejala lainnya yang mungkin ditemukan:<br />
- Hidung tampak kemerahan<br />
- Cemas, stres, tegang<br />
- Tekanan darah rendah (hipotensi).</span></div><div class="MsoListParagraph" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 54pt; text-indent: -18pt;"><span lang="EN-US" style="font-size: small;">5<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-size: small;"><b><span lang="EN-US">PENATALAKSANAAN MEDIK<o:p></o:p></span></b></span></div><div class="MsoNormal" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 36pt;"><span lang="EN-US" style="font-size: small;">Pneumotoraks terbuka membutuhkan intervensi kedaruratan. Menghentikan aliran udara yang melewati lubang pada dinding dada merupakan tindakan menyelamatkan jiwa. Pada situasi darurat tersebut, apa saja dapat digunakan untuk mentup luka dada misalnya handuk, sapu tangan, atau punggung tangan. Jika sadar, pasien diinstruksikan untuk menghirup dan mengejan dengan glotis tertutup. Aksi ini membantu mengembangkan kembali paru dan mengeluarkan udara dari toraks. Di rumah sakit, lubang ditutup dengan kassa yang dibasahi dengan petrolium. Balutan tekan dipasang dan diamankan dengan lilitan melingkar. Biasanya, selang dada yang dihubungkan dengan drainase water-seal (WSD) dipasang untuk memungkinkan udara dan cairan mengalir. Anti biotik biasanya diresepkan untuk melawan infeksi akibat kontaminasi.</span></div><div class="MsoListParagraphCxSpFirst" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 54pt;"><span style="font-size: small;"><br />
</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 54pt;"><span style="font-size: small;"><br />
</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 54pt;"><span style="font-size: small;"><br />
</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 54pt;"><span style="font-size: small;"><br />
</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 54pt; text-indent: -18pt;"><span lang="EN-US" style="font-size: small;">6<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-size: small;"><b><span lang="EN-US">PEMERIKSAAN DIAGNOSTIK<o:p></o:p></span></b></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt; text-indent: -18pt;"><span style="font-size: small;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small;">Ro. Thoraks<br />
Menyatakan akumulasi udara atau cairan pada area pleura; dapat menunjukkan penyimpangan struktur mediastinal (jantung).</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt; text-indent: -18pt;"><span style="font-size: small;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small;">Gas Darah Arteri (GDA)<br />
Variabel tergantung dari derajat fungsi paru yang dipengaruhi atau gangguan mekanik pernafasan dan kemampuan mengkompensasi PaCO2 kadang meningkat. PaCO2 mungkin normal atau menurun ;saturasi O2 bisa menurun.</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt; text-indent: -18pt;"><span style="font-size: small;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small;">Torasentesis<br />
Menyatakan darah atau cairan serosanguinosa.</span></div><div class="MsoListParagraphCxSpLast" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt; text-indent: -18pt;"><span style="font-size: small;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small;">Hb<br />
Mungkin menurun, menunjukkan kehilangan darah.</span></div><div class="MsoNormal" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%;"><span lang="EN-US" style="font-size: small;"><br />
<br />
</span></div><div class="MsoListParagraph" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 54pt; text-indent: -18pt;"><span style="font-size: small;"><b><span lang="EN-US" style="line-height: 150%;">B.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span lang="EN-US" style="line-height: 150%;">ASUHAN KEPERAWATAN GAWAT DARURAT<o:p></o:p></span></b></span></div><div class="MsoNormal" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 36pt; text-indent: 36pt;"><span style="font-size: small;">Asuhan Keperawatan pada kasus Gawat Darurat dengan pasien yang mengalami OPEN PNEUMOTORAKS, berbeda dengan pemberian ASKEP pada Konsep Medikal Bedah.</span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 36pt;"><span style="font-size: small;">Dalam mengkaji pasien Gawat Darurat dengan kasus OPEN PNEUMOTORAKS, harus dilakukan dengan sistematis mulai dari:<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt; text-indent: -18pt;"><span style="font-size: small;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>A: Airway (jalur nafas):<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt;"><span style="font-size: small;">Pada airway yang perlu diperhatikan adalah mempertahankan jalan nafas, memperhatikan apakah ada obstruksi pada jalan nafas( benda asing,secret,darah). Pada kasus open pneumotoraks terdapat masalah pada jalan napasnya </span><span style="font-size: small;"> yang disebabkan oleh penumpukan darah dan udara.<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt;"><span style="font-size: small;">Diagnose :<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt;"><span style="font-size: small;"> Bersihan jalan napas tidak efektif</span><span style="font-size: small;"> b/d penumpukan darah dan udara.<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt;"><span style="font-size: small;"><i>Intervensi :<o:p></o:p></i></span></div><div class="MsoListParagraphCxSpFirst" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 90pt; text-indent: -18pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">a.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small; line-height: 150%;">Kaji kesadaran pasien dengan menyentuh, menggoyang dan memanggil namanya.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 90pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">R/ mengetahui tingkat kesadaran pasien, apakah masih dalam tahap unrespon, pain, voice, dan alert.<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 90pt; text-indent: -18pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">b.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small; line-height: 150%;">Lakukan panggilan untuk pertolongan darurat<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;"> </span><span lang="EN-US" style="font-size: small; line-height: 150%;">R/ bantuan segera dapat m</span><span lang="EN-US" style="font-size: small; line-height: 150%;">embantu mempercepat pertolongan.<o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 90pt; text-indent: -18pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">c.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small; line-height: 150%;"> Beri posisi terlentang pada permukaan rata yang tidak keras, kedua lengan pasien disamping tubuhnya.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 90pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">R/ mengantisipasi trauma servikal, posisi yang tepat dan lingkungan yang nyaman dapat penolong dan korban dalam melakukan tindakan.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 90pt; text-indent: -18pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">d.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small; line-height: 150%;">Berikan posisi nyaman pada klien seperti semifowler/fowler<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 90pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">R/meningkatkan inspirasi maksimal,meningkatkan ekspansi paru dan ventilasi pada sisi yang tak sakit.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 90pt; text-indent: -18pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">e.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small; line-height: 150%;">Buka jalan nafas dengan mengunakan tekhnik gabungan head tilt-chin lift atau dengan tekhnik jaw thrust apabila klien dicurigai mengalami trauma cervical.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 90pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">R/membuka jalan nafas dengan mengangkat epiglottis.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 90pt; text-indent: -18pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">f.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small; line-height: 150%;">Beri O<sub>2</sub> atau pasang ventilator<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 90pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">R/alat dalam menurunkan kerja napas, meningkatkan penghilangan distress respirasi dan sianosis sehubungan dengan hipoksemia.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 90pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">R/mengurangi tekanan intrapleura<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 90pt; text-indent: -18pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">g.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small; line-height: 150%;">Berikan obat jenis analgetik <br />
R/mengurangi hingga menghilangkan rasa nyeri<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 90pt; text-indent: -18pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">h.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small; line-height: 150%;">Lakukan pemasangan WSD<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 90pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">R/untuk mengeluarkan darah yang menumpuk pada rongga pleura.<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 36pt; text-indent: 36pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">Evaluasi :<o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 153pt; text-indent: -18pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">1.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small; line-height: 150%;">Kebutuhan oksigen pasien adekuat<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 153pt; text-indent: -18pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">2.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small; line-height: 150%;">Jalan nafas pasien kembali efektif<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 153pt;"><span style="font-size: small;"><br />
</span></div><div class="MsoListParagraphCxSpLast" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt; text-indent: -18pt;"><span style="font-size: small;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-size: small;"> B:Breathing (pernapasan)<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt;"><span style="font-size: small;">Pada auskultasi suara napas menghilang yang mengindikasikan bahwa paru tidak mengembang dalam rongga pleura.perkusi dinding dada hipersonor,semakin lama tekanan udara didalam rongga pleura didalam rongga pleura akan meningkat dan melebihi tekanan atmosfir. Udara yang terkumpul dalam rongga pleura ini dapat menekan paru sehingga dapat terjadi sesak nafas tiba-tiba,nafas pendek bahkan sering menimbulkan gagal nafas.<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt;"><span style="font-size: small;">Diagonose<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt;"><span style="font-size: small;">Ketidak efektifan pola nafas berhubungan dengan penurunan kemampuan oksigenase karena akumulasi udara.<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt;"><span style="font-size: small;"><i>Intervensi:<o:p></o:p></i></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 90pt; text-indent: -18pt;"><span style="font-size: small;">a.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Kaji pernapasan klien dengan mendekatkan telinga di atas hidung atu mulut sambil mempertahankan pembukaan jalan nafas </span><br />
<span style="font-size: small;">R/mengetahui ada tidaknya pernapasan.<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 90pt; text-indent: -18pt;"><span style="font-size: small;">b.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Perhatikan dada pasien dengan melihat gerakan naik turunnya dada pasien.</span><br />
<span style="font-size: small;">R/mengetahui apakah masih terjadi pengembangan paru.<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 90pt; text-indent: -18pt;"><span style="font-size: small;">c.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Auskultasi yang keluar waktu ekspirasi,merasakan adanya aliran udara.</span><br />
<span style="font-size: small;">R/mendengarkan apakah terdapat suara tambahan atau tidak.<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 90pt; text-indent: -18pt;"><span style="font-size: small;">d.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Berikan posisi nyaman pada klien seperti semifowler/fowler.<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 90pt;"><span style="font-size: small;">R/Meningkatkan ekspansi paru.<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 90pt; text-indent: -18pt;"><span style="font-size: small;">e.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Observasi kembali naik turunnya dada,mendengar dan merasakan udara yang keluar pada ekshalasi.<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 90pt;"><span style="font-size: small;">R/mengetahui keberhasilan tindakan yang telah dilakukan<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 90pt; text-indent: -18pt;"><span style="font-size: small;">f.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Berikan O2 atau pasang ventilator<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 90pt;"><span style="font-size: small;">R/memenuhi kebutuhan oksigen pasien.<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 36pt; text-indent: 36pt;"><span style="font-size: small;">Evaluasi <o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 108pt; text-indent: -18pt;"><span style="font-size: small;">1.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Pola napas pasien menjadi 16-24 x/ menit<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 108pt; text-indent: -18pt;"><span style="font-size: small;">2.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Tampak pergerakan dada pasien simetris pada saat bernapas<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 108pt;"><span style="font-size: small;"><br />
</span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt; text-indent: -18pt;"><span style="font-size: small;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>C:Circulation (sirkulasi)<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt;"><span style="font-size: small;">Peningkatan tekanan intratoraks mengakibatkan tergesernya organ mediastinum secara massif ke arah berlawanan dari sisi paru yang mengalami tekanan. Pergeseran mediastinum ke arah berlawanan dari area cedera ini dapat menyebabkan penyumbatan aliran vena kava superior dan inferior yang dapat mengurangi cardiac preload dan menurunkan cardiac output.<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt;"><span style="font-size: small;">Diagnosa :<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt;"><span style="font-size: small;">Resiko gangguan perfusi jaringan cerebral b/d penurunan aliran balik vena,penurunan curah jantung.<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt;"><span style="font-size: small;">Intervensi :<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 108pt; text-indent: -18pt;"><span style="font-size: small;">a.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Tentukan ada tidaknya denyut nadi .<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 108pt;"><span style="font-size: small;">R/perabaan dilakukan untuk mengetahui apakah jantung masih berkontrasi atau tidak. <o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 108pt; text-indent: -18pt;"><span style="font-size: small;">b.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Hubungi system darurat dengan memberikan informasi tentang hal-hal yang terjadi dan peralatan yang diutuhkan.</span><br />
<span style="font-size: small;">R/informasi yang diperoleh akan membantu dalam menentukan tindakan selanjutnya sehingga pertolongannya akan lebih mudah<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 108pt; text-indent: -18pt;"><span style="font-size: small;">c.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Kolaborasi dalam pemasangan dan pemberian cairan infuse</span><br />
<span style="font-size: small;">R/memenuhi kebutuhan cairan dan elektorlit. Pantau pemberian cairan yang dilakukan, jangan sampai terjadi udem<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 54pt; text-indent: 18pt;"><span style="font-size: small;"><br />
</span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 54pt; text-indent: 18pt;"><span style="font-size: small;"><br />
</span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 54pt; text-indent: 18pt;"><span style="font-size: small;">Evaluasi<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 110.25pt; text-indent: -18pt;"><span style="font-size: small;">1.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Tekanan darah kembali pada nilai 120/80<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 110.25pt; text-indent: -18pt;"><span style="font-size: small;">2.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Tampak tidak adanya sianosis<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 54pt;"><span style="font-size: small;"><br />
</span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt; text-indent: -18pt;"><span style="font-size: small;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>D:Disability (kesadaran)<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt;"><span style="font-size: small;">Pada pasien open pneumotoraks memang mungkin akan mengalami penurunan kesadaran tapi GCS nya sekitar 12-14<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt; text-indent: -18pt;"><span style="font-size: small;">·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>E:Exposure <o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt;"><span style="font-size: small;">Adanya luka tembus menyebabkan luka terbuka dan bunyi aliran udara terdengar pada area luka tembus. Yang selanjutnya disebut “ sucking” chest wound (luka dada menghisap).<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt;"><span style="font-size: small;">Resiko terjadinya infeksi b/d adanya luka tusuk<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt;"><span style="font-size: small;"><i>Intervensi:<o:p></o:p></i></span></div><div class="MsoListParagraph" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 90pt; text-indent: -18pt;"><span style="font-size: small;"><i><span lang="EN-US" style="line-height: 150%;">a.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></i></span><span lang="EN-US" style="font-size: small; line-height: 150%;">Luka tembus perlu segera ditutup dengan pembalut darurat atau balutan tekan dibuat kedap udara dengan petroleum jelly.<br />
R/ memungkinkan udara yang terhisap dapat dikeluarkan dan bagian yang terbuka sebagai katup dimana udara dapat keluar dan paru-paru akan mengembang.<i><o:p></o:p></i></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 90pt; text-indent: -18pt;"><span style="font-size: small;">b.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Pemberian antobiotik</span><br />
<span style="font-size: small;">R/mengurangi terjadi proses infeksi<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 90pt; text-indent: -18pt;"><span style="font-size: small;">c.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Pertahankan kebersihan daerah sekitar luka</span><br />
<span style="font-size: small;">R/mencegah terjadinya iritasi <o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt;"><span style="font-size: small;">Evaluasi<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 108pt; text-indent: -18pt;"><span style="font-size: small;">1.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Tidak terjadinya infeksi pada daerah sekitar luka<o:p></o:p></span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 108pt; text-indent: -18pt;"><span style="font-size: small;">2.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Paru-paru dapat berkembang dengan baik<o:p></o:p></span></div><div align="center" class="MsoNormal" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; text-align: center;"><span style="font-size: small;"><br />
</span></div><div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif;"><span style="font-size: small;"><b><span lang="EN-US" style="line-height: 115%;"><o:p> </o:p></span></b></span> </div><div align="center" class="MsoNormal" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; text-align: center;"><span style="font-size: small;"><b><span lang="EN-US" style="line-height: 115%;">BAB III <o:p></o:p></span></b></span></div><div align="center" class="MsoNormal" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; text-align: center;"><span style="font-size: small;"><b><span lang="EN-US" style="line-height: 115%;">PENUTUP<o:p></o:p></span></b></span></div><div class="MsoListParagraphCxSpFirst" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; margin-left: 126pt;"><span style="font-size: small;"><br />
</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; text-indent: -18pt;"><span style="font-size: small;"><b><span lang="EN-US">1.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span lang="EN-US">KESIMPULAN<o:p></o:p></span></b></span></div><div class="MsoListParagraphCxSpLast" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; margin-left: 126pt;"><span style="font-size: small;"><br />
</span></div><div class="MsoNormal" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 18pt; text-indent: 18pt;"><span lang="EN-US" style="font-size: small;">OPEN PNEUMOTORAKS merupakan pneumotoraks yang ter jadi akibat terdapat hubungan antara rongga pleura dengan bronkus yang merupakan bagian dari luar. Tekanan intra pleura sama dengan tekanan barometer atau sama dengan udara luar sedangkan tekanan intra pleura sekitar nol. Perubahan tekanan ini sesuai dengan perubahan tekanan gerakan pernapasan, pada saat inspirasi tekanan menjadi negative dan pada saat ekspirasi tekanan menjadi positif. . Untuk dapat memberikan terapi yang tepat pada penderita OPEN PNEUMOTORAKS pemahaman mengenai patofisiologinya adalah sangat penting.<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif;"><span style="font-size: small;"><br />
</span></div><div class="MsoListParagraph" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; text-indent: -18pt;"><span style="font-size: small;"><b><span lang="EN-US" style="line-height: 150%;">2.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span lang="EN-US" style="line-height: 150%;">SARAN<o:p></o:p></span></b></span></div><div class="MsoNormal" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 18pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">Untuk menangani kasus gawat darurat dengan masalah OPEN PNEUMOTORAKS<o:p></o:p></span></div><div class="MsoNormal" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 18pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">Hal yang perlu dilakukan adalah :<o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; text-indent: -18pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">a.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small; line-height: 150%;">Tekankan tindakan pertolongan untuk mengatasi masalah pernapasan yang dialami.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; text-indent: -18pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">b.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small; line-height: 150%;">Kita perlu memperhatikan linkungan sekitar demi keamanan dan kenyaman penolong dan korban.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; text-indent: -18pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">c.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small; line-height: 150%;">Prioritaskan ke-3 hal penting yaitu system kardi, pulmoner, dan serebral yang mana jika tidak ditangani segera dalam waktu 4-6 menit maka akan menyebabkan kematian biologis.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; text-indent: -18pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">d.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small; line-height: 150%;">Jangan cepat menyerah apabila tindakannya yang kita berikan belum mencapai hasil yang kita inginkan. Tetap monitor dan berikan tindakan untuk membantu menyelamatkan nyawa korban.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; text-indent: -18pt;"><span lang="EN-US" style="font-size: small; line-height: 150%;">e.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="EN-US" style="font-size: small; line-height: 150%;">Jangan lupa proteksi diri untuk menghindari penularan penyakit.<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%;"><span style="font-size: small;"><br />
</span></div><div class="MsoNormal" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif;"><span style="font-size: small;"><br />
</span></div><div align="center" class="MsoListParagraphCxSpFirst" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: center;"><span style="font-size: small;"><b><span lang="EN-US" style="line-height: 150%;">DAFTAR PUSTAKA<o:p></o:p></span></b></span></div><div align="center" class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: center;"><span style="font-size: small;"><br />
</span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 108pt; text-align: justify;"><span lang="EN-US" style="font-size: small; line-height: 150%;">Kristanty, Paula, dkk.2009.<b> Asuhan Keperawatan Gawat Darurat. </b>Jakarta:TIM<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 108pt; text-align: justify;"><span lang="EN-US" style="font-size: small; line-height: 150%;">http///G.Keperawatan Gadar Trauma Dada.akses tanggal 28 maret 2010.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 108pt; text-align: justify;"><span lang="EN-US" style="font-size: small; line-height: 150%;">Nirwan Arief , Wibowo Suryatenggara: Pneumotoraks. Dlam Symposium Penatalaksanna Gawat Paru Masa Kini. Achmad Husain AS, Dkk. Yogykarta,1984.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 108pt; text-align: justify;"><span lang="EN-US" style="font-size: small; line-height: 150%;">Eddy Yapri, Thomas Kardjito, Mohammad Amin. Pneumotorax: Symposium Ilmu Kedokteran Darurat. Surabaya 1998.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 108pt; text-align: justify;"><span lang="EN-US" style="font-size: small; line-height: 150%;">Hood Alsegaf, Isnu Pradjoko, Pneumotoraks, Buku Ajar Ilmu Penyakit Paru, Fk Unair Surabaya, 2004<o:p></o:p></span></div><div align="center" class="MsoListParagraphCxSpLast" style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: center;"><span style="font-size: small;"><br />
</span></div>Isma Octavianihttp://www.blogger.com/profile/15581531620650172904noreply@blogger.com0tag:blogger.com,1999:blog-1044479776242564942.post-51171684995721068252012-01-02T01:50:00.000-08:002012-01-02T02:07:35.950-08:00Tentang Perasaanq<div style="background-color: white; color: magenta; text-align: center;">tuhan tau aq mash mncintainya</div><div style="background-color: white; color: magenta; text-align: center;">tuhan selalu tau kalau aq ingin selalu bersamanya</div><div style="background-color: white; color: magenta; text-align: center;">tapi disatu sisi aq tw </div><div style="background-color: white; color: magenta; text-align: center;">begitu sulit untukq bs bersama mu kembali</div><div style="background-color: white; color: magenta; text-align: center;"><br />
</div><div style="background-color: white; color: magenta; text-align: center;">begitu besar kenangan yang kw tlah berikan padaq</div><div style="background-color: white; color: magenta; text-align: center;">namun begitu besar pula sakit yg kw berikan padaq</div><div style="background-color: white; color: magenta; text-align: center;">tp, aq tak pernah menyimpan kebencian itu terlalu lama...</div><div style="background-color: white; color: magenta; text-align: center;">karena yang q tw cinta itu terlalu besar ntuk mu</div><div style="background-color: white; color: magenta; text-align: center;"><br />
</div><div style="background-color: white; color: magenta; text-align: center;">mngkin qt mash bs bersama</div><div style="background-color: white; color: magenta; text-align: center;">tp, bagiq tak mngkin karena kw tlah bersamanya...</div><div style="background-color: white; color: magenta; text-align: center;">walaupun kw yang memintanya..</div><div style="background-color: white; color: magenta; text-align: center;"><br />
tapi aq yakin </div><div style="background-color: white; color: magenta; text-align: center;">tuhan pasti punya rencana yang indah buat qt nantinya</div><div style="background-color: white; color: magenta; text-align: center;"><br />
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</style> <![endif]--> <div align="center" class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 0cm; text-align: center;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB 1<o:p></o:p></span></div><div align="center" class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 0cm; text-align: center;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PENDAHULUAN<o:p></o:p></span></div><div class="MsoListParagraph" style="color: magenta; line-height: 150%; margin-left: 21.3pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Latar Belakang<o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 21.3pt; text-align: justify; text-indent: 1cm;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kejang demam merupakan salah satu kelainan neurologis yang paling sering dijumpai pada bayi dan anak. Dari penelitian oleh beberapa pakar didapatkan bahwa sekitar 2,2%-5% anak pernah mengalami kejang demam sebelum mereka mencapai umur 5 tahun. Penelitian di jepang bahkan mendapatkan angka kejadian (inseden) yang lebih tinggi, yaitu Maeda dkk, 1993 mendapatkan angka 9,7% (pada pria 10,5% dan pada wanita 8,9% dan Tsuboi mendapatkan angka sekitar 7%.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 21.3pt; text-align: justify; text-indent: 1cm;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kejadian kejang demam diperkirakan 2-4% da Amerika Serikat, Amerika Selatan dan Eropa Barat. Di Asia lebih tinngi kira-kira 20% kasus merupakan kejang demam komplek.Akhir-akhir ini kejang demam diklasifikasikan menjadi 2 golongan yaitu kejang demam sederhana yang berlangsung kurang dari 15 menit dan umum, dan kejang demam komplek yang berlangsung lebih dari dari 15 menit, fokal atau multifel (lebih dari 1 kali kejang</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">demam dalam 24 jam)</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">(Arif Manajer, 2000).</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 21.3pt; text-align: justify; text-indent: 1cm;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kejang demam bisa diakibatkan oleh infeksi ekstrakranial seperti ISPA, radang telinga, campak, cacar air. Dalam keadaan demam, kenaikan suhu tubuh sebesar 1<sup>0</sup>C pun bisa mengakibatkan kenaikan metabolisme basal yang mengakibatkan peningkatan kebutuhan oksigen jaringan sebesar 10 – 15 % dan otak sebesar 20 %. Apabila kebutuhan tersebut tidak terpenuhi maka anak akan kejang. Umumnya kejang tidak akan menimbulkan dampak sisa jika kejang tersebut berlangsung kurang dari 5 menit tetapi anak harus tetap mendapat penanganan agar tidak terjadi kejang ulang yang biasanya lebih lama frekuensinya dari kejang pertama. Timbulnya kejang pada anak akan menimbulkan berbagai masalah seperti resiko cidera, resiko terjadinya aspirasi atau yang lebih fatal adalah lidah jatuh ke belakang yang mengakibatkan obstruksi pada jalan nafas.<o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 21.3pt; text-align: justify; text-indent: 1cm;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hemiparesis biasanya terjadi pada penderita yang mengalami kejang lama (berlangsung lebih dari setengah jam) baik bersifat umum maaupun fokal, kelumpuhannya </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">sesuai dengan kejang vokal yang terjadi. Mula-mula kelumpuhannya bersifat flasid, tetapi setelah 2 minggu spasitisitas. Milichap (1998) melaporkan dari 1990 anak menderita kejang demam, hanya 0,2 % saja yang mengalami hemiparese sesudah kejang lama.<o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 21.3pt; text-align: justify; text-indent: 1cm;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dengan melihat latar belakang tersebut, masalah atau kasus ini dapat diturubkan melalui upaya pencegahan dan penanggulangan optimal yang diberikan sedini mungkin pada anak. Dan perlu diingat bahwa maslah penanggulangan kejang demam ini bukan hanya masalah di rumah sakit tetapi mencskup permasalahan yang menyeluruh dimulai dari individu anak tersebut, keluarga, kelompok maupun masyarakat.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="color: magenta; line-height: 150%; margin-left: 21.3pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan Penulisan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>Ø<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan umum: <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; text-align: justify; text-indent: 18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk memperoleh informasi mengenai penyakit kejang demam pada anak.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Wingdings; font-size: 12pt; line-height: 150%;"><span>Ø<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan khusus:<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui;</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1. definisi penyakit kejang demam pada anak.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2. etiologi penyakit kejang demam pada anak<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3. manifestasi klinik penyakit kejang demam pada anak .<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">4. patofisiologi penyakit kejang demam pada anak.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">5. komplikasi penyakit kejang demam pada anak.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">6. pemeriksaan diagnostik penyakit kejang demam pada anak .<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">7. penatalaksanaan penyakit kejang demam pada anak.<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">8. asuhan keperawatan yang harus diberikan pada klien dengan kejang demam.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div align="center" class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 0cm; text-align: center;"><br />
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</div><div align="center" class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 0cm; text-align: center;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">BAB II<o:p></o:p></span></div><div align="center" class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 0cm; text-align: center;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">TINJAUAN TEORITIS</span><span style="font-family: "Times New Roman","serif";"><o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="color: magenta; line-height: 150%; margin-left: 21.3pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif";"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif";">KONSEP DASAR MEDIK<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="color: magenta; line-height: 150%; margin-left: 42.55pt; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anatomi Fisiologi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 42.55pt; text-align: justify; text-indent: 21.25pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sistem persyarafan terdiri dari sel-sel syaraf (neuron) yang tersusun membentuk sistem saraf pusat dan sistem saraf perifer. Sistem saraf pusat (SSP) terdiri atas otak dan medula spinalis sedangkan sistem saraf tepi (perifer)<span> </span>merupakan susunan saraf diluar SSP yang membawa pesan dari sistem saraf pusat. <o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 42.55pt; text-align: justify; text-indent: 21.25pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Stimulasi atau rangsangan yang diterima oleh tubuh baik yang bersumber dari lingkungan internal maupun eksternal menyebabkan berbagai perubahan dan menuntut tubuh untuk mampu mengadaptasinya sehingga tubuh tetap simbang. Upaya tubuh untuk mengadaptasi berlangsung melalui kegiatan sistem saraf disebut sebagai kegiatan refleks. Bila tubuh tidak mampu mengadaptasinya maka akan terjadi kondisi yang tidak seim</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">`</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">bang atau sakit. <o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 42.55pt; text-align: justify; text-indent: 21.25pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Stimulus diterima oleh reseptor (penerim</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> rangsang) sistem saraf yang selanjutnya akan dihantarkan oleh sistem saraf tepi ke sistem saraf pusat. Di sistem saraf pusat impuls diolah untuk kemudian meneruskan jawaban (respon) kembali melalui sistem saraf tepi menuju efektor yang berfungsi<span> </span>sebagai pencetus jawaban akhir. Jawaban yang terjadi dapat berupa jawaban yang dipengaruhi oleh kemauan (volunter) dan jawaban yang tidak dipengaruhi oleh kemauan (anvolunter)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 42.55pt; text-align: justify; text-indent: 21.25pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jawaban yang volunter melibatkan sistem saraf somatis sedangkan yang involunter melibatkaan sistem saraf otonom. Yang berfungsi sebagai efektor dari sistem saraf somatik adalah otot rangka sedangkan untuk sistem saraf otonom, efektornya adalah otot polos, otot jantung dan kelenjer sebasea.<o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 42.55pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Secara garis besar sistem saraf mempunyai empat fungsi tentang :<o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menerima informasi dari dalam maupun dari luar tubuh melalui saraf sensory (afferent sensory pathway)<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengkomunikasikan informasi antara sistem saraf perifer dan sistem saraf pusat<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengelola informasi yang diterima baik ditingkat medulla spinalis maupun di otak untuk selanjutnya menentukan jawaban atau respon<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menghantarkan jawaban secara cepat melalui saraf motorik ke organ-organ tubuh sebagai kontrol atau modifikasi dari tindakan<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 1cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 42.55pt; text-align: justify;"><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sel Saraf Neuron<o:p></o:p></span></i></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 42.55pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Merupakan sel tubuh yang berfungsi mencetuskan dan menghantarkan impuls listrik. Neuron merupakan unit dasar dan fungsional sistem saraf yang mempunyai sifat exitability artinya siap memberi respon apabila terstimulasi. Satu sel saraf mempunyai badan sel (soma) yang mempunyai satu atau lebih tonjolan (dendrit). Tonjolan-tonjolan ini keluar dari sitoplasma sel saraf. Satu atau dua ekspansi yang sangat panjang disebut akson. Serat saraf adalah akson dari neuron.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 42.55pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dendrit dan badan sel saraf berfungsi sebagai pencetus impuls, sedangkan akson berfungsi sebagai pembawa impuls. Sel-sel saraf membentuk mata rantai yang panjang dari perifer ke pusat dan sebaliknya, dengan demikian impuls dihantarkan secara berantai dari satu neuron ke neuron lainnya. Tempat diman terjadi antara satu neuron dan neuron lainnya disebut sinaps. Penghantaran impuls dari satu neuron ke neuron lainnya belangsung dengan perantaraan zat kimia</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 42.55pt; text-align: justify;"><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sistem Saraf Pusat<o:p></o:p></span></i></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 42.55pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sistem saraf pusat terdiri atas otak dan medula spinalis. Dibungkus oleh selaput meningaen yang berfungsi umtuk melindungi CNS. Meningen terdiri dari 3 lapisan yaitu duramater, arachnoid, dan piamater. Secara fisiologis SSP berfungsi intuk interpretasi, integrasi, koordinasi, dan insiasi berbagai impuls saraf<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 42.55pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Otak, terdiri dari otak besar (cerbelum), otak kecil (cerebrum), dan batang otak (brainstem). Otak merupakan jaringan yang paling banyak menggunakan energi yang didukung oleh metabolisme oksidasi glukosa. Kebutuhan oksigen dan glukosa relatif konstan, hal ini disebabkan oleh karena metabolisme otak yang merupakan proses yang</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">-</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">terus menerus tanpa periode istirahat yang berarti. Bila kadar oksigen dan glukosa kurang dalam jaringan otak maka metabolisme akan terganggu dan jaringan saraf akan mengalami kerusakan.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 42.55pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Medula spinalis merupakan perpenjangan dari medula oblongata yang mempunyai fungsi sebagai berikut : <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pusat gerakan otot tubuh terbesar yaitu kornu motorik atau kornu ventralis<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengurus kegiatan refleks spinalis dan refleks lutut<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menghantarkan rangsangan koordinasi otot dan sendi menuju cerebellum<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 63.8pt; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengadakan komunikasi antara otak dan semua bagian tubuh</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 63.8pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpLast" style="color: magenta; line-height: 150%; margin-left: 1cm; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengertian<o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 1cm; text-align: justify; text-indent: 18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kejang demam adalah bangkitan kejang yang terjadi pada kenaikan suhu tubuh (suhu rectal diatas 38<sup>o</sup>c) yang disebabkan oleh suatu proses ekstracranial (mansjoer, 2000)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 1cm; text-align: justify; text-indent: 21.3pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kejang demam sering juga disebut kejang demam tonik-klonik, sangat sering dijumpai pada anak-anak usia di bawah 5 tahun. Kejang ini disebabkan oleh adanya suatu awitan hypertermia yang timbul mendadak pada infeksi bakteri atau virus. (Sylvia A. Price, Latraine M. Wikson, 1995).<o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 1cm; text-align: justify; text-indent: 21.3pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kejang demam adalah terbebasnya sekelompok neuron secara tiba-tiba yang mengakibatkan suatu kerusakan kesadaran, gerak, sensasi atau memori yang bersifat sementara (Hudak and Gallo,1996).<o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 1cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dari pengertian diatas dapat disimpulkan kejang demam adalah bangkitan kejang yang terjadi karena peningkatan suhu tubuh yaitu 38<sup>0</sup> C yang sering di jumpai pada usia anak dibawah lima tahun.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 18pt;"><br />
</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 18pt;"><br />
</div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 7.1pt; text-align: justify;"><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Klasifikasi</span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> kejang demam;<o:p></o:p></span></i></div><div class="MsoListParagraphCxSpFirst" style="color: magenta; line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menurut Ngastiyah ( 1997:</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">231), klasikfikasi kejang demam adalah<br />
Kejang demam sederhan yaitu kejang berlangsung kurang dari 15 menit dan umum. Adapun pedoman untuk mendiagnosa kejang demam sederhana dapat diketahui melalui criteria Livingstone, yaitu :<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 2cm; text-align: justify; text-indent: -21.3pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">umur anak ketika kejang antara 6 bulan sampai 4 tahun<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 2cm; text-align: justify; text-indent: -21.3pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">kejang berlangsung hanya sebentar, tidak lebih dari 15 menit.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 2cm; text-align: justify; text-indent: -21.3pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kejang bersifat umum<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 2cm; text-align: justify; text-indent: -21.3pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Kejang timbul dalam 16 jam pertama setelah timbul demam.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 2cm; text-align: justify; text-indent: -21.3pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan saraf sebelum dan sesudah kjang normal<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 2cm; text-align: justify; text-indent: -21.3pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan EEG yang dibuat sedikitnya 1 minggu sesudah suhu normal tidak menunjukan kelainan.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 2cm; text-align: justify; text-indent: -21.3pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>g.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Frekuensi kejang bangkitan dalam 1 tahun tidak melebihi 4 kali<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-bottom: 10pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kejang kompleks (epilepsi yang dicetuskan oleh demam)<br />
Kejang kompleks adalah tidak memenuhi salah satu lebih dari ketujuh criteria Livingstone. Menurut Mansyur ( 2000: 434) biasanya dari kejang kompleks diandai dengan:<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 2cm; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">kejang yang berlangsung lebih dari 15 menit</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 2cm; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">usia penderita lebih dari 6 tahun saat serangan kejang demam pertama</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 2cm; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">frekuensi serangan kejang melebihi 4 kali dalam satu tahun</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 2cm; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">kejang berlangsung lama atau bersifat fokal atau multiple ( lebih dari 1 kali dalam 24jam)</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 1cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Di sini anak sebelumnya dapat mempunyai kelainan neurology atau riwayat kejang dalam atau tanpa kejang dalam riwayat keluarga.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 14.2pt; text-align: justify; text-indent: 21.25pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kejang yang merupakan pergerakan abnormal atau perubahan tonus badan dan tungkai dapat </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">diklasifikasikan menjadi 3 bagian yaitu : kejang, klonik, kejang tonik dan kejang mioklonik.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 14.2pt; text-align: justify; text-indent: 21.25pt;"><br />
</div><div class="MsoListParagraph" style="color: magenta; line-height: 150%; margin-left: 35.45pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kejang Tonik</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 35.45pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kejang ini biasanya terdapat pada bayi baru lahir dengan berat badan rendah dengan masa kehamilan kurang dari 34 minggu dan bayi dengan komplikasi prenatal berat. Bentuk klinis kejang ini yaitu berupa pergerakan tonik satu ekstrimitas atau pergerakan tonik umum dengan ekstensi lengan dan tungkai yang menyerupai deserebrasi atau ekstensi tungkai dan fleksi lengan bawah dengan bentuk dekortikasi. Bentuk kejang tonik yang menyerupai deserebrasi harus di bedakan dengan sikap epistotonus yang disebabkan oleh rangsang meningkat karena infeksi selaput otak atau kernikterus<o:p></o:p></span></div><div class="MsoListParagraph" style="color: magenta; line-height: 150%; margin-left: 35.45pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kejang Klonik<o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 35.45pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kejang Klonik dapat berbentuk fokal, unilateral, bilateral dengan pemulaan fokal dan multifokal yang berpindah-pindah. Bentuk klinis kejang klonik fokal berlangsung 1 – 3 detik, terlokalisasi dengan baik, tidak disertai gangguan kesadaran dan biasanya tidak diikuti oleh fase tonik. Bentuk kejang ini dapat disebabkan oleh kontusio cerebri akibat trauma fokal pada bayi besar dan cukup bulan atau oleh ensepalopati metabolik.<o:p></o:p></span></div><div class="MsoListParagraph" style="color: magenta; line-height: 150%; margin-left: 35.45pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kejang Mioklonik<o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 35.45pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gambaran klinis yang terlihat adalah gerakan ekstensi dan fleksi lengan atau keempat anggota gerak yang berulang dan terjadinya cepat. Gerakan tersebut menyerupai reflek moro. Kejang ini merupakan pertanda kerusakan susunan saraf pusat yang luas dan hebat. Gambaran EEG pada kejang mioklonik pada bayi tidak spesifik.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraph" style="color: magenta; line-height: 150%; margin-left: 21.3pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">E</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tiologi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 21.3pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penyebab kejang demam yang sering ditemukan adalah :<o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 21.3pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Faktor predisposisi :<o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 35.45pt; text-align: justify; text-indent: -14.15pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Keturunan, orang tua yang memiliki riwayat kejang sebelumnya dapat diturunkan pada anakmya.<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 35.45pt; text-align: justify; text-indent: -14.15pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Umur, (lebih sering pada umur < 5 tahun), karena sel otak pada anak belum matang sehingga mudah mengalami perubahan konsentrasi ketika mendapat rangsangan tiba-tiba.<o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 21.3pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Faktor presipitasi<o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 35.45pt; text-align: justify; text-indent: -14.15pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adanaya proses infeksi ekstrakranium oleh bakteri atau virus misalnya infeksi saluran pernapasan atas, otitis media akut, tonsilitis, gastroenteritis, infeksi </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">t</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">raktus urinarius dan faringitis.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 35.45pt; text-align: justify; text-indent: -14.15pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ketidak seimbangan ion yang mengubah keseimbangan elektrolit sehingga mengganggu homeostatis kimiawi neuron sehingga terjadi kelainan depolarisasi neuron misalnya hiponatremia, hipernatremia, hipoglikemia, hipokalsemia, dan hipomagnesemia.<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 35.45pt; text-align: justify; text-indent: -14.15pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kejang demam yang disebabkan oleh kejadian perinatal (trauma kepala, infeksi premature, hipoksia) yang dapat menyebabkan kerusakan otak.<o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 35.45pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menurut staf pengajar ilmu kesehatan anak FKUI (1985: 50), faktor presipitasi kejang demam: cenderung timbul 24 jam pertama pada waktu sakit demam atau dimana demam mendadak tinggi karena infeksi pernafasan bagian atas. Demam lebih sering disebabkan oleh virus daripada bakterial.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="color: magenta; line-height: 150%; margin-left: 21.3pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Patofisiologi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="color: magenta; line-height: 150%; margin-left: 21.3pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mempertahankan kelangsungan hidup sel / organ otak diperlukan energi yang didapat dari metabolisme. Bahan baku untuk metabolisme otak yang terpenting adalah glucose,sifat proses itu adalah oxidasi dengan perantara pungsi paru-paru dan diteruskan ke</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">otak melalui system kardiovaskuler.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 21.3pt; text-align: justify; text-indent: 18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berdasarkan hal diatas bahwa energi otak adalah glukosa yang melalui proses oxidasi, dan dipecah menjadi karbon dioksida dan air. Sel dikelilingi oleh membran sel. Yang terdiri dari permukaan dalam yaitu </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">lipoid</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> dan permukaan luar yaitu </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ionik.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Dalam keadaan normal membran sel neuron </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dengan mudah dapat dilalui oleh ion Kalium (K<sup>+</sup>). </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Akibatnya konsentrasi K<sup>+</sup> dalam sel neuron tinggi dan konsentrasi NA<sup>+</sup> rendah. Sedangkan di</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> luar</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> sel neuron terdapat keadaan sebaliknya,karena itu</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> terdapat</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> perbedaan jenis dan konsentrasi ion didalam dan diluar sel. Maka terdapat perbedaan membran yang disebut potensial membran dari neuron. Untuk menjaga keseimbangan potensial membran ini diperlukan energi dan bantuan enzim NA, K, ATP yang terdapat pada permukaan sel.<o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 21.3pt; text-align: justify; text-indent: 18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Keseimbangan potensial membran ini dapat diubah dengan perubahan konsentrasi ion diruang extra selular, rangsangan yang datangnya mendadak misalnya mekanis, kimiawi atau aliran listrik dari sekitarnya. Perubahan dari patofisiologisnya membran sendiri karena penyakit/keturunan. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 21.3pt; text-align: justify; text-indent: 18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada seorang anak sirkulasi otak mencapai 65 % dari seluruh tubuh dibanding dengan orang dewasa 15 %. Dan karena itu pada anak tubuh dapat mengubah keseimbangan dari membran sel neuron dalam singkat terjadi di</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">f</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">usi di ion K<sup>+</sup> maupun ion NA<sup>+ </sup>melalui membran tersebut dengan akibat terjadinya lepasnya muatan listrik.<o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 21.3pt; text-align: justify; text-indent: 18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Lepasnya muatan listrik ini sedemikian besarnya sehingga dapat meluas keseluruh sel maupun membran sel sekitarnya dengan bantuan bahan yang disebut neurotransmitter sehingga mengakibatkan terjadinya kejang. Kejang yang yang berlangsung singkat pada umumnya tidak berbahaya dan tidak meninggalkan gejala sisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> t</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">etapi kejang yang berlangsung lama lebih 15 menit biasanya disertai apnea, NA meningkat, kebutuhan O2 dan energi untuk kontraksi otot skeletal yang akhirnya terjadi hipoxia dan menimbulkan terjadinya asidosis.<o:p></o:p></span></div><div class="MsoListParagraph" style="color: magenta; line-height: 150%; margin-left: 21.3pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Manifestasi klinik</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: 18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terjadinya bangkitan kejang pada bayi dan anak kebanyakan bersamaan dengan kenaikan suhu badan yang tinggi dan cepat, yang disebabkan oleh infeksi di luar susunan saraf pusat : misalnya tonsilitis, otitis media akut, </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ISPA, UTI</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">, serangan kejang biasanya terjadi dalam 24 jam pertama sewaktu demam</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">,</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> berlangsung singkat dengan sifat bangkitan dapat berbentuk tonik-klonik.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraph" style="color: magenta; line-height: 150%; margin-left: 21.3pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan Diagnostik<o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 21.3pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adapun pemeriksaan yang dapat dilakukan pada pasien kejang demam antara lain :<o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan Laboratorium<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 1cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Elektrolit <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 1cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tidak seimbang dapat berpengaruh atau menjadi predisposisi pada<span> </span>aktivitas</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">kejang</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 1cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Glukosa <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 1cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hipoglikemia ( normal 80 - 120)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 1cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ureum / kreatinin<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 1cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Meningkat (ureum normal 10 – 50 mg/dL dan kreatinin normal =< 1,4 mg/dL)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 1cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sel Darah Merah (Hb)<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 1cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menurun ( normal 14-18 g/dl, 12-16 g/dl )</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 1cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Lumbal punksi <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 1cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tes ini untuk memperoleh cairan cerebrospinalis dan untuk mengetahui keadaan lintas likuor. Tes ini dapat mendeteksi penyebab kejang demam atau kejang karena infeksi pada otak.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 2cm; text-align: justify; text-indent: -1cm;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>-<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada kejang demam tidak terdapat gambaran patologis dan pemeriksaan lumbal pungsi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 2cm; text-align: justify; text-indent: -1cm;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>-<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada kejang oleh infeksi pada otak ditemukan :</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 3cm; text-align: justify; text-indent: -1cm;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Warna cairan cerebrospinal : berwarna kuning, menunjukan pigmen kuning santokrom</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 3cm; text-align: justify; text-indent: -1cm;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jumlah cairan dalam cerebrospinal menigkat lebih dari normal (normal bayi 40-60ml, anak muda 60-100ml, anak lebih tua 80-120ml dan dewasa 130-150ml)</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 3cm; text-align: justify; text-indent: -1cm;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perubahan biokimia : kadar Kalium menigkat ( normal dewasa 3.5-5.0 mEq/L, bayi 3.6-5.8mEq/L)</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 42.55pt; text-align: justify; text-indent: -21.3pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">EEG (electroencephalography)<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 42.55pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">EEG merupakan cara untuk merekam aktivitas listrik otak melalui tengkorang yang utuh untuk menentukan adanya kelainan pada SSP, EEG dilakukan sedikitnya 1 minggu setelah suhu normal. Tidak menunjukkan kelainan pada kejang demam sederhana, gelombang EEG yang lambat di daerah belakang dan unilateral menunjukkan kejang demam kompleks<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 21.3pt; text-align: justify; text-indent: -21.3pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 42.55pt; text-align: justify; text-indent: -21.3pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">CT<span> </span>Scan<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 42.55pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tidak<span> </span>dianjurkan pada kejang demam yang beru terjadi pada pertama kalinya</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 42.55pt; text-align: justify; text-indent: -21.3pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeriksaan Radiologis<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 63.8pt; text-align: justify; text-indent: -21.3pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Foto tengkorak diperhatikan simetris tulang tengkorak, destruksi tulang peningkatan tekanan intrakranial<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 63.8pt; text-align: justify; text-indent: -21.3pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pneumonsefalografi dan ventrikulografi dilakukan atas indikasi tertentu yaitu untuk melihat gambaran sistem ventrikal, rongga subaraknoid serta gambaran otak sehingga dapat diketahui adanya atrofi otak, tumor serebri, hidrosefalus araknoiditis<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 63.8pt; text-align: justify; text-indent: -21.3pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Arteriografi untuk melihat keadaan pembuluh darah di otak, apakah ada penyumbatan </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">atau peregangan.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 63.8pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpLast" style="color: magenta; line-height: 150%; margin-left: 21.3pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>7.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penatalaksanaan Medik</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada penatalaksanaan kejang demam ada 3 hal yang perlu dikerjakan yaitu :<o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1. Pengobatan Fase Akut<o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: 18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Seringkali kejang berhenti sendiri. Pada waktu kejang pasien dimiringkan untuk mencegah aspirasi ludah atau muntahan. Jalan napas harus bebas agar oksigennisasi terjami</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">n</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">. Perhatikan keadaan vital seperti kesadaran, tekanan darah, suhu, pernapasan dan fungsi jantung. Suhu tubuh tinggi diturunkan dengan kompres air dan pemberian antipiretik.<o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: 18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Obat yang paling cepat menghentikan kejang</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">adalah diazepam yang diberikan intravena atau intrarektal. Dosis diazepam intravena 0,3-0,5 mg/kgBB/kali dengan kecepatan 1-2 mg/menit dengan dosis maksimal 20 mg. bila kejang berhenti sebelum diazepam habis, hentikan penyuntikan, tunggu sebentar, dan bila tidak timbul kejang lagi jarum dicabut. Bila diazepam intravena tidak tersedia atau pemberiannya sulit gunakan diazepam intrarektal 5 mg (BB≤10</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> kg</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> atau 10 mg(BB≥10kg)</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> bila kejang tidak berhenti dapat diulang selang </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">5 menit kemudian. Bila tidak berhenti juga, berikan fenitoin dengan dosis awal 10-20 mg/kgBB secara intravena perlahan-lahan 1 mg/kgBb/menit. Setelah pemberian fenitoin, harus dilakukan pembilasan dengan Nacl fisiologis karena fenitoin bersifat basa dan menyebabkan iritasi vena.<o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: 18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bila kejang berhenti dengan diazepam, lanjutkan dengan fenobarbital diberikan langsung setelah kejang berhenti. Dosis awal untuk</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> neonatus 30 mg,</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> bayi 1 bulan -1 tahun 50 mg dan umur 1 tahun ke atas 75 mg secara intramuscular. Empat jama kemudian diberikan fenobarbital dosis rumat. Untuk 2 hari pertama dengan dosis 8-10 mg/kgBB/hari dibagi dalam 2 dosis, untuk hari-hari berikutnya dengan dosis 4-5 mg/kgBB/hari dibagi 2 dosis. Selama keadaan belum membaik, obat diberikan secara suntikan dan setelah membaik per oral. Perhatikan bahwa dosis total tidak melebihi 200mg/hari. Efek sampingnya adalah hipotensi,penurunan kesadaran dan depresi pernapasan. Bila kejang berhenti dengan fenitoin,lanjutkna fenitoin dengan dosis 4-8mg/KgBB/hari, 12-24 jam setelah dosis awal.<o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 0cm; text-align: justify; text-indent: 18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2. Mencari dan mengobati penyebab<o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penyebab dari kejang demam baik kejang demam sederhana maupun kejang epilepsi yang diprovokasi oleh demam biasanya ISPA dan otitis media akut. Pemberian antibiotika yang tepat dan adekuat utnuk mengobati infeksi tersebut. Biasanya dilakukan pemeriksaan fungsi lumbal untuk mengetahui faktor resiko infeksi di dalam otak, misalnya: meningitis. Apabila menghadapi penderita dengan kejang demam lama, pemeriksaan yang intensif perlu dilakukan, seperti: pemeriksaan darah lengkap.<o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="color: magenta; line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengobatan </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">rumat<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengobatan ini dibagi atas 2 bagian:<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengobatan profilaksis intermiten: untuk mencegah terulangnya kejadian demam dikemudian hari, orang tua atau pengasuh harus cepat mengetahui bila anak menderita demam. Disamping pemberian antipiretik, obat yang tepat untuk mencegah kejang waktu demam adalah diazepam intrarektal. Diberiakan tiap 12 jam pada penderita demam dengan suhu 38,5<sup>o</sup>C atau lebih. Dosis Diazepam diberikan 5 mg untuk anak kurang dari 3 tahun dan 7,5 mg untuk anak lebih dari 3 tahun atau dapat diberikan Diazepam oral 0,5 mg/kgBB pada waktu penderita demam (berdasarkan resep dokter).<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengobatan profilaksis jangka panjang yaitu dengan pemberian antikonvulsan tiap hari. Hal ini diberikan pada penderita yang menunjukkan hal berikut;<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 78pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sebelum kejang demam penderita sudah ada kelainan neurologis atau perkembangannya<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 78pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kejang demam lebih dari 15 menit, fokal atau diikuti kelainan neurologis sementara atau menetap<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 78pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Riwayat epilepsi pada orang tua atau saudara kandung<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 78pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kejang demam pada bayi atau kejang multipel pada satu episode demam.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Profilaksis </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">jangka panjang</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> setiap hari dengan fenobarbital 4-5mg.kgBB/hari dibagi dalam 2 dosis. Obat lain yang dapat digunakan adalah asam valproat dengan dosis 15-40 mg/kgBB/hari. Antikonvulsan profilaksis selama 1-2 tahun setelah kejang terakhir dan dihentikan bertahap selama 1-2 bulan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 21.3pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>8.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Komplikasi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Epilepsi<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 42.55pt; text-align: justify; text-indent: -6.55pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terjadi akibat adanya kerusakan pada daerah lobus temporalis yang berlangsung lama dan dapat menjadi matang<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Retardasi mental<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 42.55pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terjadi pada pasien kejang demam yang sebelumnya telah terdapat gangguan perkembangan atau kelainan neurologis<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hemiparese<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 42.55pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Biasanya terjadi padaa pasien yang mengalemi kejang lama (berlangsung lebih dari 30 menit)<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gagal pernapasan<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 42.55pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Akibat dari ektivitas kejang yang menyebabkan otot-otot pernapasan menjadi spasme<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="color: magenta; line-height: 150%; margin: 0cm 0cm 10pt 42.55pt; text-align: justify; text-indent: -21.25pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kematian<o:p></o:p></span></div><div align="center" class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 0cm; text-align: center;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">BAB III<o:p></o:p></span></div><div align="center" class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 0cm; text-align: center;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">ASUHAN KEPERAWATAN</span><span style="font-family: "Times New Roman","serif";"><o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="color: magenta; line-height: 150%; margin-left: 21.3pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengkajian<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-bottom: 10pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pola persepsi kesehatan dan pemeliharaan kesehatan<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 35.45pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">adanya riwayat keluarga dengan kejang demam, kejang terjadi pada usia 2-5 tahun, adanya riwayat infeksi, lemah, badan/kulit teraba panas, kejang kurang dari 5 menit, kehilangan kesadaran, sianosis<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="color: magenta; line-height: 150%; margin-bottom: 10pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pola nutrisi dan metabolik<o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 35.45pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mual dan muntah berhubungan dengan aktivitas kejang, nafsu makan menurun, berat badan menurun, membrane mukosa kering, konjungtiva tampak anemis, dan suhu tubuh meningkat<o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="color: magenta; line-height: 150%; margin-bottom: 10pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pola eliminasi<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 35.45pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Frekuensi meningkat konsistensi cair, diare<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-bottom: 10pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pola aktivitas dan latihan<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 35.45pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelemahan umum, kehilangan kesadaran singkat, gerakan infolunter/kontraksi otot, kaku, penurunan tonus otot<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-bottom: 10pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pola persepsi dan konsep diri<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 35.45pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perasaan cemas, ketakutan dengan kondisi anak dikemudian hari<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-bottom: 10pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pola sistem nilai dan kepercayaan<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 35.45pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nilai keyakinan mungkian meningkat seiring kebutuhan untuk mendapat sumber kesembuhan dari Tuhan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 35.45pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpLast" style="color: magenta; line-height: 150%; margin-left: 14.2pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnosa Keperawatan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 0cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Diagnos</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> yang mungkin muncul:<o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hipertermi b/d adanya proses infeksi<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Resiko tinggi cedera fisik b/d aktifitas motorik yang meningkat (kejang)<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Resiko tinggi pola nafas tidak efektif b/d penurunan neuromuscular<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perubahan nutrisi kurang dari kebutuhan tubuh b/d intake yang kurang<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Resiko tinggi perubahan volume cairan kurang dari kebutuhanan tubuh b/d pengeluaran yang berlebihan<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Resiko tinggi gangguan perfusi jaringan ke otak b/d penurunan suplai O2 <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 21.3pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi Keperawatan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 2cm; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hipertermi b/d adanya proses infeksi<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 2cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">HYD: suhu normal 36<sup>o</sup>C – 37<sup>o</sup>C pada klien dalam jangka waktu 2 hari<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 2cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi:<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji penyebab hipertermi <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/ hipertermi merupakan salah satu gejala/kompensasi tubuh terhadap adanya infeksi baik secra lokal maupun secara sistematik<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Observasi TTV <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/ pada klien hipertermi terjadi kenaikan TTV terutama suhu, nadi, pernapasan. Hal ni disebabkan karana metabolisma tubuh meningkat.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Beri kompres hangat pada bagian dahi atau ketiak<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/ daerah dahi dan aksila merupakan jaringan tipis dan terdapat pembulu darah sehingga proses vasodilatasi pembuluh darah lebih cepat sehinggga pergerakan-pergerakan molekul cepat<span> </span>sehinga evaporasi meningkat dengan cepat<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Beri minum sedikit-sedikit tapi sering<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/ untuk mengganti cairan yang hilang dan untuk mempertahankan cairan di dalam tubuh<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pakaikan pakaian yang tipis yang dapat menyerap keringat<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/ pakaian yang tipis dapat membantu mempercepat proses evaporasi<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolaborasi dengan dokter dalam pemberian obat antipiretik<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 2cm; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Resiko tinggi cedera fisik b/d aktifitas motorik yang meningkat (kejang)<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 2cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">HYD: lidah tidak tergigit dan jatuh ke belakang<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 2cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intevensi<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jelaskan pada keluarga akibat-akibat yang terjadi sat kejang berulang (lidah tergigit)<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/ panjelasan yang baik dan tepat sangat penting untuk meningkatkan pengetahuan dalam mengatasi kejang (lidah<span> </span>tergigit)<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sediakan spatel lidah yang telah dibungkur gaas verban<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/ sptel llidah digunakan untuk menahan lidah jjika tergigit<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Beri posisi miring kiri/kanan<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/ mencegah aspirasi pada lambung<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolaborasi dengan dokter dalam pemberian obat anti konvulsan <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/ obat anti konvulsan sebagai pengatur gerakan motorik dalam hal ini anti konvulsan menghentikan gerakan motorik yang berlebihan<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 2cm; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Resiko tinggi pola nafas tidak efektif b/d penurunan neuromuscular<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 2cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">HYD : mempertahankan pola napas efektif <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 2cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi:<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anjurkan pasien mengosongkan mulut dari benda atau zat tertentu <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 72pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/ menurunkan resiko aspirasi atau<span> </span>masuknya suatu benda asing ke faring.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>Letakkan pasien pada posisi miring dan permukaan datar<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/ mencegah lidah jatuh dan menyumbat jalan napas<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Masukkan spatel lidah/jalan napas buatan <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/ mencegah tejatuhnya lidah dan memfasilitasi saat melakukan pengisapan lendir<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolabori dalm pemberian oksigen sesuai indikasi.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/ menurunkan hipoksia serebral sebagai akibat dari sirkulasi yang menurun<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 2cm; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Resiko tinggi gangguan perfusi jaringan ke otak b/d penurunan suplai O2<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 2cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">HYD: gangguan perfusi jaringan otak tidak terjadi<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 2cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi:<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tentukan faktor-faktor yang berhubungan dengan keadaan terentu atau yang menyebabkan penurunan perfusi jaringan otak<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/ penurunan tanda atau gejala neurologis atau kegagalan dalam pemulihannya setelah serangan awal menunjukkan bahwapasien itu perlu dipindahkan ke keperawatan intensif<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Observasi TTV <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/ periksa TTV sangat penting untuk mnegetahui tindakan selanjutnya <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pertahankan leher atau kepala pada posisi tengah kemudian sokong<span> </span>dengan handuk kecil atau bantal kecil <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/ kepala yang miring pada satu sisi akan menekan vena jungularis dan menghambat aliran darah vena yang selanjutnya meningkatkan TIK <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan waktu istirahat diantara aktifitas keperawatan yang dilakukan<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/ aktifitas yang dilakukan terus menerus dapat meningkatkan TIK dengan menimbulkan efek stimulasi kumulatif<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Catat adanya refleks-refleks menelan, batuk, babinski dan reaksi pupil<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/ penurunan refleks menandakan adanya kerusakan pada tigkat otak tengah atau batang otak yang sangat berpengaruh langsungj terhadap keamanan pasien.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anjurkan orang terdekat (keluarga) untuk berbicara dengan pasien.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/ ungkapan keluarga yang menyenangkan pasien tampak mempunyai efek relaksasi pada beberapa pasien. <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 2cm; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kecemasan orang tua berhubungan dengan dampak hospitalisasi<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 2cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hasil yang diharapkan : orang tua tidak merasa cemas<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 2cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Intervensi :<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kaji persepsi orang tua terhadap penyakit klien<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/ persepsi yang positif dalm membina kerja sama yang baik dalam proses keperawatan.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Beri sopport pada keluargaa bahwa klien akan sembuh kalau rutin dalam perawatan dan pengobatan<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/ menaati anjuran atau larangan serta ketekunan mengkonsummsi obat dapat mempercepat proses penyembuhan.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan kesempatan mengungkapakan perasaannya (apa yang dirasakan orang tua saat itu) <o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/ mengurangi beban psikologis dengan menyalurkan aspek emosional secara efektif dan cepat.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Beri informasi tentang cara mengatasi kejang seperti ana dibaringkan di tempat yang datar, kepalanya dimiringkan dan pasang gagang sendok yang telah dibungkus kain bersih.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/ dapat meningkatkan pengetahuan orang tua sehingga dapat mengurangi kecemasan.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anjurkan kepada keluarga untuk selalu berdoa dan mendekatkan diri kepada Tuhan.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 74.7pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">R/ dengan mendekatkan diri pada Tuhan dapat mengurangi ansietas orang tua<o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p> </o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p><br />
</o:p></span></div><div align="center" class="MsoListParagraphCxSpFirst" style="color: magenta; line-height: 150%; margin-left: 0cm; text-align: center;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB IV<o:p></o:p></span></div><div align="center" class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 0cm; text-align: center;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 0cm; text-align: center;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PENUTUP</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="color: magenta; line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">K</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">esimpulan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 35.45pt; text-align: justify; text-indent: 18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kejang demam adalah suatu keadaan dimana bangkitan kejang yang terjadi karena peningkatan suhu tubuh</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> (suhu rectal > 38<sup>0</sup></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">C </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">yang sering di jumpai pada usia anak dibawah lima tahun. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 35.45pt; text-align: justify; text-indent: 18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kejang demam merupakan </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">kelainan neurologis</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> yang</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> sering dijumpai</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> pada saat seorang bayi atau anak mengalami demam tanpa infeksi sistem saraf pusat. Kejang demam biasanya terjadi pada awal demam. Anak akan terlihat aneh untuk beberapa saat, kemudian kaku, kelojotan dan memutar matanya. Anak tidak responsif untuk beberapa waktu, napas akan terganggu, dan kulit akan tampak lebih gelap dari biasanya. Setelah kejang, anak akan segera normal kembali. Kejang biasanya berakhir kurang dari 1 menit, tetapi walaupun jarang dapat terjadi selama lebih dari 15 menit</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 35.45pt; text-align: justify; text-indent: 18pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Oleh karena itu, sangat penting bagi para orang tua untuk melakukan pemeriksaan sedini mungkin pada anaknya agar hal-hal yang tidak di inginkan dapat diketahui secara dini sehingga</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> kejang demam</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> dapat dicegah sedini mungkin</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="color: magenta; line-height: 150%; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Saran<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk meningkatkan kulaitas pelayanan keperawatan maka penulis memberikan saran-saran sebagai berikut;<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada pengkajian perawat perlu melakukan pengkajian dengan teliti melihat kondisi klien serta senantiasa mengembangkan teknik terapeutik dalam berkomunikasi dengan klien.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Agar dapat memberikan asuhan keperawatan yang berkualitas meningkatkan pengetahuan dan keterampilan serta sikap profesionl dalam menetapkan diagnosa keperawtan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diharapkan kerja sama yang baik dari berbagai pihak dari tim kesehatan lainnya khususnya dari pihak keluarga agar selalu mengunjungi klien dalam menunjang keberhasilan perawatan dan pengobatan.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="color: magenta; line-height: 150%; text-align: justify;"><br />
</div><div align="center" class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 0cm; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">DAFTAR PUSTAKA<o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hidayat, Azis Alimul. (2005). <b><i>Pengantar Ilmu Keperawatan Anak I</i></b>. Edisi:1. Jakarta: Salemba medika.<o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Staf Pengajar Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Indonesia. (2007). <b><i>Ilmu Kesehatan Anak. </i></b>Edisi: 11. Jakarta: Infomedika<o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Syaifudin (2006). <b><i>Anatomi Fisiologi untuk mahasiswa keperawatan. </i></b>Editor: Monica Ester. Edisi: 3. Jakarta: ECG<o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">www.Google.com <o:p></o:p></span></div><div class="MsoNormal" style="color: magenta; line-height: 150%; margin-left: 0cm;"><br />
</div></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac>Isma Octavianihttp://www.blogger.com/profile/15581531620650172904noreply@blogger.com0tag:blogger.com,1999:blog-1044479776242564942.post-86637972433940352272012-01-02T00:24:00.000-08:002012-01-02T00:24:20.850-08:00Memory of you<div style="background-color: white; color: magenta; font-family: Times,"Times New Roman",serif;"><span class="" id="result_box" lang="en"><span class="hps">god</span> <span class="hps">knows</span> <span class="hps">if</span> <span class="hps">the heart</span> <span class="hps">is still</span> <span class="hps">for you</span>, <span class="hps">but</span> <span class="hps">god</span> <span class="hps">knows</span> <span class="hps">if I</span>'ve <span class="hps">let</span> <span class="hps">you</span> <span class="hps">to her ...</span><br />
<span class="hps">I am aware</span> <span class="hps">when</span> <span class="hps">you</span> <span class="hps">go</span> <span class="hps">I</span> <span class="hps">miss</span> <span class="hps">you when you</span> <span class="hps">hurt me</span> <span class="hps">in</span> <span class="hps">my heart</span> <span class="hps">there's only</span> <span class="hps">a question</span> <span class="hps">why did you</span> <span class="hps">do that</span> <span class="hps">to me</span> <span class="hps">but the heart</span> <span class="hps">is</span> <span class="hps">always able</span> <span class="hps">to</span> <span class="hps">forgive</span> <span class="hps">you</span> <span class="hps">and</span> <span class="hps">will</span> <span class="hps">always be able</span> <span class="hps">to</span> <span class="hps">forgive</span> <span class="hps">you ...</span><br />
<span class="hps">I also</span> <span class="hps">realize</span> <span class="hps">that</span> <span class="hps">we are</span> <span class="hps">not going to</span> <span class="hps">be together</span> <span class="hps">again</span> <span class="hps">even if</span> <span class="hps">you</span> <span class="hps">ask</span> <span class="hps">me</span> <span class="hps">to</span> <span class="hps">come back</span> <span class="hps">to you</span> <span class="hps">until this moment</span>, <span class="hps">I</span> <span class="hps">really</span> <span class="hps">can not because</span> <span class="hps">you</span> <span class="hps">already</span> <span class="hps">have it and</span> <span class="hps">I</span> <span class="hps">do not</span> <span class="hps">want</span> <span class="hps">to hurt him</span> <span class="hps">enough</span> <span class="hps">that</span> <span class="hps">I</span> <span class="hps">felt</span> <span class="hps">it</span> <span class="hps">was not</span> <span class="hps">him</span> <span class="hps">or anyone else</span> <span class="hps">...</span><br />
<span class="hps">but</span> <span class="hps">if</span> <span class="hps">we one day</span> <span class="hps">I</span>'m sure <span class="hps">we</span>'ll <span class="hps">be paired</span> <span class="hps">together</span> <span class="hps">with the permission of</span> <span class="hps">Allah</span> <span class="hps">in any way</span> <span class="hps">whether</span> <span class="hps">it's</span> <span class="hps">because the</span> <span class="hps">gods</span> <span class="hps">had other plans</span> <span class="hps">are</span> <span class="hps">much</span> <span class="hps">more</span> <span class="hps">beautiful</span> <span class="hps">for us</span><span class="">.</span></span></div>Isma Octavianihttp://www.blogger.com/profile/15581531620650172904noreply@blogger.com0tag:blogger.com,1999:blog-1044479776242564942.post-69924478611175717222012-01-01T23:32:00.000-08:002012-01-02T02:23:07.463-08:00ASKEP CA LAMBUNG<div style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; text-align: left;"><link href="file:///C:%5CUsers%5CISMA_G%7E1%5CAppData%5CLocal%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_filelist.xml" rel="File-List"></link><link href="file:///C:%5CUsers%5CISMA_G%7E1%5CAppData%5CLocal%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_editdata.mso" rel="Edit-Time-Data"></link><link href="file:///C:%5CUsers%5CISMA_G%7E1%5CAppData%5CLocal%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_themedata.thmx" rel="themeData"></link><link href="file:///C:%5CUsers%5CISMA_G%7E1%5CAppData%5CLocal%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_colorschememapping.xml" rel="colorSchemeMapping"></link> <m:smallfrac m:val="off"> <m:dispdef> <m:lmargin m:val="0"> <m:rmargin m:val="0"> <m:defjc m:val="centerGroup"> <m:wrapindent m:val="1440"> <m:intlim m:val="subSup"> <m:narylim m:val="undOvr"> </m:narylim></m:intlim> </m:wrapindent><style>
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</style> </m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac></div><div class="MsoListParagraphCxSpFirst" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 54pt; text-align: left; text-indent: -18pt;">A.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>KONSEP DASAR MEDIK<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 54pt; text-align: left;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: -18pt;">1.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Definisi<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: 36pt;">Kanker lambung adalah suatu keganasan yang terjadi dilambung, sebagian besar adalah dari jenis adenokarsinoma. Jenis kanker lambung lainnya adalah leiomiosarkoma (kanker otot polos) dan limfoma. Kanker lambung sering terjadi pada usia lanjut. Kurang dari 25% kanker tertentu terjadi pada orang dibawah usia 50 tahun (osteen, 2003). <o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: 36pt;">Kanker lambung pada pria merupakan keganasan terbanyak ketiga setelah kanker paru dan kanker kolorektal, sedangkan pada wanita merupakan peringkat ke empat setelah kanker payudara, kanker serviks, dan kanker kolorektal (Christian, 1999).<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: 36pt;">Kanker lambung merupakan neoplasma maligna yang ditemukan di lambung, biasanya adenokarsinoma, meskipun mungkin merupakan limfoma malignansi. Diketahui bahwa kanker lambung 2 kali lebih umum terjadi pada pria daripada wanita. dan lebih sering terjadi pada klien yang mengalami anemia pernisiosa (Santacroce, 2008).<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: 36pt;">Dari beberapa defenisi diatas, dapat disimpulkan bahwa kanker lambung adalah neoplasma maligna yang terdapat dilambung yang sebagian besar merupakan jenis adenokarsinoma, dan sering terjadi pada usia lanjut.<o:p></o:p></div><div class="MsoListParagraphCxSpLast" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: 36pt;"><br />
</div><div class="MsoNormal" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left;">Klasifikasi kanker lambung:<o:p></o:p></div><div class="MsoListParagraphCxSpFirst" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 126pt; text-align: left; text-indent: -18pt;">1.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span><i>Earlic gastric cancer</i>. Berdasarkan hasil pemeriksaan radiologi, gastroskopi, dan pemeriksaan histopatologis dapat dibagi atas:<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 162pt; text-align: left; text-indent: -18pt;">1.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Tipe I (<i>protruded type</i>). Tumor ganas yang menginvasi hanya terbatas pada mukosa dan submukosa yang berbentuk polipoid. Bentunya ireguler, permukaan tidak rata, perdarahan dengan atau tanpa ulserasi<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 162pt; text-align: left; text-indent: -18pt;">2.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Tipe II (<i>superficial type</i>) dapat dibagi atas 3 sub tipe:<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 180pt; text-align: left; text-indent: -18pt;">a.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span><i>Elevated type</i>, tampak sedikit elevasi mukosa lambung, hampir seperti type I, terdapat sedikit elevasi serta dan lebih luas dan melebar,<i><o:p></o:p></i></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 180pt; text-align: left; text-indent: -18pt;">b.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span><i>Flat type, </i>tidak terlihat elevasi dan depresi pada mukosa dan hanya terlihat perubahan pada warna mukosa,<i><o:p></o:p></i></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 180pt; text-align: left; text-indent: -18pt;">c.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span><i>Depressed type, </i>didapatkan dipermukaan yang ireguler dan pinggir yang tidak rata (ireguler) hiperemesis/pendarahan.<i><o:p></o:p></i></div><div class="MsoListParagraphCxSpLast" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 162pt; text-align: left; text-indent: -18pt;">3.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Type III <i>(excavated type)</i>. Menyerupai Bormann II (tumor ganas lanjut) dan sering disertai kombinasi seperti IIC + III atau<i><o:p></o:p></i></div><div class="MsoNormal" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 126pt; text-align: left; text-indent: 36pt;"> III + IIc dan IIa + IIc<o:p></o:p></div><div class="MsoListParagraphCxSpFirst" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 126pt; text-align: left; text-indent: -18pt;">2.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span><i>Advanced gastric cancer</i> (karsinoma gaster lanjut). Menurut klasifikasi bormann dapat dibagi atas:<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 162pt; text-align: left; text-indent: -18pt;">1.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Bentuknya berupa polipoid karsinoma yang sering juga disebut sebagai <i>fungating</i> dan mukosa disekitar tumor atrofi dan ireguler<i><o:p></o:p></i></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 162pt; text-align: left; text-indent: -18pt;">2.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Bormann II. Merupakan <i>non infiltrating carcinomatous ulcer</i> dengan tepi ulkus serta mukosa sekitarnya menonjol dan disertai nodular. Dasar ulkus terlihat nekrosis dengan warna kecoklatan, keabuan, dan merah kehitaman. Mukosa sekitar ulkus tampak sangat hiperemesis,<i><o:p></o:p></i></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 162pt; text-align: left; text-indent: -18pt;">3.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Bormann III, Berupa <i>infaltring carcinomatous ulcer</i>, ulkusnya mempunyai dinding dan terlihat adanya infiltrasi progresif dan difus,<i><o:p></o:p></i></div><div class="MsoListParagraphCxSpLast" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 162pt; text-align: left; text-indent: -18pt;">4.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Bormann IV. Berupa bentuk <i>diffus infiltrating type</i>, tidak terlihat batas tegas pada dinding dan infiltrasi difus pada seluruh mukosa.<i><o:p></o:p></i></div><div class="MsoNormal" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; text-align: left;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: -18pt;">2.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Anatomi fisiologi<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: 36pt;">Lambung terletak dibagian kiri atas abdomen tepat dibawah diafragma. Secara anatomis lambung terbagi atas fundus, badan, dan antrum pilorikum atau pilorus. Sebelah kanan lambung terdapat cekungan kurvatura minor dan bagian kiri bawah lambung terdapat kurvatura mayor. <o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: 36pt;">Kapasitas normal lambung sebesar 1-2 L (Lewis, 2000). Volume lambung akan meningkat pada saat makan, dan menurun pada saat cairan lambung (kimus) masuk ke dalam usus halus. Pada saat lambung menglami relaksasi (kosong), mukosa masuk ke dalam lipatan yang disebut rugae. Rugae merupakan tempat sementara dari pembesaran lambung. Pada saat lambung di isi, maka rugae menyempit dan pada saat lambung penuh maka rugae menghilang (simon, 2003).<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: 36pt;">Sfingter pada kedua ujung lambung mengatur pengeluaran dan pemasukan. Sfingter kardia atau sfingter esofagus bawah, mengalirkan makanan masuk ke dalam lambung dan mencegah refluks isi lambung memasuki esofagus kembali. Di saat sfingter pilorikum berelaksasi, makanan masuk ke dalam duodenum dan ketika berkontraksi, sfingter ini akan mencegah terjadinya aliran balik isi usus halus ke dalam lambung. Sfingter pilorus memiliki arti klinis yang penting karena dapat mengalami stenosis (penyempitan pilorus yang menyumbat) sebagai komplikasi dari penyakit tukak lambung. Stenosis pilorus atau pilorospasme terjadi bila serat-serat otot di sekelilingnya mengalami hipertrofi atau spasme sehingga sfingter gagal berelaksasi untuk mengalirkan makanan dari lambung ke dalam duodenum.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left;">Tidak seperti pada daerah gastrointestinal lain, bagian otot-otot lambung tersusun dari tiga lapis dan buka dua lapis otot polos:<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 108pt; text-align: left;">1. Lapisan longitudinal dibagian luar<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 108pt; text-align: left;">2. Lapisan sirkulasi di tengah<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 108pt; text-align: left;">3. Lapisan oblik di bagian dalam<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left;">Susunan saraf otot yang unik akan memungkinkan berbagai macam kombinasi kontraksi yang akan diperlukan untuk memecahkan makanan menjadi partikel-partikel yang kecil, mengaduk dan mencampur makanan tersebut dengan cairan lambung, lalu mendorongnya ke arah duodenum.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: 36pt;">Persarafan lambung sepenuhnya otonom. Suplai saraf parasimpatis untuk lambung dan duodenum di hantarkan ke dan dari abdomen melalui saraf vagus. Trunkus vagus mencabangkan ramus gastrik, pilorik, hepatik, dan seliaka. Persarafan simpatis adalah melalui saraf splanknikus mayor dan ganglia seliakum. Serabut-serabut aferan menghantarkan impuls nyeri yang dirangsang oleh perengangan, kontraksi otot, dan peradangan, serta dirasakan didaerah epigastrium. Serabut-serabut aferen simpatis menghambat pergerakan dan sekresi lambung. Pleksus saraf mesenterikus (Auerbach) dan submukosa (Meissner) membentuk persarafan intrinsik dinding lambung dan mengoordinasi aktivitas motorik dan sekresi mukosa lambung.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: 36pt;">Seluruh suplai darah dilambung dan pankreas (serta hati, empedu, dan limpa) terutama berasal dari arteri seliaka atau trunkus seliakus, yang mempercabangkan cabang-cabang yang menyuplai kurvatura minor dan mayor. Dua cabang arteri yang mmperdarahi yaitu arteri gastroduodenalis dan arteri pankreatikoduodenalis (retroduodenalis) yang berjalan sepanjang bulbus posterior duodenum. Tukak dinding posterior duodenum dapat mengerosi arteri ini dan menyebabkan perdarahan. Darah vena dari lambung dan duodenum , serta yang berasal dari pankreas, limpa dan bagian lain saluran cerna, berjalan ke hati melalui vena porta.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: 36pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left;"><v:shapetype coordsize="21600,21600" filled="f" id="_x0000_t75" o:preferrelative="t" o:spt="75" path="m@4@5l@4@11@9@11@9@5xe" stroked="f"> <v:stroke joinstyle="miter"> <v:formulas> <v:f eqn="if lineDrawn pixelLineWidth 0"> <v:f eqn="sum @0 1 0"> <v:f eqn="sum 0 0 @1"> <v:f eqn="prod @2 1 2"> <v:f eqn="prod @3 21600 pixelWidth"> <v:f eqn="prod @3 21600 pixelHeight"> <v:f eqn="sum @0 0 1"> <v:f eqn="prod @6 1 2"> <v:f eqn="prod @7 21600 pixelWidth"> <v:f eqn="sum @8 21600 0"> <v:f eqn="prod @7 21600 pixelHeight"> <v:f eqn="sum @10 21600 0"> </v:f> <v:path gradientshapeok="t" o:connecttype="rect" o:extrusionok="f"> <o:lock aspectratio="t" v:ext="edit"> </o:lock><v:shape id="Picture_x0020_4" o:spid="_x0000_i1025" style="height: 276pt; visibility: visible; width: 356.25pt;" type="#_x0000_t75"> <v:imagedata o:title="IMG_0001" src="file:///C:%5CUsers%5CISMA_G%7E1%5CAppData%5CLocal%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_image001.jpg"> </v:imagedata></v:shape></v:path></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:f></v:formulas></v:stroke></v:shapetype><o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 54pt; text-align: left; text-indent: 18pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 54pt; text-align: left; text-indent: 18pt;">Fungsi lambung:<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: 18pt;">Lambung menampung makanan yang masuk melalui esophagus, menghancurkan makanan dengan gerakan peristaltik lambung dan getah lambung dan getah lambung. Penghancuran makanan dilakukan dengan dua cara:<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">a.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Mekanis : menyimpan, mencampur dengan sekret lambung dan mengeluarkan kimus ke dalam usus. Pendorongan makanan terjadi seacara gerakan periistaltik setiap 20 detik.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">b.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Kimiawi : bolus dalam lambung akan dicampur dengan asam lambung dan enzim enzim tergantung jenis makanan enzim yang dihasilkan antara lain pepsin asam garam,renin dan lapisan lambung.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 108pt; text-align: left; text-indent: -18pt;">1.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Pepsin, memecah putih telur menjadi asam amino (albumin dan pepton) agar dapat diabsorbsi di intestinum minor.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 108pt; text-align: left; text-indent: -18pt;">2.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Asam garam (HCL) mengasamkan makanan sebagai antiseptik dan disenfektan yang masuk kedalam makanan. Disamping itu mengubah pepsinogen menjadi pepsin dalam suasana asam.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 108pt; text-align: left; text-indent: -18pt;">3.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Renin, sebagai ragi pembekuan susu dan membetuk kasein dab kaseinogen dari protein.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 108pt; text-align: left; text-indent: -18pt;">4.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Lapisan lambung memecah lemak menjadi asam lemak untuk merangsang sekresi getah lambung.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left;">Sekresi getah lambung mulai terjadi pada awal orang makan apabila melihat,mencium,merasakan makanan maka sekresi lambung akan terangsang, karena pengaruh saraf sehingga menimbulkan rangsangan kimiawi yang menyebabkan dinding lambumg melepaskan hormon yang disebut sekresi getah lambung mengalami 3 fase yaitu:<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 108pt; text-align: left; text-indent: -18pt;">a.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Fase serebral<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 108pt; text-align: left;">Antisipasi dari makan menyebabkan stimulus merambat ke otak ke nervus vagus sampai kelambung yang merupakan kelenjar yang terstimulasi untuk mensekresi hormon gastrin yang disekresi oleh membran mukosa kanalis pylorus yang menghsilkan getah lambung<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 108pt; text-align: left; text-indent: -18pt;">b.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Fase gatric<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 108pt; text-align: left;">Pada fase ini gastrin lebih banyak diproduksi.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 108pt; text-align: left; text-indent: -18pt;">c.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Fase intestinal<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 108pt; text-align: left;">Masuknya darah ke dalam intestinum menyebabkan sekresi getah lambung membentuk lebih banyak gastrin.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 108pt; text-align: left;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: -18pt;">3.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Etiologi<o:p></o:p></div><div class="MsoListParagraphCxSpLast" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: 36pt;">Penyebab pasti dari kanker lambung belum diketahui, tetapi ada beberapa faktor yang bisa meningkatkan perkembangan kanker lambung, meliputi hal- hal sebagai berikut:<o:p></o:p></div><div class="MsoNormal" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; text-align: left;"> Faktor predisposisi<o:p></o:p></div><div class="MsoListParagraphCxSpFirst" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">1.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Faktor genetik. Sekitar 10% pasien yang mengalami kanker lambung memiliki hubungan genetik. Walaupun masih belum sepenuhnya dipahami, tetapi adanya mutasi dari gen <i>E-cadherin</i> terdeteksi pada 50% tipe kanker lambung. Adanya riwayat keluarga anemia pernisiosa dan polip adenomatus juga dihubungkan dengan kondisi genetik pada kanker lambung (Bresciani, 2003).<o:p></o:p></div><div class="MsoListParagraphCxSpLast" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">2.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Faktor umur. Pada kasus ini ditemukan lebih umum terjadi pada usia 50-70 tahun, tetapi sekitar 5 % pasien kanker lambung berusia kurang dari 35 tahun dan 1 % kurang dari 30 tahun (Neugut, 1996).<o:p></o:p></div><div class="MsoNormal" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left;">Faktor presipitasi<o:p></o:p></div><div class="MsoListParagraphCxSpFirst" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;"><i>1.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></i>Konsumsi makanan yang diasinkan, diasap, atau yang diawetkan. Beberapa studi menjelaskan intake diet dari makanan yang diasinkan menjadi faktor utama peningkatan kanker lambung. Sehingga menfasilitasi konversi golongan nitrat menjadi <i>carcinogenic nitrosamines </i>didalam lambung. Kondisi terlambatnya pengosongan asam lambung dan peningkatan komposisi <i>nitrosamines </i>didalam lambung memberikan konstribusi terbentuknya kanker lambung (Yarbro, 2005).<i><o:p></o:p></i></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;"><i>2.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></i>Infeksi <i>H. Pylori. H. Pylori</i> adalah bakteri penyebab lebih dari 90% ulkus doudenum dan 80% tukak lambung (fuccio, 2007). Bakteri ini menempel dipermukaan dalam tukak lambung melalui interaksi antara membran bakteri lektin dan oligosakarida spesifik dari glikoprotein membran sel-sel epitel lambung (fuccio, 2009). Mekanisme utama bakteri ini dalam menginisiasi pembentukan luka adalah melalui produksi racun VacA. Racun VacA bekerja dalam menghancurkan keutuhan sel-sel tepi lambung melalui berbagai cara; diantaranya melalui pengubahan fungsi endolisosom, peningkatan permeabilitas sel, pembentukan pori dalam membran plasma, atau apoptosis (pengaktifan bunuh diri sel). Pada beberapa individu, <i>H. Pylori </i>juga menginfeksi bagian badan lambung. Bila kondisi ini sering terjadi, maka akan menghasilkan peradangan yang lebih luas yang tidak hanya memengaruhi ulkus didaerah badan lambung, tetapi juga meningkatkan risiko kanker lambung. Peradangan dilendir lambung juga merupakan faktor risiko tipe khusus tumor limfa (<i>lymphatic neoplasm) </i>dilambung, atau disebut dengan limfoma MALT (<i>Mucosa Lymphoid Tissue)</i>. Infeksi <i>H. Pylori</i> berperan penting dalam menjaga kelangsungan tumor dengan menyebabkan dinding atrofi dan perubahan metaplastik pada dinding lambung (santacroce, 2008).<i><o:p></o:p></i></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">3.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Mengkonsumsi rokok dan alkohol. Pasien dengan konsumsi rokok lebih dari 30 batang sehari dan kombinasi dengan konsumsi alkohol kronik akan meningkatkan risiko kanker lambung (Gonzalez, 2003).<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">4.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>NSAIDs. Inflamasi polip lambung bisa terjadi pada pasien yang mengkonsumsi NSAIDs dalam jangka waktu yang lama dalam hal ini (polip lambung) dapat menjadi prekursor kanker lambung. Kondisi polip lambung berulang akan meningkatkan risiko kanker lambung (Houghton, 2006).<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">5.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Anemia pernisiosa. Kondisi ini merupakan penyakit kronis dengan kegagalan absorpsi kobalamin (vitamin B<sub>12</sub>), disebabkan oleh kurangnya faktor instrinsik sekresi lambung, kombinasi anemia pernisiosa dengan infeksi <i>H. Pylori </i>memberikan konstribusi penting terbentuknya tumorigenesis pada dinding lambung (Santacroce, 2008).<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left;"><br />
</div><div class="MsoListParagraphCxSpLast" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: -18pt;">4.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Patofisologi<o:p></o:p></div><div class="MsoNormal" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 54pt; text-align: left; text-indent: 18pt;">Seperti pada umumnya tumor ganas ditempat lain penyebab tumor gaster juga belum diketahui secara pasti. Faktor yang mempermudah timbulnya. Tumor ganas gaster adalah perubahan mukosa yang abnormal antara lain seperti gastritis atropik, polip di gaster, dan anemia pernisiosa. Disamping itu juga pengaruh keadaan lingkungan mungkin memegang peran penting.<o:p></o:p></div><div class="MsoNormal" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 54pt; text-align: left; text-indent: 18pt;">Kebanyakan kanker gaster adalah adenokarsinoma (90-95%). Yang lain limfoma, leimiosarkoma, adenoxanthoma, karsinoid dan sarkoma, adenokarsinoma lambung terdiri dari dua type, yaitu tipe intestinal (tipe struktur glandular) dan tipe difus (tipe infiltratif pada dinding lambung). Kebanyakan lokasi tumor pada daerah antropilorik, kuravtura minor lebih sering daripada kurvatura mayor.<o:p></o:p></div><div class="MsoListParagraphCxSpFirst" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 54pt; text-align: left; text-indent: 18pt;">Karsinoma gaster berasal dari perubahan epitel pada membran mukosa gaster yang berkembang pada bagian bawah gaster, sedangkan pada atrofi gaster didapatkan bagian atas gaster dan secara multisenter. Karsinoma gaster terlihat beberapa bentuk:<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">1.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Seperempatnya berasal dari propria yang berbentuk fungating yang tumbuh ke lumen sebagai massa.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">2.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Seperempatnya berbentuk tumor yang berulserasi.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">3.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Massa yang tumbuh melalui dinding menginvasi lapisan otot.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">4.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Penyebarannya melalui dinding yang disemari penyebaran pada permukaan.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">5.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Bentuk linisplatika.<o:p></o:p></div><div class="MsoListParagraphCxSpLast" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">6.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Sepertiganya karsinoma berbagai bentuk di atas. <o:p></o:p></div><div class="MsoNormal" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 54pt; text-align: left;">Dengan adanya kanker lambung, lesi tersebut akan menginvasi muskularis propia dan akan melakukan metastasis pada kelenjar getah bening regional. Lesi pada kanker lambung memberikan berbagai macam keluhan yang timbul, gangguan dapat dirasakan pada pasien biasanya jika sudah pada fase progresif, dimana berbagai kondisi akan muncul seperti dispepsia, anoreksia, penurunan BB, nyeri abdomen,konstipasi, anemia, mual serta muntah. Kondisi ini akan memberikan berbagai masalah keperawatan.<o:p></o:p></div><div class="MsoNormal" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 36pt; text-align: left;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: -18pt;">5.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Manifestasi klinik <o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 54pt; text-align: left; text-indent: 18pt;">Gejala awal dari kanker lambung sering tidak pasti karena kebanyakan tumor ini dimulai di kurvatura kecil, yang hanya sedikit menyebabkan gangguan fungsi lambung, gejala mungkin tidak ada. Beberapa penilitian telah menunjukkan bahwa gejala awal yang hilang dengan antasida, dapat menyerupai gejala pada pasien dengan ulkus benigna. Gejala penyakit progresif dapat meliputi<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: -18pt;">a.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Nyeri<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: -18pt;">b.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Penurunan berat badan<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: -18pt;">c.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Muntah<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: -18pt;">d.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Anoreksia <o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: -18pt;">e.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Disfagia<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: -18pt;">f.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Kelemahan<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: -18pt;">g.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Hematemesis<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: -18pt;">h.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Mudah kenyang<o:p></o:p></div><div class="MsoListParagraphCxSpLast" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: -18pt;">i.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Darah yang nyata atau samar dalam tinja<o:p></o:p></div><div class="MsoNormal" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; text-align: left; text-indent: 36pt;"><br />
</div><div class="MsoNormal" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; text-align: left; text-indent: 36pt;"><b>Prognosis dan stadium<o:p></o:p></b></div><div class="MsoNormal" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; text-align: left; text-indent: 36pt;"><br />
</div><div class="MsoListParagraph" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: 36pt;">Prognosis kanker lambung disesuaikan dengan stadiumnya. Penilaian untuk menentukan stadium kanker lambung dilakukan dengan menggunakan sistem TNM yang telah diserapkan (Hassan, 2009). Tabel berikut menggambarkan stadium patologis dari kanker lambung, dengan menggunakan penilaian sistem TNM.<o:p></o:p></div><div class="MsoNormal" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; text-align: left;"><br />
</div><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="background-color: #ead1dc; border-collapse: collapse; border: medium none; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 0px; margin-right: auto; text-align: left; width: 614px;"><tbody>
<tr style="height: 20.8pt;"> <td colspan="6" style="border: 1pt solid black; height: 20.8pt; padding: 0cm 5.4pt; width: 460.7pt;" valign="top" width="614"><div class="MsoListParagraph" style="line-height: 150%; margin-left: 0cm;">Stadium kanker lambung dengan menggunakan sistem TNM.<o:p></o:p></div></td> </tr>
<tr style="height: 21.1pt;"> <td colspan="2" style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; height: 21.1pt; padding: 0cm 5.4pt; width: 163pt;" valign="top" width="217"><div align="center" class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 0cm; text-align: center;">Tumor Primer<o:p></o:p></div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; text-align: center;">(T)<o:p></o:p></div></td> <td colspan="2" style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 21.1pt; padding: 0cm 5.4pt; width: 6cm;" valign="top" width="227"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; text-align: center;">Kelenjar Getah Bening (KGB)<o:p></o:p></div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; text-align: center;">Regional (N)<o:p></o:p></div></td> <td colspan="2" style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 21.1pt; padding: 0cm 5.4pt; width: 127.6pt;" valign="top" width="170"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; text-align: center;">Metastasis Jauh<o:p></o:p></div><div align="center" class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 0cm; text-align: center;">(M)<o:p></o:p></div></td> </tr>
<tr style="height: 20.65pt;"> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; height: 20.65pt; padding: 0cm 5.4pt; width: 1cm;" valign="top" width="38"><div align="center" class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 0cm; text-align: center;">Tis<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.65pt; padding: 0cm 5.4pt; width: 134.65pt;" valign="top" width="180"><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm;">Carcinoma in situ, tumor intraepitel<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.65pt; padding: 0cm 5.4pt; width: 1cm;" valign="top" width="38"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; text-align: center;">N0<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.65pt; padding: 0cm 5.4pt; width: 5cm;" valign="top" width="189"><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm;">Kelenjar getah bening regional tidak terlibat<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.65pt; padding: 0cm 5.4pt; width: 1cm;" valign="top" width="38"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; text-align: center;">M0<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.65pt; padding: 0cm 5.4pt; width: 99.25pt;" valign="top" width="132"><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 0cm;">Tidak ada metastasis jauh<o:p></o:p></div></td> </tr>
<tr style="height: 21pt;"> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; height: 21pt; padding: 0cm 5.4pt; width: 1cm;" valign="top" width="38"><div align="center" class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 0cm; text-align: center;">T1<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 21pt; padding: 0cm 5.4pt; width: 134.65pt;" valign="top" width="180"><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm;">Ekstensi tumor ke submukosa.<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 21pt; padding: 0cm 5.4pt; width: 1cm;" valign="top" width="38"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; text-align: center;">N1<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 21pt; padding: 0cm 5.4pt; width: 5cm;" valign="top" width="189"><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm;">Metastasis pada 1-6 nodus limfe regional<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 21pt; padding: 0cm 5.4pt; width: 1cm;" valign="top" width="38"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; text-align: center;">M1<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 21pt; padding: 0cm 5.4pt; width: 99.25pt;" valign="top" width="132"><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 0cm;">Ada metastasis jauh.<o:p></o:p></div></td> </tr>
<tr style="height: 20.55pt;"> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; height: 20.55pt; padding: 0cm 5.4pt; width: 1cm;" valign="top" width="38"><div align="center" class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 0cm; text-align: center;">T2<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.55pt; padding: 0cm 5.4pt; width: 134.65pt;" valign="top" width="180"><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm;">Ekstensi tumor ke propia muskular dan serosa<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.55pt; padding: 0cm 5.4pt; width: 1cm;" valign="top" width="38"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; text-align: center;">N2<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.55pt; padding: 0cm 5.4pt; width: 5cm;" valign="top" width="189"><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm;">Metastasis pada 7-15 nodus limfe regional<o:p></o:p></div></td> <td colspan="2" rowspan="3" style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.55pt; padding: 0cm 5.4pt; width: 127.6pt;" valign="top" width="170"><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 0cm;"><br />
</div></td> </tr>
<tr style="height: 20.85pt;"> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; height: 20.85pt; padding: 0cm 5.4pt; width: 1cm;" valign="top" width="38"><div align="center" class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 0cm; text-align: center;">T3<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.85pt; padding: 0cm 5.4pt; width: 134.65pt;" valign="top" width="180"><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm;">Penetrasi serosa<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.85pt; padding: 0cm 5.4pt; width: 1cm;" valign="top" width="38"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; text-align: center;">N3<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.85pt; padding: 0cm 5.4pt; width: 5cm;" valign="top" width="189"><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm;">Metastasis pada >15 nodus limfe regional<o:p></o:p></div></td> </tr>
<tr style="height: 26.4pt;"> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; height: 26.4pt; padding: 0cm 5.4pt; width: 1cm;" valign="top" width="38"><div align="center" class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 0cm; text-align: center;">T4<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 26.4pt; padding: 0cm 5.4pt; width: 134.65pt;" valign="top" width="180"><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm;">Invasi ke struktur sekitar<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 26.4pt; padding: 0cm 5.4pt; width: 1cm;" valign="top" width="38"><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm;"><br />
</div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 26.4pt; padding: 0cm 5.4pt; width: 5cm;" valign="top" width="189"><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm;"><br />
</div></td> </tr>
<tr style="height: 19.65pt;"> <td colspan="6" style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; height: 19.65pt; padding: 0cm 5.4pt; width: 460.7pt;" valign="top" width="614"><div class="MsoListParagraph" style="line-height: 150%; margin-left: 0cm;">(Greene FL, Compton CC, Fritz AJ, et al. AJCC Cancer Staging Manual, 6<sup>th </sup>ed. 2002)<o:p></o:p></div></td> </tr>
</tbody></table><div class="MsoNormal" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; text-align: left;"><br />
</div><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="background-color: #ead1dc; border-collapse: collapse; border: medium none; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 0px; margin-right: auto; text-align: left; width: 614px;"><tbody>
<tr style="height: 17.15pt;"> <td colspan="5" style="border: 1pt solid black; height: 17.15pt; padding: 0cm 5.4pt; width: 460.7pt;" valign="top" width="614"><div class="MsoListParagraph" style="line-height: 150%; margin-left: 0cm;">Pengelompokkan stadium dan prediksi bertahan hidup<o:p></o:p></div></td> </tr>
<tr style="height: 20.95pt;"> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; height: 20.95pt; padding: 0cm 5.4pt; width: 130.4pt;" valign="top" width="174"><div align="center" class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 0cm; text-align: center;">Stadium<o:p></o:p></div></td> <td colspan="3" style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.95pt; padding: 0cm 5.4pt; width: 174.35pt;" valign="top" width="232"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; text-align: center;">TNM<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.95pt; padding: 0cm 5.4pt; width: 155.95pt;" valign="top" width="208"><div align="center" class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 0cm; text-align: center;">Bertahan hidup setelah<o:p></o:p></div></td> </tr>
<tr style="height: 20.55pt;"> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; height: 20.55pt; padding: 0cm 5.4pt; width: 130.4pt;" valign="top" width="174"><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 0cm;">Stadium I<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.55pt; padding: 0cm 5.4pt; width: 60.95pt;" valign="top" width="81"><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm;">T1<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.55pt; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm;">N0<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.55pt; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; text-align: center;">M0<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.55pt; padding: 0cm 5.4pt; width: 155.95pt;" valign="top" width="208"><div align="center" class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 0cm; text-align: center;">88%<o:p></o:p></div></td> </tr>
<tr style="height: 20.85pt;"> <td rowspan="3" style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; height: 20.85pt; padding: 0cm 5.4pt; width: 130.4pt;" valign="top" width="174"><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 0cm;">Stadium II<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.85pt; padding: 0cm 5.4pt; width: 60.95pt;" valign="top" width="81"><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm;">T1<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.85pt; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm;">N2<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.85pt; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; text-align: center;">M0<o:p></o:p></div></td> <td rowspan="3" style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.85pt; padding: 0cm 5.4pt; width: 155.95pt;" valign="top" width="208"><div align="center" class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 0cm; text-align: center;">65%<o:p></o:p></div></td> </tr>
<tr style="height: 21.1pt;"> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 21.1pt; padding: 0cm 5.4pt; width: 60.95pt;" valign="top" width="81"><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm;">T2<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 21.1pt; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm;">N1<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 21.1pt; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; text-align: center;">M0<o:p></o:p></div></td> </tr>
<tr style="height: 20.75pt;"> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.75pt; padding: 0cm 5.4pt; width: 60.95pt;" valign="top" width="81"><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm;">T3<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.75pt; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm;">N0<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.75pt; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; text-align: center;">M0<o:p></o:p></div></td> </tr>
<tr style="height: 21.05pt;"> <td rowspan="3" style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; height: 21.05pt; padding: 0cm 5.4pt; width: 130.4pt;" valign="top" width="174"><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 0cm;">Satdium III a<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 21.05pt; padding: 0cm 5.4pt; width: 60.95pt;" valign="top" width="81"><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm;">T2<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 21.05pt; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm;">N2<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 21.05pt; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; text-align: center;">M0<o:p></o:p></div></td> <td rowspan="3" style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 21.05pt; padding: 0cm 5.4pt; width: 155.95pt;" valign="top" width="208"><div align="center" class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 0cm; text-align: center;">35%<o:p></o:p></div></td> </tr>
<tr style="height: 20.65pt;"> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.65pt; padding: 0cm 5.4pt; width: 60.95pt;" valign="top" width="81"><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm;">T3<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.65pt; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm;">N1<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.65pt; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; text-align: center;">M0<o:p></o:p></div></td> </tr>
<tr style="height: 20.9pt;"> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.9pt; padding: 0cm 5.4pt; width: 60.95pt;" valign="top" width="81"><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm;">T4<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.9pt; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm;">N0<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.9pt; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; text-align: center;">M0<o:p></o:p></div></td> </tr>
<tr style="height: 20.55pt;"> <td style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; height: 20.55pt; padding: 0cm 5.4pt; width: 130.4pt;" valign="top" width="174"><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 0cm;">Satdium III b<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.55pt; padding: 0cm 5.4pt; width: 60.95pt;" valign="top" width="81"><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm;">T3<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.55pt; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm;">N2<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.55pt; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; text-align: center;">M0<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.55pt; padding: 0cm 5.4pt; width: 155.95pt;" valign="top" width="208"><div align="center" class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 0cm; text-align: center;">35%<o:p></o:p></div></td> </tr>
<tr style="height: 20.85pt;"> <td rowspan="3" style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; height: 20.85pt; padding: 0cm 5.4pt; width: 130.4pt;" valign="top" width="174"><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 0cm;">Stadium IV<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.85pt; padding: 0cm 5.4pt; width: 60.95pt;" valign="top" width="81"><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm;">T4<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.85pt; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm;">N1-3<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.85pt; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; text-align: center;">M0<o:p></o:p></div></td> <td rowspan="3" style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.85pt; padding: 0cm 5.4pt; width: 155.95pt;" valign="top" width="208"><div align="center" class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 0cm; text-align: center;">35%<o:p></o:p></div></td> </tr>
<tr style="height: 20.3pt;"> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.3pt; padding: 0cm 5.4pt; width: 60.95pt;" valign="top" width="81"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; text-align: center;">Setiap T<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.3pt; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; text-align: center;">N3<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.3pt; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; text-align: center;">M0<o:p></o:p></div></td> </tr>
<tr style="height: 20.65pt;"> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.65pt; padding: 0cm 5.4pt; width: 60.95pt;" valign="top" width="81"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; text-align: center;">Setiap T<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.65pt; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; text-align: center;">N3<o:p></o:p></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; height: 20.65pt; padding: 0cm 5.4pt; width: 2cm;" valign="top" width="76"><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; text-align: center;">M1<o:p></o:p></div></td> </tr>
<tr style="height: 15.65pt;"> <td colspan="5" style="border-color: -moz-use-text-color black black; border-style: none solid solid; border-width: medium 1pt 1pt; height: 15.65pt; padding: 0cm 5.4pt; width: 460.7pt;" valign="top" width="614"><div class="MsoListParagraph" style="line-height: 150%; margin-left: 0cm;">(Greene FL, Compton CC, Fritz AJ, et al. AJCC Cancer Staging Manual. 6<sup>th </sup>ed. 2002)<o:p></o:p></div></td> </tr>
</tbody></table><div class="MsoNormal" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; text-align: left;"><br />
</div><div class="MsoNormal" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; text-align: left;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: -18pt;">6.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Pemeriksaan diagnostik<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">1.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Pemeriksaan fisis, pemeriksaan fisis dapat membantu diagnosis berupa berat badan menurun dan anemia. Didaerah epigastrium mungkin ditemukan suatu massa dan jika telah terjadi metastasis ke hati,teraba hati hati yang ireguler, dan kadang kadang kelenjar limfe klavikula teraba.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">2.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>CT Scan. <o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left;">Pemeriksaan CT Scan ini dilakukan sebagai evaluasi praoperatif dan untuk melihat stadium dengan sistem TNM dan penyebaran ekstra lambung, yang penting untuk penentuan intervensi bedah radikal dan pemberian informasi prabedah pada pasien.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">3.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Endoskopi dan biopsi.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left;">Pada pemeriksaan endoskopi dan biopsi sangat penting untuk mendiagnosis karsinoma lambung, terutama untuk membedakan antara karsinoma epidermal dan adenokarsinoma. Paling tidak diperlukan beberapa tindakan biopsi, karena kemungkinan terjadi penyebaran ke submukosa dan adanya kecendrungan tertutupnya karsinoma epidermal oleh sel epitel skuamus yang normal.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">4.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Pemeriksaan darah pada tinja.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left;">Pada tumor ganas gaster sering didaptkan perdarahan dalam tinja (occult blood), untuk itu perlu dilakukan pemeriksaan tes benzidin.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">5.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>sitologi<o:p></o:p></div><div class="MsoListParagraphCxSpLast" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left;">pemeriksaan papanicolao dari cairan lambung dapat memasukkan tumor ganas lambung dengan hasil 80-90%. Tentu pemeriksaan ini perlu dilengkapi dengan pemeriksaan gastroskopi dan biopsi<o:p></o:p></div><div class="MsoNormal" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; text-align: left;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: -18pt;">7.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Komplikasi<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">1.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Perforasi<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left;">Dapat terjadi perforasi akut dan perforasi kronik.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">2.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Hematemesis<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left;">Hematemesis yang masif dan melena dapat terjadi pada tumor ganas lambung sehingga dapat menimbulkan anemia.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">3.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Obstruksi<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left;">Dapat terjadi pada bagian bawah lambung dekat daerah pilorus yang disertai keluhan muntah muntah.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">4.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Adhesi<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left;">Jika tumor mengenai dinding lambung dapat terjadi perlengketan dan infiltrasi dengan organ sekitarnya dan menimbulkan keluhan nyeri perut.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: -18pt;">8.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Penatalaksanaan Medik<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: 36pt;">Penatalaksaan medis disesuaikan dengan penentuan stadium (staging) dan pengelompokkan stadium tumor. Intervensi yang lazim dilakukan adalah tindakan endoskopi,kemoterapi,radioterapi,dan intervensi bedah.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: 36pt;">Pada polip lambung jinak, diangkat dengan menggunakan endoskopi. Bila karsinoma ditemukan di dalam lambung, pembedahan biasanya dilakukan untuk mencoba menyembuhkannya. Sebagian besar atau semua lambung diangkat (gastrektomi) dan kelenjar getah bening di dekatnya juga ikut diangkat. Bila karsinoma telah menyebar ke luar lambung, tujuan pengobatan yang dilakukan adalah untuk mengurangi gejala dan memperpanjang harapan hidup pasien. Kemoterapi dan terapi penyinaran pada limfoma lebih pada karsinoma. Beberapa pasien dengan tingkat toleransi yang baik akan bertahan hidup lebih lama bahkan bisa sembuh total<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: 36pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 54pt; text-align: left; text-indent: -18pt;">B.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>KONSEP DASAR KEPERAWATAN<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 54pt; text-align: left;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: -18pt;">A.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Pengkajian<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">1.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Kaji riwayat diet klien, seperti masukan makanan asap, diasinkan masukan buah dan sayuran yang rendah.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">2.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Kaji rasa tidak nyaman pada epigastrium, tidak dapat makan, dan perasaan kembung setelah makan. Jika ya sudah berapa lama dan upaya pengobatan apa yang telah dilakukan, apakah sudah berobat ke dokter atau minum obat yang dijual bebas.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">3.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Kaji adanya gejala nyeri abdomen, nyeri punggung, anemia, anoreksia, mual, muntah, cepat kenyang, disfagia, dan malaise serta hematemesis.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">4.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Kaji adanya penurunan berat badan, sejak kapan dan berapa kg penurunan berat badan sejak sakit.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">5.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Kaji apakah kalian merokok, berapa banyak dalam sehari, sejak kapan, dan selama atau setelah merokok, apakah mengalami ketidaknyamanan pada lambung.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">6.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Kaji apakah klien minum alkohol, berapa banyak dalam sehari dan sejak kapan.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">7.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Kaji anggota keluarga ada yang menderita penyakit kanker, jika ada apakah anggota keluarga langsung, keluarga dekat atau kerbat jauh.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">8.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Kaji apakah ada seseorang yang dapat memberikan dukungan emosional kepada klien.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">9.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Pemeriksaan fisik: melakukan palpasi pada abdomen untuk mengetahui adanya massa dalam lambung.<o:p></o:p></div><div class="MsoListParagraphCxSpLast" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">10.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Kaji adanya ansietas dan tanyakan apa yang menyebabkan ansietas pada klien.<o:p></o:p></div><div class="MsoNormal" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; text-align: left;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: -18pt;">B.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Diagnosa keperawatan<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">1.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Nyeri b.d. iritasi mukosa esofagus, respons pembedahan.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">2.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Perubahan nutrisi kurang dari kebutuhan tubuh b.d. intake makanan tidak adekuat.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">3.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Ansietas b.d penyakitnya, perubahan pada status kesehatan/sosioekonomi, fungsi peran, pola interaksi, ancaman kematian dan pengobatan.<o:p></o:p></div><div class="MsoListParagraphCxSpLast" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">4.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Kurang pengetahuan tentang gangguan lambung, pemeriksaan diagnostik, penatalaksanaan medik, intervensi bedah dan rehabilitasi.<o:p></o:p></div><div class="MsoNormal" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; text-align: left;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 72pt; text-align: left; text-indent: -18pt;">C.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Rencana keperawatan<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">1.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Nyeri b.d. iritasi mukosa esofagus, respons pembedahan.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left;">Tujuan : dalam waktu 7 x 24 jam pascabedah, nyeri berkurang atau teradaptasi<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 127.6pt; text-align: left; text-indent: -37.6pt;">HYD : - Nyeri hilang/terkontrol.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 140.75pt; text-align: left; text-indent: -18pt;">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Ekspresi wajah klien rileks.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 140.75pt; text-align: left; text-indent: -18pt;">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Klien dapat istirahat dengan cukup<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 92.15pt; text-align: left;">Intervensi :<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 110.15pt; text-align: left; text-indent: -18pt;">1.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Kaji riwayat nyeri: lokasi, frekuensi, durasi dan intensitas (skala 0-10).<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 110.15pt; text-align: left;">R/ identifikasi data dasar untuk mengevaluasi kebutuhan atau keefektifan intervensi<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 110.15pt; text-align: left; text-indent: -18pt;">2.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Istirahatkan pasien pada saat nyeri muncul<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 110.15pt; text-align: left;">R/ istirahat, secara fisiologis akan menurunkan kebutuhan oksigen yang diperlukan untuk memenuhi kebutuhan metabolisme basal.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 110.15pt; text-align: left; text-indent: -18pt;">3.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Ajarkan teknik relaksasi napas dalam pada saat nyeri muncul<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 110.15pt; text-align: left;">R/ meningkatkan asupan oksigen sehingga akan menurunkan nyeri sekunder sehingga akan menurunkan nyeri sekunder dari iskemia intestinal.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 110.15pt; text-align: left; text-indent: -18pt;">4.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Anjurkan duduk tegak selama 1-4 jam setiap selesai makan <o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 110.15pt; text-align: left;">R/ untuk mencegah terjadinya refluk<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 110.15pt; text-align: left; text-indent: -18pt;">5.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Kolaborasi dalam pemberian analgesik<o:p></o:p></div><div class="MsoListParagraphCxSpLast" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 110.15pt; text-align: left;">R/ dapat menurunkan atau menghilangkan nyeri, nyeri merupakan komplikasi yang sering terjadi dari kanker, meskipun respon individu berbeda.<o:p></o:p></div><div class="MsoNormal" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; text-align: left;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">2.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Perubahan nutrisi kurang dari kebutuhan tubuh b.d. intake makanan tidak adekuat.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 92.15pt; text-align: left;">Tujuan : Kebutuhan nutrisi dapat terpenuhi setelah dilakukan keperawatan<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left;">HYD : - Nafsu makan meningkat<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 140.75pt; text-align: left; text-indent: -18pt;">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Makan habis satu porsi<o:p></o:p></div><div class="MsoListParagraphCxSpLast" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 140.75pt; text-align: left; text-indent: -18pt;">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Berat badan bertambah<o:p></o:p></div><div class="MsoNormal" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 92.15pt; text-align: left;">Intervensi :<o:p></o:p></div><div class="MsoListParagraphCxSpFirst" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 110.15pt; text-align: left; text-indent: -18pt;">1.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Kaji masukan makanan klien setiap hari.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 110.15pt; text-align: left;">R/ mengidentifikasi status nutrisi klien<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 110.15pt; text-align: left; text-indent: -18pt;">2.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Berikan makanan sedikit tapi sering dengan bahan makanan yang tidak bersifat iritatif<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 110.15pt; text-align: left;">R/ untuk mengurangi mual dan muntah.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 110.15pt; text-align: left; text-indent: -18pt;">3.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Hindari makanan terlalu manis, berlemak atau makanan pedas<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 110.15pt; text-align: left;">R/ dapat menjcegah respon mual/muntah.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 110.15pt; text-align: left; text-indent: -18pt;">4.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Ajarkan klien teknik relaksasi, dan latihan sedang sebelum makan.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 110.15pt; text-align: left;">R/ dapat menurunkan perasaan mual dan meningkatkan masukan oral.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 110.15pt; text-align: left; text-indent: -18pt;">5.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Kolaborasi dalam pemberian antasida<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 110.15pt; text-align: left;">R/ meminimalkan iritasi lambung dan mengurangi resiko ulserasi mukosa<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 110.15pt; text-align: left;"><br />
</div><div class="MsoListParagraphCxSpLast" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">3.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span> Ansietas b.d penyakitnya, perubahan pada status kesehatan/sosioekonomi, fungsi peran, pola interaksi, ancaman kematian dan pengobatan.<o:p></o:p></div><div class="MsoNormal" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left;">Tujuan : Kecemasan dapat diminimalkan setelah dilakukan tindakan keperawatan<o:p></o:p></div><div class="MsoNormal" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 134.7pt; text-align: left; text-indent: -44.7pt;">HYD : - Pasien mampu mengungkapkan perasaannya kepada perawat.<o:p></o:p></div><div class="MsoListParagraphCxSpFirst" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 134.7pt; text-align: left; text-indent: -11.95pt;">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Pasien dapat mendemonstrasikan keterampilan<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 134.7pt; text-align: left;">pemecahan masalahnya dan perubahan koping yang digunakan sesuai situasi yang dihadapi.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 134.7pt; text-align: left; text-indent: -11.95pt;">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Pasien dapat mencatat penurunan kecemasan/ketakutan dibawah standar.<o:p></o:p></div><div class="MsoListParagraphCxSpLast" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 134.7pt; text-align: left; text-indent: -11.95pt;">-<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Pasien dapat rileks dan tidur/istirahat dengan baik.<o:p></o:p></div><div class="MsoNormal" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 92.15pt; text-align: left;">Intervensi:<o:p></o:p></div><div class="MsoListParagraphCxSpFirst" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 110.15pt; text-align: left; text-indent: -18pt;">1.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Kaji pengalaman klien/keluarga sebelumnya dengan kanker<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 110.15pt; text-align: left;">R/ Mengidentifikasi rasa takut dan kesalahan konsep berdasarkan pengalaman dengan kanker.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 110.15pt; text-align: left; text-indent: -18pt;">2.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Beri kesempatan klien untuk mengungkapkan perasaannya<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 110.15pt; text-align: left;">R/ klien dapat mengekspresikan rasa takut yang dialaminya.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 110.15pt; text-align: left; text-indent: -18pt;">3.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Berikan lingkungan yang nyaman dan rileks.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 110.15pt; text-align: left;">R/ membantu klien agar merasa diterima pada kondisi saat ini.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 110.15pt; text-align: left; text-indent: -18pt;">4.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Jelaskan tujuan pengobtan yang dianjurkan, dan kemungkinan efek samping<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 110.15pt; text-align: left;">R/ klien mendapatkan pemahaman tujuan pengobtan kanker.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 110.15pt; text-align: left; text-indent: -18pt;">5.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Kolaborasi dengan dokter dalam pemberian obat anticemas seperti diazepam.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 110.15pt; text-align: left;">R/ menurunkan relaksasi dan menurunkan kecemasan.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 110.15pt; text-align: left;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left; text-indent: -18pt;">4.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Kurang pengetahuan tentang gangguan lambung, pemeriksaan diagnostik, penatalaksanaan medik, intervensi bedah dan rehabilitasi.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left;">Tujuan : informasi mengenai kanker lambung dapat dipahami setelah dilakukannya tindakan keperawatan<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left;">HYD : pemahaman klien tentang penyakitnya dapat meningkat.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 90pt; text-align: left;">Intervensi :<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 108pt; text-align: left; text-indent: -18pt;">1.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Kaji pemahaman klien/orang terdekat tentang diagnosa dan alternatif pengobatan yang akan dilakukan.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 108pt; text-align: left;">R/ mengidentifikasi pemahaman klien dan menentukan kebutuhan informasi yang diperlukan.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 108pt; text-align: left; text-indent: -18pt;">2.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Jelaskan dan diskusikan tentang diagnosa dan alternatif pengobatan/prosedur tindakan serta tujuannya.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 108pt; text-align: left;">R/ klien mendapatkan kejelasan tentang penyakitnya dan alternatifnya pengobatan yang akan dilakukan.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 108pt; text-align: left; text-indent: -18pt;">3.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Siapkan secara fisik dan psikologis untuk tes diagnostik dan pengobatan dan kemungkinan tindakan pembedahan.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 108pt; text-align: left;">R/ mengurangi kecemasan klien dan dapat berpartisipasi dalam pengobatan.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 108pt; text-align: left; text-indent: -18pt;">4.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Jelaskan beberapa gangguan esofagus dapat timbul sewaktu waktu akibat trauma (luka bakar kimiawi atau perforasi)<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 108pt; text-align: left;">R/ agar klien mengetahui kemungkinan yang akan terjadi.<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 108pt; text-align: left; text-indent: -18pt;">5.<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Evaluasi intervensi pengobatan secara terus menerus,dan beri informasi yang cukup pada klien.<o:p></o:p></div><div class="MsoListParagraphCxSpLast" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 108pt; text-align: left;">R/ untuk mengetahui efek terapi dan klien berpartisipasi dalam perawatan.<o:p></o:p></div><div class="MsoNormal" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; text-align: left;"><br />
</div><div class="MsoNormal" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; text-align: left;"><br />
</div><div class="MsoNormal" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; text-align: left;"><o:p><br />
</o:p></div><div class="MsoNormal" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 144pt; text-align: left; text-indent: 36pt;"><br />
</div><div class="MsoNormal" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 144pt; text-align: left; text-indent: 36pt;">DAFTAR PUSTAKA<o:p></o:p></div><div class="MsoNormal" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; margin-left: 144pt; text-align: left; text-indent: 36pt;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; text-align: left; text-indent: -18pt;">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Brunner & Suddarth. (2002). <i>Buku Ajar Keperawatan Medikal Bedah</i>. Jakarta: EGC<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; text-align: left; text-indent: -18pt;">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Muttaqin, Arif dan Kumala Sari.(2011). <i>Gangguan Gastrointestinal Aplikasi Asuhan Keperawatan Medikal Bedah</i>. Jakarta: Salemba Medika<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; text-align: left; text-indent: -18pt;">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Otto, Shirley E. 2005. <i>Keperawatan Onkologi</i>. Jakarta: EGC<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; text-align: left; text-indent: -18pt;">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Price, Sylvia A. (2006). <i>Patofisiologi </i>. jakarta: EGC<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; text-align: left; text-indent: -18pt;">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Sudoyo, Aru W, dkk. (2006). <i>Buku Ajar Ilmu Penyakit Dalam</i>. Jakarta: Departemen Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Indonesia<o:p></o:p></div><div class="MsoListParagraphCxSpLast" style="background-color: #ead1dc; color: #3d85c6; font-family: Times,"Times New Roman",serif; text-align: left; text-indent: -18pt;">·<span style="font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>Suratum, Skep, M.Kep & Lusiana, Skep, M.Kep. (2010). <i>Asuhan Keperawatan Klien Gangguan Sistem Gastrointestinal.</i> Jakarta: TIM<o:p></o:p></div><div class="MsoNormal" style="color: #3d85c6; font-family: Times,"Times New Roman",serif; text-align: left;"><br />
</div>Isma Octavianihttp://www.blogger.com/profile/15581531620650172904noreply@blogger.com0tag:blogger.com,1999:blog-1044479776242564942.post-45234318465041198512012-01-01T23:14:00.000-08:002012-01-01T23:14:42.871-08:00whatever...Hy dear...<br />
perkenalkan saya "isma octaviani" didalam blog saya ini nanti nya saya akan berbagi bermacam-macam hal mulai dari catatan-catatan pribadi saya hingga artikel artikel penting lainnya yang saya anggap penting untuk dibaca..:)Isma Octavianihttp://www.blogger.com/profile/15581531620650172904noreply@blogger.com2