Makalah Efusi Pleura

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{\phpg\posx4556\pvpg\posy1450\absw2895\absh611 \b \f20 \fs21 \cf0 \fi1076 \b \f2
0 \fs21 \cf0 BAB I
\par}{\phpg\posx4556\pvpg\posy1450\absw2895\absh611 \sl-413 \b \f20 \fs21 \cf0 K
ONSEP EFUSI PLEURA \par
}
{\phpg\posx1802\pvpg\posy3106\absw3691\absh239 \b \f20 \fs21 \cf0 \b \f20 \fs21
\cf0 1.1 Anatomi dan Fisiologi Pleura \par
}
{\phpg\posx2160\pvpg\posy3934\absw8408\absh2474 \f20 \fs21 \cf0 \f20 \fs21 \cf0
Pleura terletak dibagian terluar dari paru-paru dan mengelilingi paru.
Pleura
\par}{\phpg\posx2160\pvpg\posy3934\absw8408\absh2474 \sl-414 \f20 \fs21 \cf0 dis
usun oleh jaringan ikat fibrosa yang didalamnya terdapat banyak kapiler limfa
\par}{\phpg\posx2160\pvpg\posy3934\absw8408\absh2474 \sl-413 \f20 \fs21 \cf0 dan
kapiler darah serta serat saraf kecil. Pleura disusun juga oleh sel-sel (teruta
ma
\par}{\phpg\posx2160\pvpg\posy3934\absw8408\absh2474 \sl-414 \f20 \fs21 \cf0 fib
roblast dan makrofag). Pleura paru ini juga dilapisi oleh selapis mesotel. Pleur
a
\par}{\phpg\posx2160\pvpg\posy3934\absw8408\absh2474 \sl-414 \f20 \fs21 \cf0 mer
upakan membran tipis, halus, dan licin yang membungkus dinding anterior
\par}{\phpg\posx2160\pvpg\posy3934\absw8408\absh2474 \sl-413 \f20 \fs21 \cf0 tor
aks dan permukaan superior diafragma. Lapisan tipis ini mengandung kolagen
jaringan elastis (Sylvia Anderson Price dan Lorraine M, 2005: 739). \par
}
Ada 2 macam pleura yaitu pleura parietalis dan pleura viseralis. Pleura pariet
alis
\par}{\phpg\posx2160\pvpg\posy7246\absw8439\absh7984 \sl-413 \f20 \fs21 \cf0 mel
apisi toraks atau rongga dada sedangkan pleura viseralis melapisi paruparu.
\par}{\phpg\posx2160\pvpg\posy7246\absw8439\absh7984 \sl-413 \f20 \fs21 \cf0 Ked

ua pleura ini bersatu pada hilus paru. Dalam beberapa hal terdapat perbedaan
\par}{\phpg\posx2160\pvpg\posy7246\absw8439\absh7984 \sl-414 \f20 \fs21 \cf0 ant
ara kedua pleura ini yaitu pleura viseralis bagian permukaan luarnya terdiri dar
i
\par}{\phpg\posx2160\pvpg\posy7246\absw8439\absh7984 \sl-413 \f20 \fs21 \cf0 sel
apis sel mesotelial yang tipis (tebalnya tidak lebih dari 30 m). Diantara celah\par}{\phpg\posx2160\pvpg\posy7246\absw8439\absh7984 \sl-413 \f20 \fs21 \cf0 cel
ah sel ini terdapat beberapa sel limfosit. Di bawah sel-sel mesotelia ini terdap
at
\par}{\phpg\posx2160\pvpg\posy7246\absw8439\absh7984 \sl-413 \f20 \fs21 \cf0 end
opleura yang berisi fibrosit dan histiosit. Seterusnya dibawah ini (din
amakan
\par}{\phpg\posx2160\pvpg\posy7246\absw8439\absh7984 \sl-413 \f20 \fs21 \cf0 lap
isan tengah) terdapat jaringan kolagen dan serat-serat elastik. Pada la
pisan
\par}{\phpg\posx2160\pvpg\posy7246\absw8439\absh7984 \sl-414 \f20 \fs21 \cf0 ter
bawah terdapat jaringan intertitial subpleura yang sangat banyak mengand
ung
\par}{\phpg\posx2160\pvpg\posy7246\absw8439\absh7984 \sl-413 \f20 \fs21 \cf0 pem
buluh darah kapiler dari A. Pulmonalis dan A. Brankialis serta pembulu
h
\par}{\phpg\posx2160\pvpg\posy7246\absw8439\absh7984 \sl-414 \f20 \fs21 \cf0 get
ah bening. Keseluruhan jaringan pleura viseralis ini menempel dengan ku
at
\par}{\phpg\posx2160\pvpg\posy7246\absw8439\absh7984 \sl-414 \f20 \fs21 \cf0 pad
a jaringan parenkim paru. Pleura parietalis mempunyai lapisan jaringan
lebih
\par}{\phpg\posx2160\pvpg\posy7246\absw8439\absh7984 \sl-413 \f20 \fs21 \cf0 teb
al dan terdiri dari sel-sel mesotelial juga dan jaringan ikat (jaringa
n kolagen
serat-serat elastik). Dalam jaringan ikat, terdapat pembuluh kapiler d
ari A.
\par}{\phpg\posx2160\pvpg\posy7246\absw8439\absh7984 \sl-413 \f20 \fs21 \cf0 Int
erkostalis dan A. Mammaria interna, pembuluh getah bening dan ban
yak
\par}{\phpg\posx2160\pvpg\posy7246\absw8439\absh7984 \sl-414 \f20 \fs21 \cf0 res
eptor saraf-saraf sensorik yang peka terhadap rasa sakit dan p
erbedaan
\par}{\phpg\posx2160\pvpg\posy7246\absw8439\absh7984 \sl-414 \f20 \fs21 \cf0 tem
peratur. Sistem persarafan ini berasal dari nervus intercostalis dinding
dada.
\par}{\phpg\posx2160\pvpg\posy7246\absw8439\absh7984 \sl-413 \f20 \fs21 \cf0 Kes
eluruhan jaringan pleura parietalis ini menempel dengan mudah, tapi jug
a
\par}{\phpg\posx2160\pvpg\posy7246\absw8439\absh7984 \sl-414 \f20 \fs21 \cf0 mud
ah dilepaskan dari dinding dada di atasnya. Di antara pleura terdapat ruangan
\par}{\phpg\posx2160\pvpg\posy7246\absw8439\absh7984 \sl-413 \f20 \fs21 \cf0 yan
g disebut spasium pleura, yang mengandung sejumlah kecil cairan
yang
\par}{\phpg\posx2160\pvpg\posy7246\absw8439\absh7984 \sl-370 \par\f20 \fs21 \cf0
\fi7826 1 \par
}
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}}\par}{\phpg\posx2160\pvpg\posy1450\absw8287\absh2847 \f20 \fs21 \cf0 \f20 \fs2
1 \cf0 melicinkan permukaan dan memungkinkan keduanya bergeser secara bebas
pada
\par}{\phpg\posx2160\pvpg\posy1450\absw8287\absh2847 \sl-413 \f20 \fs21 \cf0 saa
t ventilasi. Cairan tersebut dinamakan cairan pleura. Cairan ini terletak
antara
\par}{\phpg\posx2160\pvpg\posy1450\absw8287\absh2847 \sl-414 \f20 \fs21 \cf0 par
u dan thoraks. Tidak ada ruangan yang sesungguhnya memisahkan pleura
ietalis dengan pleura viseralis sehingga apa yang disebut sebagai rongga pleura
\par}{\phpg\posx2160\pvpg\posy1450\absw8287\absh2847 \sl-414 \f20 \fs21 \cf0 ata
u kavitas pleura hanyalah suatu ruangan potensial. Tekanan dalam rongga
\par}{\phpg\posx2160\pvpg\posy1450\absw8287\absh2847 \sl-414 \f20 \fs21 \cf0 ple
ura lebih rendah daripada tekanan atmosfer sehingga mencegah kolaps par
u.
\par}{\phpg\posx2160\pvpg\posy1450\absw8287\absh2847 \sl-413 \f20 \fs21 \cf0 Jum
lah normal cairan pleura adalah 10-20 cc (Hood Alsagaff dan H. Abdul
\par}{\phpg\posx2160\pvpg\posy1450\absw8287\absh2847 \sl-414 \f20 \fs21 \cf0 Muk
ty, 2002: 786). \par
}
Cairan pleura berfungsi untuk memudahkan kedua permukaan pleura parietal
is
pleura viseralis bergerak selama pernapasan dan untuk mencegah pemisahan
\par}{\phpg\posx2162\pvpg\posy5176\absw8325\absh5082 \sl-413 \f20 \fs21 \cf0 tor
aks dan paru yang dapat dianalogkan seperti dua buah kaca objek yang
akan
\par}{\phpg\posx2162\pvpg\posy5176\absw8325\absh5082 \sl-414 \f20 \fs21 \cf0 sal
ing melekat jika ada air. Kedua kaca objek tersebut dapat bergeseran
satu
\par}{\phpg\posx2162\pvpg\posy5176\absw8325\absh5082 \sl-413 \f20 \fs21 \cf0 den
gan yang lain tetapi keduanya sulit dipisahkan. Cairan pleura dalam ke
adaan
\par}{\phpg\posx2162\pvpg\posy5176\absw8325\absh5082 \sl-413 \f20 \fs21 \cf0 nor
mal akan bergerak dari kapiler di dalam pleura parietalis ke ruang pl
eura
\par}{\phpg\posx2162\pvpg\posy5176\absw8325\absh5082 \sl-413 \f20 \fs21 \cf0 kem
udian diserap kembali melalui pleura viseralis. Hal ini disebabkan kare
na
\par}{\phpg\posx2162\pvpg\posy5176\absw8325\absh5082 \sl-413 \f20 \fs21 \cf0 per
bedaan tekanan antara tekanan hidrostatik darah yang cenderung mendorong
\par}{\phpg\posx2162\pvpg\posy5176\absw8325\absh5082 \sl-414 \f20 \fs21 \cf0 cai
ran keluar dan tekanan onkotik dari protein plasma yang cenderung mena
han
ran agar tetap di dalam. Selisih perbedaan absorpsi cairan pleura melalui pleura
\par}{\phpg\posx2162\pvpg\posy5176\absw8325\absh5082 \sl-413 \f20 \fs21 \cf0 vis
eralis lebih besar daripada selisih perbedaan pembentukan cairan oleh
pleura
ietalis dan permukaan pleura viseralis lebih besar dari pada pleura pa
rietalis
\par}{\phpg\posx2162\pvpg\posy5176\absw8325\absh5082 \sl-413 \f20 \fs21 \cf0 seh
ingga dalam keadaan normal hanya ada beberapa mililiter cairan di dala
m
\par}{\phpg\posx2162\pvpg\posy5176\absw8325\absh5082 \sl-414 \f20 \fs21 \cf0 ron
gga pleura (Sylvia Anderson Price dan Lorraine M, 2005: 739). \par
}
Gambar 1.1 Gambaran Anatomi Pleura (dikutip dari{\f10 \fs16 Poslal}{\f10 \fs16
medicina,}{\f10 \fs16 2007: }
\fi1260 {\f10 \fs16 www.google.com) }\par
}
{\phpg\posx9986\pvpg\posy15852\absw165\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 2
\par
}
ffd8ffe000104a46494600010100000100010000ffdb004300010101010101010101010101010101
01010101010101010101010101010101010101010101010101010101010101010101010101010101
010101010101010101ffdb0043010101010101010101010101010101010101010101010101010101
0101010101010101010101010101010101010101010101010101010101010101010101010101ffc0
001108034a025303012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
00ffd9
}}\par}{\phpg\posx1802\pvpg\posy1450\absw8676\absh9240 \b \f20 \fs21 \cf0 \b \f2
0 \fs21 \cf0 1.2 Definisi Efusi Pleura
\par}{\phpg\posx1802\pvpg\posy1450\absw8676\absh9240 \sl-326 \par\b \f20 \fs21 \
cf0 \fi360 {\b0 Efusi}{\b0 pleura}{\b0 adalah}{\b0 pengumpulan}{\b0 cairan}{
\b0 di}{\b0 dalam}{\b0 rongga}{\b0 pleura}{\b0 akibat}{\b0 transudasi }
\par}{\phpg\posx1802\pvpg\posy1450\absw8676\absh9240 \sl-414 \b \f20 \fs21 \cf0
\fi360 {\b0 atau}{\b0 eksudasi}{\b0 yang}{\b0 berlebihan}{\b0 dari}{\b0
permukaan}{\b0 pleura}{\b0 (Suzanne}{\b0 Smeltzer:}{\b0 2001). }
\fi360 {\b0 Rongga}{\b0 pleura}{\b0 adalah}{\b0 rongga}{\b0 yang}{\b0
terletak}{\b0 diantara}{\b0 selaput}{\b0 yang}{\b0 melapisi}{\b0 paru}
\fi360 {\b0 paru}{\b0 dan}{\b0 rongga}{\b0 dada,}{\b0 diantara}{\b0 pe
rmukaan}{\b0 viseral}{\b0 dan}{\b0 parietal.}{\b0 Dalam}{\b0 keadaan }
\fi360 {\b0 normal,}{\b0 rongga}{\b0 pleura}{\b0 hanya}{\b0 mengandung}{\b0
sedikit}{\b0 cairan}{\b0 sebanyak}{\b0 10-20}{\b0 ml}{\b0 yang }
\fi360 {\b0 membentuk}{\b0 lapisan}{\b0 tipis}{\b0 pada}{\b0 pleura}{\b0 pa
rietalis}{\b0 dan}{\b0 viseralis,}{\b0 dengan}{\b0 fungsi}{\b0 utama }
\fi360 {\b0 sebagai}{\b0 pelicin}{\b0 gesekan}{\b0 antara}{\b0 permukaan
}{\b0 kedua}{\b0 pleura}{\b0 pada}{\b0 waktu}{\b0 pernafasan. }
\fi360 {\b0 Jenis}{\b0 cairan}{\b0 lainnya}{\b0 yang}{\b0 bisa}{\b0 te
rkumpul}{\b0 di}{\b0 dalam}{\b0 rongga}{\b0 pleura}{\b0 adalah}{\b0
darah, }
\fi360 {\b0 nanah,}{\b0 cairan}{\b0 seperti}{\b0 susu}{\b0 dan}{\b0 ca
iran}{\b0 yang}{\b0 mengandung}{\b0 kolesterol}{\b0 tinggi.}{\b0 Efusi
}
\fi360 {\b0 pleura}{\b0
bukan}{\b0 merupakan}{\b0
suatu}{\b0 penyakit,
}{\b0 akan}{\b0 tetapi}{\b0
merupakan}{\b0
tanda}{\b0 suatu }
\fi360 {\b0 penyakit. }
cf0 \fi360 {\b0 Pada}{\b0 gangguan}{\b0 tertentu,}{\b0 cairan}{\b0 dapat
}{\b0 berkumpul}{\b0 dalam}{\b0 ruang}{\b0 pleural}{\b0 pada}{\b0 ti
tik }
\fi360 {\b0 dimana}{\b0 penumpukan}{\b0 ini}{\b0 akan}{\b0 menjadi}{\b0 buk
ti}{\b0 klinis,}{\b0 dan}{\b0 hampir}{\b0 selalu}{\b0 merupakan }
\fi360 {\b0 signifikasi}{\b0
patologi.}{\b0
Efusi}{\b0
dapat}{\b0
te
rdiri}{\b0
dari}{\b0
cairan}{\b0
yang}{\b0
relatif}{\b0
jernih,}{
\b0
yang }
\fi360 {\b0 mungkin}{\b0 merupakan}{\b0 cairan}{\b0 transudat}{\b0 atau}{\b0
eksudat,}{\b0 atau}{\b0 dapat}{\b0 mengandung}{\b0 darah }
\fi360 {\b0 dan}{\b0 purulen.}{\b0 Transudat}{\b0 (filtrasi}{\b0 plasma}{\b0
yang}{\b0 mengalir}{\b0 menembus}{\b0 dinding}{\b0 kapiler }
\fi360 {\b0 yang}{\b0
utuh)}{\b0
terjadi}{\b0
jika}{\b0
faktor-fakto
r}{\b0
yang}{\b0
mempengaruhi}{\b0
pembentukan}{\b0
dan }

\fi360 {\b0 reabsorpsi}{\b0 cairan}{\b0 pleural}{\b0 terganggu.}{\b0 Bia
sanya}{\b0 oleh}{\b0 ketidakseimbangan}{\b0 tekanan }
\fi360 {\b0 hidrostatik}{\b0 atau}{\b0 onkotik.}{\b0 Transudat}{\b0 menandak
an}{\b0 bahwa}{\b0 kondisi}{\b0 seperti}{\b0 asites}{\b0 atau }
\fi360 {\b0 gagal}{\b0 ginjal}{\b0 mendasari}{\b0 penumpukan}{\b0 cairan.}{\
b0 Eksudat}{\b0 (ekstravasasi}{\b0 cairan}{\b0 ke}{\b0 dalam }
\fi360 {\b0 jaringan}{\b0 atau}{\b0 kavitas).}{\b0 Biasanya}{\b0 terjadi
}{\b0 akibat}{\b0 inflamasi}{\b0 oleh}{\b0 produk}{\b0 bakteri}{\b0 atau
}
\fi360 {\b0 tumor}{\b0 yang}{\b0 mengenai}{\b0 permukaan}{\b0 pleural}{\
b0 (Sylvia}{\b0 Anderson}{\b0 Price}{\b0 dan}{\b0 Lorraine, }
\fi360 {\b0 2005:}{\b0 739). }\par
}
Efusi yang mengandung darah disebut dengan efusi hemoragis. Pada keadaan ini
\par}{\phpg\posx2162\pvpg\posy12280\absw8367\absh2102 \sl-206 \par\f20 \fs21 \cf
0 kadar eritrosit di dalam cairan pleural meningkat antara 5.000
-10.000 mm{\up006 \fs12 3}.
\par}{\phpg\posx2162\pvpg\posy12280\absw8367\absh2102 \sl-414 \f20 \fs21 \cf0 Ke
adaan ini sering dijumpai pada keganasan pneumonia. Berdasarkan lokasi
\par}{\phpg\posx2162\pvpg\posy12280\absw8367\absh2102 \sl-413 \f20 \fs21 \cf0 ca
iran yang terbentuk, efusi pleura dibagi menjadi unilateral dan bilater
al. Efusi
\par}{\phpg\posx2162\pvpg\posy12280\absw8367\absh2102 \sl-414 \f20 \fs21 \cf0 ya
ng
unilateral
tidak
mempunyai
kaitan
yang
spesifik
dengan
penyakit
\par}{\phpg\posx2162\pvpg\posy12280\absw8367\absh2102 \sl-414 \f20 \fs21 \cf0 pe
nyebabnya, akan tetapi efusi yang bilateral seringkali ditemukan pada penyakit :
\par
}
\par
}
ffd8ffe000104a46494600010100000100010000ffdb004300010101010101010101010101010101
01010101010101010101010101010101010101010101010101010101010101010101010101010101
010101010101010101ffdb0043010101010101010101010101010101010101010101010101010101
0101010101010101010101010101010101010101010101010101010101010101010101010101ffc0
001108034a025303012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
00ffd9
\cf0 kegagalan
jantug
kongestif,
sindroma
nefrotik,
asites,
i
nfark
paru,
lupus
\par}{\phpg\posx2162\pvpg\posy1450\absw8276\absh611 \sl-413 \f20 \fs21 \cf0 erit
ematosis sistemik, tumor dan tuberkulosis. \par
}
Terdapat beberapa jenis efusi berdasarkan penyebabnya, yakni :
\par}{\phpg\posx2162\pvpg\posy2692\absw8284\absh3965 \sl-414 \f20 \fs21 \cf0 \fi
360 a.
Bila efusi berasal dari implantasi sel-sel limfoma pada
permukaan
360 pleura, cairannya adalah eksudat, berisi sel limfosit yang banyak d
an sering
360 hemoragik.
360 b.
Bila efusi terjadi akibat obstruksi aliran getah bening,
cairannya bisa
360 transudat atau eksudat dan ada limfosit.
360 c.
Bila efusi terjadi akibat obstruksi duktus torasikus, cai
rannya akan
360 berbentuk cairan kelenjar limfa (chylothorak)
360 d.
Bila efusi terjadi karena infeksi pleura pada pasien lim
foma maligna
360 karena menurunnya resistensinya terhadap infeksi, efusi akan b
erbentuk
360 empiema akut atau kronik (www.medicastore.com). \par
}
{\phpg\posx2162\pvpg\posy7660\absw7141\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 B
erdasarkan jenis cairan yang terbentuk, cairan pleura dibagi menjadi : \par
}
{\phpg\posx2162\pvpg\posy8074\absw228\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 1.
\par
}
a)
\par}{\phpg\posx1982\pvpg\posy10558\absw245\absh1356 \sl-413 \f20 \fs21 \cf0 b)
\par}{\phpg\posx1982\pvpg\posy10558\absw245\absh1356 \sl-414 \f20 \fs21 \cf0 c)
\par}{\phpg\posx1982\pvpg\posy10558\absw245\absh1356 \sl-414 \f20 \fs21 \cf0 d)
\par
}
{\phpg\posx2522\pvpg\posy8074\absw7962\absh3592 \f20 \fs21 \cf0 \fi1080 \f20 \fs
21 \cf0 Transudat
\par}{\phpg\posx2522\pvpg\posy8074\absw7962\absh3592 \sl-414 \f20 \fs21 \cf0 Tra
nsudat Dalam keadaan normal cairan pleura yang jumlahnya sedikit itu
\par}{\phpg\posx2522\pvpg\posy8074\absw7962\absh3592 \sl-413 \f20 \fs21 \cf0 ada
lah transudat. Transudat terjadi apabila hubungan normal antara tekanan
\par}{\phpg\posx2522\pvpg\posy8074\absw7962\absh3592 \sl-413 \f20 \fs21 \cf0 kap
iler
hidrostatik
dan
koloid
osmotik
menjadi
terganggu,
sehi
ngga
bentuknya cairan pada satu sisi pleura akan melebihi reabsorbsi oleh pleura
\par}{\phpg\posx2522\pvpg\posy8074\absw7962\absh3592 \sl-413 \f20 \fs21 \cf0 lai
nnya. Biasanya hal ini terdapat pada:
\par}{\phpg\posx2522\pvpg\posy8074\absw7962\absh3592 \sl-414 \f20 \fs21 \cf0 Men
ingkatnya tekanan kapiler sistemik
ingkatnya tekanan kapiler pulmonal
urunnya tekanan koloid osmotik dalam pleura
urunnya tekanan intra pleura \par
}
{\phpg\posx1982\pvpg\posy13042\absw245\absh984 \f20 \fs21 \cf0 \f20 \fs21 \cf0 a
)
\par}{\phpg\posx1982\pvpg\posy13042\absw245\absh984 \sl-414 \f20 \fs21 \cf0 b)
\par}{\phpg\posx1982\pvpg\posy13042\absw245\absh984 \sl-414 \f20 \fs21 \cf0 c) \
par
}
Penyakit-penyakit yang menyertai transudat adalah:
\par}{\phpg\posx2522\pvpg\posy12628\absw5181\absh1356 \sl-413 \f20 \fs21 \cf0 Ga
gal jantung kiri (terbanyak)
\par}{\phpg\posx2522\pvpg\posy12628\absw5181\absh1356 \sl-414 \f20 \fs21 \cf0 Si
ndrom nefrotik
\par}{\phpg\posx2522\pvpg\posy12628\absw5181\absh1356 \sl-414 \f20 \fs21 \cf0 Ob
struksi vena cava superior \par
}
{\phpg\posx2702\pvpg\posy14284\absw245\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 d
) \par
}
Asites pada sirosis hati (asites menembus suatu defek diafragma atau
\par}{\phpg\posx3242\pvpg\posy14284\absw7223\absh611 \sl-414 \f20 \fs21 \cf0 mas
uk melalui saluran getah bening) \par
}
\par
}
ffd8ffe000104a46494600010100000100010000ffdb004300010101010101010101010101010101
01010101010101010101010101010101010101010101010101010101010101010101010101010101
010101010101010101ffdb0043010101010101010101010101010101010101010101010101010101
0101010101010101010101010101010101010101010101010101010101010101010101010101ffc0
001108034a025303012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
00ffd9
\cf0 2. \par
}
{\phpg\posx3242\pvpg\posy1450\absw860\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 Ek
sudat \par
}
Eksudat merupakan cairan pleura yang terbentuk melalui membran kapiler
g permeable abnormal dan berisi protein transudat. Terjadinya perubahan
meabilitas membrane adalah karena adanya peradangan pada pleura
\par}{\phpg\posx2522\pvpg\posy1864\absw7932\absh3965 \sl-414 \f20 \fs21 \cf0 mis
alnya: infeksi, infark paru atau neoplasma. Protein yang terdapat dalam
ra pleura kebanyakan berasal dari saluran getah bening. Kegagalan alira
n
\par}{\phpg\posx2522\pvpg\posy1864\absw7932\absh3965 \sl-413 \f20 \fs21 \cf0 pro
tein getah bening ini akan menyebabkan peningkatan konsentrasi protein
ran pleura, sehingga menimbulkan eksudat. Penyakit yang menyertai
\par}{\phpg\posx2522\pvpg\posy1864\absw7932\absh3965 \sl-413 \f20 \fs21 \cf0 eks
udat, antara lain: infeksi (tuberkulosis, pneumonia) tumor pada pleura,
\par}{\phpg\posx2522\pvpg\posy1864\absw7932\absh3965 \sl-414 \f20 \fs21 \cf0 inf
ark paru, karsinoma bronkogenik radiasi, penyakit dan jaringan i
kat/
\par}{\phpg\posx2522\pvpg\posy1864\absw7932\absh3965 \sl-414 \f20 \fs21 \cf0 kol
agen/ SLE (Sistemic Lupus Eritematosis).
\par}{\phpg\posx2522\pvpg\posy1864\absw7932\absh3965 \sl-413 \f20 \fs21 \cf0 (Ha
di Halim, 2001: 787-788) \par
}
\cf0 1.3 Etiologi \par
}
Efusi pleura merupakan proses penyakit primer yang jarang terjad
i, tetapi
\par}{\phpg\posx2162\pvpg\posy7660\absw8326\absh2474 \sl-413 \f20 \fs21 \cf0 bia
sanya merupakan penyakit sekunder terhadap penyakit lain.
urut Brunner & Suddart. 2001, terjadinya efusi pleura disebabkan oleh
2
\par}{\phpg\posx2162\pvpg\posy7660\absw8326\absh2474 \sl-413 \f20 \fs21 \cf0 fak
tor yaitu:
360 1.
Infeksi
360 Penyakit-penyakit infeksi yang menyebabkan efusi pleura antara
lain:
360 tuberculosis, pnemonitis, abses paru, abses subfrenik. \par
}
Macam-macam penyakit infeksi lain yang dapat menyebabkan efusi pleura
\par}{\phpg\posx2522\pvpg\posy10972\absw7895\absh2847 \sl-414 \f20 \fs21 \cf0 an
tara lain:
\par}{\phpg\posx2522\pvpg\posy10972\absw7895\absh2847 \sl-414 \f20 \fs21 \cf0 \f
i360 a.
Pleuritis karena Virus dan mikoplasma
i360 Efusi pleura karena virus atau mikoplasma agak jarang. Bila
terjadi
i360 jumlahnya pun tidak banyak dan kejadiannya hanya selintas saja. Je
nis\par}{\phpg\posx2522\pvpg\posy10972\absw7895\absh2847 \sl-413 \f20 \fs21 \cf0 \f
i360 jenis virusnya adalah : Echo virus, Coxsackie virus, Chlamidia, Rickettsia,
i360 dan mikoplasma. Cairan efusi biasanya eksudat dan berisi leukosit ant
ara
i360 100-6000 per cc. \par
}
\par
}
ffd8ffe000104a46494600010100000100010000ffdb004300010101010101010101010101010101
01010101010101010101010101010101010101010101010101010101010101010101010101010101
010101010101010101ffdb0043010101010101010101010101010101010101010101010101010101
0101010101010101010101010101010101010101010101010101010101010101010101010101ffc0
001108034a025303012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
00ffd9
1 \cf0 b. Pleuritis karena bakteri Piogenik
\par}{\phpg\posx2882\pvpg\posy1450\absw7802\absh2474 \sl-413 \f20 \fs21 \cf0 Per
mukaan pleura dapat ditempeli oleh bakteri yang berasal dari jaringan
enkim paru dan menjalar secara hematogen, dan jarang yang melalui
\par}{\phpg\posx2882\pvpg\posy1450\absw7802\absh2474 \sl-413 \f20 \fs21 \cf0 pen
etrasi diafragma, dinding dada atau esophagus.
\par}{\phpg\posx2882\pvpg\posy1450\absw7802\absh2474 \sl-414 \f20 \fs21 \cf0 Aer
ob :{\i Streptococcus}{\i pneumonia,}{\i Streptococcus}{\i mileri,}{\i
Saphylococcus }
\par}{\phpg\posx2882\pvpg\posy1450\absw7802\absh2474 \sl-414 \f20 \fs21 \cf0 {\i
aureus,}{\i Hemofilus}{\i spp,}{\i E.}{\i coli,}{\i Klebsiella,}{\i Pseud
omonas}{\i spp. }
\par}{\phpg\posx2882\pvpg\posy1450\absw7802\absh2474 \sl-413 \f20 \fs21 \cf0 Ana
erob :{\i Bacteroides}{\i spp,}{\i Peptostreptococcus,}{\i Fusobacterium. }\
par
}
c.
Pleuritis Tuberkulosa
mulaan penyakit ini terlihat sebagai efusi yang bersifat eksudat
.
\par}{\phpg\posx2882\pvpg\posy4762\absw7561\absh1356 \sl-414 \f20 \fs21 \cf0 Pen
yakit kebanyakan terjadi sebagai komplikasi tuberkulosis paru melalui
\par}{\phpg\posx2882\pvpg\posy4762\absw7561\absh1356 \sl-413 \f20 \fs21 \cf0 fok
us subpleura yang robek atau melalui aliran getah bening. \par
}
Cairan efusi yang biasanya serous, kadang-kadang bisa juga hemoragis.
\par}{\phpg\posx2882\pvpg\posy6832\absw7666\absh1356 \sl-413 \f20 \fs21 \cf0 Jum
lah leukosit antara 500-2000 per cc. mula-mula yang dominan adalah
polimorfonuklear, tapi kemudian sel limfost. Cairan efusi sangat sedikit
\par}{\phpg\posx2882\pvpg\posy6832\absw7666\absh1356 \sl-413 \f20 \fs21 \cf0 men
gandung kuman tuberculosis. \par
}
d. Pleura karena Fungi
\par}{\phpg\posx2882\pvpg\posy8902\absw7671\absh2102 \sl-413 \f20 \fs21 \cf0 Ple
uritis karena fungi amat jarang. Biasanya terjadi karena penjalaran
eksi fungi dari jaringan paru. Jenis fungi penyebab pleuritis adalah :
\par}{\phpg\posx2882\pvpg\posy8902\absw7671\absh2102 \sl-413 \f20 \fs21 \cf0 akt
inomikosis,
koksidioidomikosis,
aspergillus,
kriptoko
kus,
\par}{\phpg\posx2882\pvpg\posy8902\absw7671\absh2102 \sl-414 \f20 \fs21 \cf0 his
toplasmosis, blastomikosis, dll. Patogenesis timbulnya efusi pleura
lah karena reaksi hipersensitivitas lambat terhadap organisme fungi. . \par
}
e.
Pleuritis karena parasit
\par}{\phpg\posx2882\pvpg\posy11800\absw7593\absh3885 \sl-413 \f20 \fs21 \cf0 Pa
rasit yang dapat menginfeksi ke dalam rongga pleura hanyalah amoeba.
\par}{\phpg\posx2882\pvpg\posy11800\absw7593\absh3885 \sl-414 \f20 \fs21 \cf0 Be
ntuk tropozoit datang dari parenkim hati menembus diafragma terus ke
\par}{\phpg\posx2882\pvpg\posy11800\absw7593\absh3885 \sl-413 \f20 \fs21 \cf0 pa
renkim paru dan rongga pleura. Efusi pleura karena parasit ini terjadi
\par}{\phpg\posx2882\pvpg\posy11800\absw7593\absh3885 \sl-414 \f20 \fs21 \cf0 ka
rena peradangan yang ditimbulkannya. Di samping ini dapat terjadi
\par}{\phpg\posx2882\pvpg\posy11800\absw7593\absh3885 \sl-414 \f20 \fs21 \cf0 em
piema karena karena ameba yang cairannya berwarna khas merah
\par}{\phpg\posx2882\pvpg\posy11800\absw7593\absh3885 \sl-413 \f20 \fs21 \cf0 co
klat.di sini parasit masuk ke rongga pleura secara migrasi dari perenkim
\par}{\phpg\posx2882\pvpg\posy11800\absw7593\absh3885 \sl-414 \f20 \fs21 \cf0 ha
ti. Dapat juga karena adanya robekan dinding abses amuba pada hati ke
\par}{\phpg\posx2882\pvpg\posy11800\absw7593\absh3885 \sl-413 \f20 \fs21 \cf0 ar
ah rongga pleura.
0 \fi7104 6 \par
}
ffd8ffe000104a46494600010100000100010000ffdb004300010101010101010101010101010101
01010101010101010101010101010101010101010101010101010101010101010101010101010101
010101010101010101ffdb0043010101010101010101010101010101010101010101010101010101
0101010101010101010101010101010101010101010101010101010101010101010101010101ffc0
001108034a025303012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
00ffd9
\cf0 2. \par
}
{\phpg\posx3242\pvpg\posy1450\absw1200\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 N
on infeksi \par
}
Sedangkan penyakit non infeksi yang dapat menyebabkan efusi pleura antara
n: Ca paru, Ca pleura (primer dan sekunder), Ca mediastinum, tumor
\par}{\phpg\posx2522\pvpg\posy1864\absw7887\absh1356 \sl-413 \f20 \fs21 \cf0 ova
rium, bendungan jantung (gagal jantung), perikarditis konstruktifa, gagal
\par}{\phpg\posx2522\pvpg\posy1864\absw7887\absh1356 \sl-414 \f20 \fs21 \cf0 hat
i, gagal ginjal. \par
}
Adapun penyakit non infeksi lain yang dapat menyebabkan efusi pleura antara

n:
\par}{\phpg\posx2522\pvpg\posy3934\absw7864\absh3965 \sl-413 \f20 \fs21 \cf0 a.
Efusi pleura karena gangguan sirkulasi
720 1.
Gangguan Kardiovaskuler
720 Payah jantung (decompensatio cordis) adalah penyebab terbanyak
720 timbulnya
efusi
pleura.
Penyebab
lainnya
dalah
perik
arditis
720 konstriktiva dan sindrom vena kava superior. Patogenesisnya dalah
720 akibat terjadinya peningkatan tekanan vena sistemik dan tekana
n
720 kapiler
pulmonal akan menurunkan kapasitas reabsorbsi pembuluh
720 darah subpleura dan aliran getah bening juga akan menurun (terhalang)
720 sehingga filtrasi cairan ke rongga pleura dan paru-paru meningkat. \par
}
\par
}
{\phpg\posx4142\pvpg\posy8902\absw1788\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 E
mboli Pulmonal \par
}
Efusi pleura dapat terjadi pada sisi paru yang terkena emboli pulmonal.
\par}{\phpg\posx3242\pvpg\posy9316\absw7170\absh2474 \sl-413 \f20 \fs21 \cf0 Kea
daan ini dapat disertai infark paru ataupun tanpa infark. Emboli
yebabkan turunnya aliran darah arteri pulmonalis, sehingga terjadi
\par}{\phpg\posx3242\pvpg\posy9316\absw7170\absh2474 \sl-414 \f20 \fs21 \cf0 isk
emia
maupun
kerusakan
parenkim
paru
dan
memberikan
adangan dengan efusi yang berdarah (warna merah). Di samping itu
meabilitas antara satu atau kedua bagian pleura akan meningkat,
ingga cairan efusi mudah terbentuk. \par
}
Cairan efusi biasanya bersifat eksudat, jumlahnya tidak banyak, dan
\par}{\phpg\posx3242\pvpg\posy12628\absw7172\absh1356 \sl-413 \f20 \fs21 \cf0 bi
asanya sembuh secara spontan, asal tidak terjadi emboli pulmonal
\par}{\phpg\posx3242\pvpg\posy12628\absw7172\absh1356 \sl-414 \f20 \fs21 \cf0 la
innya. Pada efusi pleura denga infark paru jumlah cairan efusinya
\par}{\phpg\posx3242\pvpg\posy12628\absw7172\absh1356 \sl-414 \f20 \fs21 \cf0 le
bih banyak dan waktu penyembuha juga lebih lama. \par
}
\par
}
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01010101010101010101010101010101010101010101010101010101010101010101010101010101
010101010101010101ffdb0043010101010101010101010101010101010101010101010101010101
0101010101010101010101010101010101010101010101010101010101010101010101010101ffc0
001108034a025303012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
00ffd9
\cf0 3. \par
}
{\phpg\posx4142\pvpg\posy1450\absw1815\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 H
ipoalbuminemia \par
}
Efusi pleura juga terdapat pada keadaan hipoalbuminemia seperti
\par}{\phpg\posx3242\pvpg\posy1864\absw7197\absh1729 \sl-414 \f20 \fs21 \cf0 sin
drom nefrotik, malabsorbsi atau keadaan lain dengan asites serta
\par}{\phpg\posx3242\pvpg\posy1864\absw7197\absh1729 \sl-413 \f20 \fs21 \cf0 ana
sarka. Efusi terjadi karena rendahnya tekana osmotic protein cairan
ura dibandingkan dengan tekana osmotic darah. Efusi yang terjadi
\par}{\phpg\posx3242\pvpg\posy1864\absw7197\absh1729 \sl-414 \f20 \fs21 \cf0 keb
anyakan bilateral dan cairan bersifat transudat. \par
}
{\phpg\posx2162\pvpg\posy4348\absw210\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 b.
\par
}
{\phpg\posx2522\pvpg\posy4348\absw7938\absh2102 \f20 \fs21 \cf0 \fi720 \f20 \fs2

1 \cf0 Efusi pleura karena neoplasma
\par}{\phpg\posx2522\pvpg\posy4348\absw7938\absh2102 \sl-413 \f20 \fs21 \cf0 Neo
plasma primer ataupun sekunder (metastasis) dapat menyerang pleura dan
\par}{\phpg\posx2522\pvpg\posy4348\absw7938\absh2102 \sl-414 \f20 \fs21 \cf0 umu
mnya menyebabkan efusi pleura. Keluhan yang paling banyak ditemukan
lah sesak nafas dan nyeri dada. Gejala lain adalah adanya cairan yang
alu berakumulasi kembali dengan cepat walaupun dilakukan torakosentesis
\par}{\phpg\posx2522\pvpg\posy4348\absw7938\absh2102 \sl-414 \f20 \fs21 \cf0 ber
kali-kali. \par
}
{\phpg\posx2522\pvpg\posy7246\absw7884\absh611 \f20 \fs21 \cf0 \f20 \fs21 \cf0 T
erdapat beberapa teori tentang timbulnya efusi pleura pada neopl
asma,
\par}{\phpg\posx2522\pvpg\posy7246\absw7884\absh611 \sl-413 \f20 \fs21 \cf0 yakn
i : \par
}
{\phpg\posx2522\pvpg\posy8074\absw110\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 \par
}
1 \cf0 Menumpuknya sel-sel tumor akan meningkatnya permeabilitas
ura terhadap air dan protein
900 Adanya
massa
tumor
mengakibatkan
tersumbatnya
aliran
buluh darah vena dan getah bening, sehingga rongga pleura gaga
l
\par}{\phpg\posx2702\pvpg\posy8074\absw7680\absh2474 \sl-413 \f20 \fs21 \cf0 mem
indahkan cairan dan protein
1093 Adanya
tumor
membuat
infeksi
lebih
mudah
terjadi
dan
anjutnya timbul hipoproteinemia. \par
}
}
}
{\phpg\posx722\pvpg\posy11386\absw210\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 c.
\par
}
Efusi pleura karena sebab lain
i1080 1.
Efusi pleura dapat terjadi karena trauma yaitu trauma
tumpul,
i1080 laserasi, luka tusuk pada dada, rupture esophagus karena muntah h
ebat
i1080 atau karena pemakaian alat waktu tindakan esofagoskopi. \par
}
2. Uremia
i360 Salah satu gejala penyakit uremia lanjut adalah poliserositis yang
terdiri
i360 dari efusi pleura, efusi perikard dan efusi peritoneal (asites). M
ekanisme
i360 penumpukan cairan ini belum diketahui betul, tetapi diketahui denga
n
i360 timbulnya
eksudat terdapat peningkatan permeabilitas jaringan pleur
a,
0 \fi7464 8 \par
}
ffd8ffe000104a46494600010100000100010000ffdb004300010101010101010101010101010101
01010101010101010101010101010101010101010101010101010101010101010101010101010101
010101010101010101ffdb0043010101010101010101010101010101010101010101010101010101
0101010101010101010101010101010101010101010101010101010101010101010101010101ffc0
001108034a025303012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
00ffd9
}}\par}{\phpg\posx1802\pvpg\posy1450\absw8681\absh7318 \f20 \fs21 \cf0 \fi1080 \

f20 \fs21 \cf0 perikard atau peritoneum. Sebagian besar efusi pleura karena urem
ia tidak
1080 memberikan gejala yang jelas seperti sesak nafas, sakit dada, atau batuk.
1080 3.
Miksedema
1080 Efusi pleura dan efusi perikard dapat terjadi sebagai bagian mikse
dema.
1080 Efusi dapat terjadi tersendiri maupun secara bersama-sama. Cairan bersifat
1080 eksudat dan mengandung protein dengan konsentrasi tinggi.
180 Limfedema
1080 Limfedema secara kronik dapat terjadi pada tungkai, muka, tangan d
an
1080 efusi pleura yang berulang pada satu atau kedua paru. Pada bebera
pa
1080 pasien terdapat juga kuku jari yang berwarna kekuning-kuningan.
180 Reaksi hipersensitif terhadap obat
1080 Pengobatan dengan nitrofurantoin, metisergid, praktolol kadang-kadang
1080 memberikan reaksi/perubahan terhadap paru-paru dan pleura berup
a
1080 radang dan dan kemudian juga akan menimbulkan efusi pleura.
\par}{\phpg\posx1802\pvpg\posy1450\absw8681\absh7318 \sl-413 \f20 \fs21 \cf0 Efu
si pleura idiopatik
1080 Pada beberapa efusi pleura, walaupun telah dilakukan prosedur diagnostic
1080 secara berulang-ulang (pemeriksaan radiologis, analisis cairan,
biopsy
1080 pleura), kadang-kadang masih belum bisa didapatkan diagnostic y
ang
1080 pasti. Keadaan ini dapat digolongkan daloam efusi pleura idiopatik.
1080 (Asril Bahar, 2001) \par
}
\par
}
\par
}
\par
}
. \par
}

21 \cf0 Efusi pleura karena kelainan Intra-abdominal
\par}{\phpg\posx2882\pvpg\posy10144\absw7652\absh3965 \sl-414 \f20 \fs21 \cf0 Ef
usi pleura dapat terjadi
secara steril karena reaksi infeksi
dan
radangan yang terdapat di bawah diafragma, seperti pankreatitis,
\par}{\phpg\posx2882\pvpg\posy10144\absw7652\absh3965 \sl-414 \f20 \fs21 \cf0 ps
eudokista pancreas atau eksaserbasi akut pankreatitis kronik, abse
s
\par}{\phpg\posx2882\pvpg\posy10144\absw7652\absh3965 \sl-414 \f20 \fs21 \cf0 gi
njal, abses hati, abses limpa, dll. Biasanya efusi terjadi pada pleura k
iri
\par}{\phpg\posx2882\pvpg\posy10144\absw7652\absh3965 \sl-413 \f20 \fs21 \cf0 ta
pi dapat juga bilateral. Mekanismenya adalah karena berpindahnya
iran yang kaya dengan enzim pancreas ke rongga pleura melalui saluran
\par}{\phpg\posx2882\pvpg\posy10144\absw7652\absh3965 \sl-413 \f20 \fs21 \cf0 ge
tah bening. Efusi disini bersifat eksudat serosa, tetapi kadang-kadang
\par}{\phpg\posx2882\pvpg\posy10144\absw7652\absh3965 \sl-414 \f20 \fs21 \cf0 ju
ga dapat hemoragik. Efusi pleura juga sering terjadi setelah 48-72 jam
sca operasi abdomen seperti splenektomi, operasi terhadap obstruksi
\par}{\phpg\posx2882\pvpg\posy10144\absw7652\absh3965 \sl-413 \f20 \fs21 \cf0 in
testinal atau pascaoperasi atelektasis. \par
}
\par
}
ffd8ffe000104a46494600010100000100010000ffdb004300010101010101010101010101010101
01010101010101010101010101010101010101010101010101010101010101010101010101010101
010101010101010101ffdb0043010101010101010101010101010101010101010101010101010101
0101010101010101010101010101010101010101010101010101010101010101010101010101ffc0
001108034a025303012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
00ffd9
}}\par}{\phpg\posx542\pvpg\posy1450\absw228\absh239 \f20 \fs21 \cf0 \f20 \fs21 \
cf0 1. \par
}
{\phpg\posx1802\pvpg\posy1450\absw1215\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 S
irosis Hati \par
}
Efusi pleura dapat terjadi pada pasien sirosis hati. Kebanyakan efusi
ura timbul bersamaan dengan asites. Secara khas terdapat kesamaan
\par}{\phpg\posx3242\pvpg\posy1864\absw7168\absh1729 \sl-413 \f20 \fs21 \cf0 ant
ara cairan asites dengan cairan pleura, karena terdapat hubungnan
\par}{\phpg\posx3242\pvpg\posy1864\absw7168\absh1729 \sl-414 \f20 \fs21 \cf0 fun
gsional antara rongga pleura dan rongga abdomen melalui saluran
\par}{\phpg\posx3242\pvpg\posy1864\absw7168\absh1729 \sl-414 \f20 \fs21 \cf0 get
ah bening atau celah jaringan otot diafragma. \par
}
\par
}
indrom Meig \par
}
Tahun 1937 Meig dan Cass menemukan penyakit tumor pada ovarium
\par}{\phpg\posx3242\pvpg\posy4762\absw7201\absh2102 \sl-414 \f20 \fs21 \cf0 (ji
nak atau ganas) disertai asites dan efusi pleura. Patogenesis
jadinya efusi pleura masih belum diketahui betul. Bila tumor
\par}{\phpg\posx3242\pvpg\posy4762\absw7201\absh2102 \sl-413 \f20 \fs21 \cf0 ova
rium tersebut dioperasi, efusi pleura dan asitesnya pun segera
\par}{\phpg\posx3242\pvpg\posy4762\absw7201\absh2102 \sl-414 \f20 \fs21 \cf0 hil
ang. Adanya massa di rongga pelvis disertai asites dan eksudat
ran pleura sering dikira sebagai neoplasma dan metastasisnya. \par
}
\par
}
Dialisis Peritoneal
1440 Efusi pleura dapat terjadi selama dan sesudah dilakukannya dialysis
1440 peritoneal. Efusi terjadi pada salah satu paru maupun bilat
eral.
1440 Perpindahan cairan dialisat dari rongga peritoneal ke rongga pleura
1440 terjadi melalui celah diafragma. Hal ini terbukti dengan sa
manya
1440 komposisi antara cairan pleura dengan cairan dialisat. \par
}
\cf0 1.4
Manifestasi Klinis \par
}
Biasanya manifestasi klinisnya adalah yang disebabkan oleh penyak
it dasar.
\par}{\phpg\posx2162\pvpg\posy11386\absw8292\absh4258 \sl-414 \f20 \fs21 \cf0 Pn
eumonia akan menyebabkan demam, menggigil, dan nyeri dada pleuri
tis,
\par}{\phpg\posx2162\pvpg\posy11386\absw8292\absh4258 \sl-413 \f20 \fs21 \cf0 se
mentara efusi malignan dapat mengakibatkan dispnea dan batuk. Ukuran ef
usi
\par}{\phpg\posx2162\pvpg\posy11386\absw8292\absh4258 \sl-414 \f20 \fs21 \cf0 ak
an menentukan keparahan gejala. Efusi yang luas akan menyebabkan sesak
\par}{\phpg\posx2162\pvpg\posy11386\absw8292\absh4258 \sl-413 \f20 \fs21 \cf0 na
pas. Area yang mengandung cairan atau menunjukkan bunyi napas minimal
\par}{\phpg\posx2162\pvpg\posy11386\absw8292\absh4258 \sl-414 \f20 \fs21 \cf0 at
au tidak sama sekali mengandung bunyi datar, pekak saat perkus
i. Suara
\par}{\phpg\posx2162\pvpg\posy11386\absw8292\absh4258 \sl-414 \f20 \fs21 \cf0 eg
ophoni akan terdengar diatas area efusi. Deviasi trakea menjauhi tempat
yang
\par}{\phpg\posx2162\pvpg\posy11386\absw8292\absh4258 \sl-413 \f20 \fs21 \cf0 sa
kit dapat terjadi jika penumpukan cairan pleural yang signifikan. Bila
terdapat
\par}{\phpg\posx2162\pvpg\posy11386\absw8292\absh4258 \sl-414 \f20 \fs21 \cf0 ef
usi pleura kecil sampai sedang, dispnea mungkin saja tidak ditemukan.( Brunner
\par}{\phpg\posx2162\pvpg\posy11386\absw8292\absh4258 \sl-413 \f20 \fs21 \cf0 &
Suddart, 2001: 593)
0 \fi7704 10 \par
}
ffd8ffe000104a46494600010100000100010000ffdb004300010101010101010101010101010101
01010101010101010101010101010101010101010101010101010101010101010101010101010101
010101010101010101ffdb0043010101010101010101010101010101010101010101010101010101
0101010101010101010101010101010101010101010101010101010101010101010101010101ffc0
001108034a025303012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
00ffd9
\fs21 \cf0 1.5 Patogenesis Efusi Pleura \par
}
Pada orang normal, cairan di rongga pleura sebanyak 10-20 cc. Cairan di rongga
ura jumlahnya tetap karena ada keseimbangan antara produksi oleh pleura
ientalis dan absorbsi oleh pleura viceralis. Keadaan ini dapat dipertah
ankan
\par}{\phpg\posx2162\pvpg\posy2278\absw8299\absh3965 \sl-414 \f20 \fs21 \cf0 kar
ena adanya keseimbangan antara tekanan hidrostatis pleura parientalis sebesar
9 cm H{\dn006 \fs12 2}O dan tekanan koloid osmotic pleura viceralis.
Namun dalam keadaan
tentu, sejumlah cairan abnormal dapat terakumulasi di rongga pleura. Ca
iran
ura tersebut terakumulasi ketika pembentukan cairan pleura lebih dari p
ada
\par}{\phpg\posx2162\pvpg\posy2278\absw8299\absh3965 \sl-414 \f20 \fs21 \cf0 abs
orbsi cairan pleura, misalnya reaksi radang yang meningkatkan permeabili
tas
\par}{\phpg\posx2162\pvpg\posy2278\absw8299\absh3965 \sl-414 \f20 \fs21 \cf0 vas
kuler. Selain itu, hipoprotonemia dapat menyebabkan efusi pleura kare
na
\par}{\phpg\posx2162\pvpg\posy2278\absw8299\absh3965 \sl-413 \f20 \fs21 \cf0 ren
dahnya tekanan osmotic di kapiler darah ( Hood Alsagaff dan H. Abdul Mukty,
\par}{\phpg\posx2162\pvpg\posy2278\absw8299\absh3965 \sl-414 \f20 \fs21 \cf0 200
2). \par
}
Menurut Hood Alsagaff dalam bukunya Dasar-Dasar Ilmu Penyakit Da

lam,
\par}{\phpg\posx2162\pvpg\posy7246\absw8210\absh1729 \sl-413 \f20 \fs21 \cf0 kea
daan normal pada cavum pleura dipertahankan oleh:
1. Tekanan hidrostatik pleura parientalis 9 cm H{\dn006 \fs12 2}O
2. Tekanan osmotik pleura viceralis 10 cm H{\dn006 \fs12 2}O
\par}{\phpg\posx2162\pvpg\posy7246\absw8210\absh1729 \sl-392 \f20 \fs21 \cf0 3.
Produksi cairan 0,1 ml/kgBB/hari \par
}
Secara garis besar akumulasi cairan pleura disebabkan karena dua hal yaitu:
Pembentukan cairan pleura berlebih
360 Hal ini dapat terjadi karena peningkatan: permeabilitas kapiler (ke
radangan,
360 neoplasma), tekanan
hidrostatis di pembuluh
darah
ke
jantung / v. \par
}
pulmonalis ( kegagalan
\par}{\phpg\posx2522\pvpg\posy11386\absw2511\absh611 \sl-414 \f20 \fs21 \cf0 (at
elektasis ). \par
}
{\phpg\posx5246\pvpg\posy11386\absw795\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 j
antung \par
}
kiri ), tekanan \par
}
{\phpg\posx8093\pvpg\posy11386\absw763\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 n
egatif \par
}
intrapleura \par
}
Ada tiga faktor yang mempertahankan tekanan negatif paru yang normal
ini.
\par}{\phpg\posx2522\pvpg\posy12628\absw7921\absh2102 \sl-413 \f20 \fs21 \cf0 Pe
rtama, jaringan elastis paru memberikan kontinu yang cenderung menarik
ru-paru menjauh dari rangka thoraks. Tetapi, permukaan pleura viseralis dan
\par}{\phpg\posx2522\pvpg\posy12628\absw7921\absh2102 \sl-414 \f20 \fs21 \cf0 pl
eura parietalis yang saling menempel itu tidak dapat dipisahkan, sehing
ga
\par}{\phpg\posx2522\pvpg\posy12628\absw7921\absh2102 \sl-413 \f20 \fs21 \cf0 te
tap ada kekuatan kontinyu yang cenderung memisahkannya. Kekuatan ini
\par}{\phpg\posx2522\pvpg\posy12628\absw7921\absh2102 \sl-414 \f20 \fs21 \cf0 di
kenal sebagai kekuatan negatif dari ruang pleura. \par
}
1 \par
}

ffd8ffe000104a46494600010100000100010000ffdb004300010101010101010101010101010101
01010101010101010101010101010101010101010101010101010101010101010101010101010101
010101010101010101ffdb0043010101010101010101010101010101010101010101010101010101
0101010101010101010101010101010101010101010101010101010101010101010101010101ffc0
001108034a025303012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
00ffd9
1 \cf0 Faktor utama kedua dalam mempertahankan tekanan negatif int
ra pleura
urut Sylvia Anderson Price dalam bukunya Patofisiologi adalah kekuatan
\par}{\phpg\posx2522\pvpg\posy1450\absw7974\absh4710 \sl-414 \f20 \fs21 \cf0 osm
otic yang terdapat di seluruh membran pleura. Cairan dalam keadaan
\par}{\phpg\posx2522\pvpg\posy1450\absw7974\absh4710 \sl-413 \f20 \fs21 \cf0 nor
mal akan bergerak dari kapiler di dalam pleura parietalis ke ruang pl
eura
kemudian di serap kembali melalui pleura viseralis. Pergerakan cairan
ura dianggap mengikuti hukum Starling tentang pertukaran trans kapiler
\par}{\phpg\posx2522\pvpg\posy1450\absw7974\absh4710 \sl-413 \f20 \fs21 \cf0 yai
tu, pergerakan cairan bergantung pada selisih perbedaan antara tekanan
\par}{\phpg\posx2522\pvpg\posy1450\absw7974\absh4710 \sl-414 \f20 \fs21 \cf0 hid
rostatik darah yang cenderung mendorong cairan keluar dan tekana
n
\par}{\phpg\posx2522\pvpg\posy1450\absw7974\absh4710 \sl-413 \f20 \fs21 \cf0 onk

otik dari protein plasma yang cenderung menahan cairan agar tetap di
\par}{\phpg\posx2522\pvpg\posy1450\absw7974\absh4710 \sl-414 \f20 \fs21 \cf0 dal
am. Selisih perbedaan absorbsi cairan pleura melalui pleura viseralis lebih
\par}{\phpg\posx2522\pvpg\posy1450\absw7974\absh4710 \sl-414 \f20 \fs21 \cf0 bes
ar daripada selisih perbedaan pembentukan cairan parietalis dan permukaan
ura viseralis lebih besar daripada plura parietalis sehingga pada ruang
ura dalam keadaan normal hanya terdapat beberapa milliliter cairan. \par
}
Faktor ketiga yang mendukung tekanan negatif intrapleura adalah kekuatan
\par}{\phpg\posx2522\pvpg\posy7246\absw7983\absh1729 \sl-413 \f20 \fs21 \cf0 pom
pa limfatik. Sejumlah kecil protein secara normal memasuki ruang pleura
\par}{\phpg\posx2522\pvpg\posy7246\absw7983\absh1729 \sl-413 \f20 \fs21 \cf0 tet
api akan dikeluarkan oleh sistem limfatik dalam pleura parietalis. Keti
ga
\par}{\phpg\posx2522\pvpg\posy7246\absw7983\absh1729 \sl-414 \f20 \fs21 \cf0 fak
tor ini kemudian, mengatur dan mempertahankan tekanan negatif intra
ura normal. \par
}
2. Penurunan kemampuan absorbsi sistem limfatik
360 Hal ini disebabkan karena beberapa hal antara lain: obstruks
i stomata,
360 gangguan kontraksi saluran limfe, infiltrasi pada kelenjar get
ah bening,
360 peningkatan tekanan vena sentral tempat masuknya saluran limfe dan tekanan
360 osmotic koloid yang menurun dalam darah, misalnya pada hipoalbuminem
i.
360 Sistem limfatik punya kemampuan absorbsi sampai dengan 20 kali juml
ah
360 cairan yang terbentuk. \par
}
Pada orang sehat pleura terletak pada posisi yang sangat dekat satu sa
ma
\par}{\phpg\posx2522\pvpg\posy13042\absw7902\absh2768 \sl-414 \f20 \fs21 \cf0 la
in dan hanya dipisahkan oleh cairan serous yang sangat sedikit,
yang
\par}{\phpg\posx2522\pvpg\posy13042\absw7902\absh2768 \sl-414 \f20 \fs21 \cf0 be
rfungsi untuk
melicinkan dan membuat keduanya bergesekan dengan
\par}{\phpg\posx2522\pvpg\posy13042\absw7902\absh2768 \sl-413 \f20 \fs21 \cf0 mu
dah
selama
bernafas. Sedikitnya
cairan
serous
menyeba
bkan
\par}{\phpg\posx2522\pvpg\posy13042\absw7902\absh2768 \sl-414 \f20 \fs21 \cf0 ke
seimbangan diantara transudat dari kapiler pleura dan reabsorbsi
oleh
\par}{\phpg\posx2522\pvpg\posy13042\absw7902\absh2768 \sl-413 \f20 \fs21 \cf0 ve
na dan jaringan limfatik di selaput visceral dan parietal. Jumlah cairan

0 \fi7344 12 \par
}
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0101010101010101010101010101010101010101010101010101010101010101010101010101ffc0
001108034a025303012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
00ffd9
1 \cf0 yang abnormal dapat terkumpul jika tekanan vena meningkat
karena
\par}{\phpg\posx2522\pvpg\posy1450\absw7875\absh1356 \sl-413 \f20 \fs21 \cf0 dek
ompensasi cordis atau tekanan vena cava oleh tumor intrathorax.
\par}{\phpg\posx2522\pvpg\posy1450\absw7875\absh1356 \sl-414 \f20 \fs21 \cf0 Sel
ain itu, hypoprotonemia
dapat
menyebabkan
efusi
pleura kar
ena
dahnya tekanan osmotic di kapailer darah. \par
}
Eksudat pleura lebih pekat, tidak terlalu jernih, dan agak menggumpal. Cairan
ura jenis ini biasanya terjadi karena rusaknya dinding kapiler melalui
ses suatu penyakit, seperti pneumonia atau TBC, atau karena adan
ya
campuran dengan drainase limfatik, atau dengan neoplasma. Bila efusi
\par}{\phpg\posx2522\pvpg\posy3520\absw7927\absh9397 \sl-414 \f20 \fs21 \cf0 cep
at permulaanya, banyak leukosit terbentuk, dimana pada umumnya limfatik
\par}{\phpg\posx2522\pvpg\posy3520\absw7927\absh9397 \sl-414 \f20 \fs21 \cf0 aka
n mendominasi. Efusi yang disebabkan oleh inflamasi pleura selal
u
\par}{\phpg\posx2522\pvpg\posy3520\absw7927\absh9397 \sl-413 \f20 \fs21 \cf0 sek
under terhadap proses inflamasi yang melibatkan paru, mediastinum,
\par}{\phpg\posx2522\pvpg\posy3520\absw7927\absh9397 \sl-414 \f20 \fs21 \cf0 eso
phagus atau ruang subdiafragmatik. Pada tahap awal, ada serabut pleura
g
kering
tapi
ada
sedikit
peningkatan
cairan
pleura.selama
lesi
kembang, selalu ada peningkatan cairan pleura. Cairan eksudat ini sesua
i
gan yang sudah di jelaskan sebelumnya. Pada tahap awal, cairan pleura
g berupa eksudat ini bening, memiliki banyak fibrinogen, dan sering
\par}{\phpg\posx2522\pvpg\posy3520\absw7927\absh9397 \sl-414 \f20 \fs21 \cf0 dis
ebut serous atau serofibrinous. Pada tahap selanjutnya akan menjadi kurang
\par}{\phpg\posx2522\pvpg\posy3520\absw7927\absh9397 \sl-413 \f20 \fs21 \cf0 jer
nih,
lebih
gelap
dan
konsistensinya
kental
karena
meningkat
kanya
\par}{\phpg\posx2522\pvpg\posy3520\absw7927\absh9397 \sl-413 \f20 \fs21 \cf0 kan
dungan sel PMN.
Efusi pleura tanpa peradangan menghasilkan cairan serous yang jernih, pucat,
warna jerami, dan tidak menggumpal, cairan ini merupakan transudat.,
\par}{\phpg\posx2522\pvpg\posy3520\absw7927\absh9397 \sl-414 \f20 \fs21 \cf0 bia
sanya terjadi pada penyakit yang dapat mengurangi tekanan osmotic darah
\par}{\phpg\posx2522\pvpg\posy3520\absw7927\absh9397 \sl-413 \f20 \fs21 \cf0 ata
u
retensi
Na,
kebanyakan
ditemukan
pada
pasien
yang
mend
erita
\par}{\phpg\posx2522\pvpg\posy3520\absw7927\absh9397 \sl-414 \f20 \fs21 \cf0 oed
emumum sekunder terhadap penyakit yang melibatkan jantung, ginjal, atau
\par}{\phpg\posx2522\pvpg\posy3520\absw7927\absh9397 \sl-414 \f20 \fs21 \cf0 hat
i. Bila cairan di ruang pleura terdiri dari darah, kondisi ini meruju
k pada
\par}{\phpg\posx2522\pvpg\posy3520\absw7927\absh9397 \sl-413 \f20 \fs21 \cf0 hem
othorax. Biasanya hal ini disebabkan oleh kecelakaan penetrasi traumatik
\par}{\phpg\posx2522\pvpg\posy3520\absw7927\absh9397 \sl-414 \f20 \fs21 \cf0 dar
i dinding dada dan menyobek arteri intercostalis, tapi bisa juga terja
di
\par}{\phpg\posx2522\pvpg\posy3520\absw7927\absh9397 \sl-413 \f20 \fs21 \cf0 sec
ara spontan saat subpleural rupture atau sobeknya adhesi pleural (Sylvi
a
\par}{\phpg\posx2522\pvpg\posy3520\absw7927\absh9397 \sl-414 \f20 \fs21 \cf0 And
erson Price dan Lorraine, 2005: 739). \par
}

3 \par
}
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\fs21 \cf0 1.6 WOC \par
}
\cf0 Infeksi (TB)
\par}{\phpg\posx3118\pvpg\posy2039\absw2580\absh694 \sl-266 \f20 \fs18 \cf0 {\fs
21 tuberculosis,}{\fs21 pnemonitis, }
\par}{\phpg\posx3118\pvpg\posy2039\absw2580\absh694 \sl-275 \f20 \fs18 \cf0 \fi7
00 {\fs21 abses}{\fs21 paru }\par
}
on Infeksi mis.{\fs21 Ca}{\fs21 paru,}{\fs21 Ca}{\fs21 pleura}{\fs21 (prime
r}{\fs21 dan }
21 sekunder),}{\fs21 Ca}{\fs21 mediastinum,}{\fs21 tumor}{\fs21 ovarium, }
21 bendungan}{\fs21 jantung}{\fs21 (gagal}{\fs21 jantung),}{\fs21 perikardit
is }
21 konstruktifa,}{\fs21 gagal}{\fs21 hati,}{\fs21 gagal}{\fs21 ginjal }\par
}
{\phpg\posx3830\pvpg\posy3739\absw1200\absh199 \f20 \fs18 \cf0 \f20 \fs18 \cf0 R
eaksi Ag -Ab \par
}
{\phpg\posx6490\pvpg\posy3799\absw2132\absh199 \f20 \fs18 \cf0 \f20 \fs18 \cf0 P
enumpukan sel-sel tumor \par
}
Massa tumor
{\fs18 Tersumbatnya }
\par}{\phpg\posx9324\pvpg\posy3988\absw1735\absh1235 \sl-230 \f20 \fs21 \cf0 {\f
s18 pembuluh}{\fs18 darah}{\fs18 vena }
\par}{\phpg\posx9324\pvpg\posy3988\absw1735\absh1235 \sl-230 \f20 \fs21 \cf0 {\f
s18 dan}{\fs18 getah}{\fs18 bening }\par

}
{\phpg\posx3590\pvpg\posy4525\absw1760\absh406 \f20 \fs18 \cf0 \f20 \fs18 \cf0 M
erangsang mediator
01 inflamasi \par
}
radikinin, prostaglandin,
35 histamine, serotonin \par
}
ongga pleura gagal
\par}{\phpg\posx9324\pvpg\posy5965\absw1671\absh406 \sl-230 \f20 \fs18 \cf0 memi
ndahkan cairan \par
}
{\phpg\posx4146\pvpg\posy6529\absw828\absh199 \f20 \fs18 \cf0 \f20 \fs18 \cf0 Va
so aktif \par
}
{\phpg\posx3532\pvpg\posy7229\absw2016\absh613 \f20 \fs18 \cf0 \f20 \fs18 \cf0 G
angguan keseimbangan
4 tekanan Hidrostatik dan
80 Onkotik \par
}
{\phpg\posx9324\pvpg\posy6969\absw1621\absh406 \f20 \fs18 \cf0 \f20 \fs18 \cf0 A
kumulasi cairan di
\par}{\phpg\posx9324\pvpg\posy6969\absw1621\absh406 \sl-230 \f20 \fs18 \cf0 rong
ga pleura \par
}
eningkatkan permeabilitas
64 membran \par
}
erpindahan cairan \par
}
\cf0 EFUSI PLEURA \par
}
\cf0 Peningkatan
ran Pleura \par
}
Menekan pleura \par
}
\cf0 PK: Atelektasis \par
}
8 \cf0 Rangsangan
204 serabut saraf
\par}{\phpg\posx1960\pvpg\posy11179\absw1445\absh615 \sl-230 \f20 \fs18 \cf0 sen
soris parietalis \par
}
Ekspansi paru
175 inadekuat \par
}
\cf5 MK: Nyeri \par
}
esak nafas
5 (Dispnea) \par
}
0 \fs18 \cf0 Indikasi Tindakan
cf0 \fi1771 {\b0 Pemasangan }
{\b0 Torakosintesis}{\b0
WSD }\par
}
Nafsu makan {\field{\*\fldinst SYMBOL 175 \\f Symbol }} \par
}
0 \fs18 \cf5 MK:
Ketidakefektifan
\fi241 Pola Napas \par
}
Nafas pendek
\par}{\phpg\posx6244\pvpg\posy12741\absw1526\absh1218 \sl-230 \f20 \fs18 \cf0 de
ngan usaha kuat
0 \fi366 Kelelahan {\field{\*\fldinst SYMBOL 173 \\f Symbol }}
0 \fi250 Kesulitan tidur \par
}
8 \cf0 Terputusnya
\par}{\phpg\posx9172\pvpg\posy13387\absw1640\absh406 \sl-230 \f20 \fs18 \cf0 Kon
tinuitas jaringan \par
}
0 \fs18 \cf5 MK: Perubahan
nutrisi kurang dari
\fi80 kebutuhan tubuh \par
}
\cf5 MK: Gangguan
\fi210 Pola Tidur \par
}
\cf5 MK: Nyeri \par
}

18 \cf0 Perlukaan
0 Port de entre kuman
0 \fi276 {\fs21 14 }\par
}
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}}\par}{\phpg\posx9646\pvpg\posy1827\absw1383\absh615 \b \f20 \fs18 \cf5 \fi216
\b \f20 \fs18 \cf5 MK: Rsiko
\par}{\phpg\posx9646\pvpg\posy1827\absw1383\absh615 \sl-230 \b \f20 \fs18 \cf5 T
inggi terhadap
\par}{\phpg\posx9646\pvpg\posy1827\absw1383\absh615 \sl-232 \b \f20 \fs18 \cf5 \
fi397 Infeksi \par
}
\cf0 1.7 Pemeriksaan Fisik dan Diagnostik \par
}
\par
}
\fs19 \cf0 Pemeriksaan fisik
\par}{\phpg\posx2162\pvpg\posy3813\absw8202\absh968 \sl-414 \b \f20 \fs19 \cf0 {
\b0 \fs21 Pada}{\b0 \fs21 pemeriksaan}{\b0 \fs21 fisik}{\b0 \fs21 pasien}{\b0
\fs21 dengan}{\b0 \fs21 efusi}{\b0 \fs21 pleura}{\b0 \fs21 akan}{\b0 \fs21
ditemukan: }
\par}{\phpg\posx2162\pvpg\posy3813\absw8202\absh968 \sl-413 \b \f20 \fs19 \cf0 \
fi360 {\b0 \fs21 1.}{\b0 \fs21

Inspeksi:}{\b0 \fs21
pencembungan
}{\b0 \fs21
hemithorax}{\b0 \fs21
yang}{\b0 \fs21
sakit,}{\b0 \fs21
ICS}{\b0 \fs21
melebar, }\par
}
\par}{\phpg\posx2162\pvpg\posy5866\absw228\absh984 \sl-413 \f20 \fs21 \cf0 4. \p
ar
}
pergerakan pernafasan menurun pada sisi sakit, mediastinum terdorong ke
\par}{\phpg\posx2522\pvpg\posy5038\absw7924\absh1729 \sl-413 \f20 \fs21 \cf0 ara
h kontralateral.
840 Palpasi: sesuai dengan inspeksi, fremitus raba menurun.
840 Perkusi: perkusi yang pekak, garis Elolis damoisseaux
840 Auskultasi: suara nafas yang menurun bahkan menghilang. \par
}
\cf0 Diagnostik
\fi303 {\b0 \fs21 Diagnosis}{\b0 \fs21 kadang-kadang}{\b0 \fs21 dapat}{\b0 \
fs21 ditegakkan}{\b0 \fs21 secara}{\b0 \fs21 anamnesis}{\b0 \fs21 dan}{\
b0 \fs21 pemeriksaan }
\fi303 {\b0 \fs21 fisik}{\b0 \fs21 saja.}{\b0 \fs21 Tapi}{\b0 \fs21 kadang
-kadang}{\b0 \fs21 sulit}{\b0 \fs21 juga,}{\b0 \fs21 sehingga}{\b0 \fs21
perlu}{\b0 \fs21 pemeriksaan}{\b0 \fs21 tambahan }
\fi303 {\b0 \fs21 sinar}{\b0 \fs21
tembus}{\b0 \fs21
dada.}{\b0 \fs21
U
ntuk}{\b0 \fs21
diagnosis}{\b0 \fs21
yang}{\b0 \fs21
pasti}{\b0 \fs21
perlu}{\b0 \fs21
dilakukan}{\b0 \fs21
tindakan }
\fi303 {\b0 \fs21 torakosentesis}{\b0 \fs21 dan}{\b0 \fs21 pada}{\b0 \fs21 be
berapa}{\b0 \fs21 kasus}{\b0 \fs21 dilakukan}{\b0 \fs21 juga}{\b0 \fs21 biop
sy}{\b0 \fs21 pleura. }\par
}
1. Sinar tembus dada
i300 Permukaan cairan yang terdapat dalam rongga pleura akan mem
bentuk
i300 bayangan seperti kurva, dengan permukaan daerah lateral lebih tinggi daripa
da
i300 bagian medial. \par
}
Cairan dalam pleura kadang-kadang menumpuk menggelilingi lobus paru
\par}{\phpg\posx2522\pvpg\posy12076\absw7969\absh2474 \sl-414 \f20 \fs21 \cf0 (b
iasanya lobus bawah) dan terlihat dalam foto sebagai bayangan konsolidasi
renkim lobus. Dapat juga menggumpul di daerah para-mediastinal dan
rlihat dalam foto sebagai figura interlobaris. Bisa juga terdapa
t secara

rallel dengan sisi jantung, sehingga terlihat sebagai kardiomegali.
\par}{\phpg\posx2522\pvpg\posy12076\absw7969\absh2474 \sl-414 \f20 \fs21 \cf0 Ha
l lain yang dapat juga terlihat dalam foto dada pada efusi pleura ad
alah
rdorongnya mediastenum pada sisi yang berlawanan dengan cairan. Tapi bila \par
}
5 \par
}
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\cf0 terdapat atelektasis pada sisi yang berlawanan dengan cairan, medi
astenum
\par}{\phpg\posx2522\pvpg\posy1450\absw7881\absh611 \sl-413 \f20 \fs21 \cf0 akan
tetap pada tempatnya. \par
}
Di samping itu gambaran foto dada dapat juga menerangkan asal
mula
jadinya efusi pleura yaitu bila terdapat jantung yang membesar, adanya
\par}{\phpg\posx2522\pvpg\posy2692\absw7861\absh1356 \sl-414 \f20 \fs21 \cf0 mas
a tumor, adanya lesi tulang yang destruktif pada keganasan, ad
anya
sitas parenkimynag lebih kerang dpada pneumonia atau abses paru. \par
}
Pemeriksaan dengan ultrasonografi pada pleura dapat menentukan adanya
ran dalam rongga pleura. Pemeriksaan ini sangat membantu sebagai
entuan waktu melakukan aspirasi cairan tersebut, terutama pada efusi yang
lokalisasi. Demikian juga dengan pemeriksaan{\i
CT}{\i Scan} dada.
Adanya
bedaan densitas cairan dengan jaringan sekitarnya, sangat memudahkan
am menentukan adanya efusi pleura. Hanya saja pemeriksaan ini tidak
\par}{\phpg\posx2522\pvpg\posy4762\absw7883\absh2474 \sl-413 \f20 \fs21 \cf0 ban

yak dilakukan karena biayanya masih mahal. \par
}
{\phpg\posx2522\pvpg\posy8074\absw6616\absh611 \f20 \fs21 \cf0 \f20 \fs21 \cf0 G
ambar 1.2 Gambaran Toraks dengan Efusi Pleura
200 (http://www.efusi pleura/080308/thorax/weblog.htm) \par
}
2. Torakosentesis
i478 Aspirasi cairan pleura (torakosentesis) berguna sebagai sarana
untuk
i300 diagnostic maupun terapeutik. Pelaksanaannya sebaiknya dilakukan
pada
i300 penderita dengan posisi duduk. Aspirasi dilakukan pada bagian bawah paru di
i300 sela iga IX garis aksilaris posterioar dengan memakai jarum Abbocath nomor
i300 14 atau 16. Pengeluaran cairan pleura sebaiknya tidak melebihi 1.000-1.500
cc \par
}
6 \par
}
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001108034a025303012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
00ffd9
1 \cf0 pada setiap kali aspirasi. Adalah lebih baik mengerjakan aspirasi
berulang\par}{\phpg\posx2522\pvpg\posy1450\absw7919\absh1356 \sl-413 \f20 \fs21 \cf0 ula
ng daripada satu kali aspirasi sekaligus yang dapat menimbulkan{\i ple
ural }
\par}{\phpg\posx2522\pvpg\posy1450\absw7919\absh1356 \sl-414 \f20 \fs21 \cf0 {\i
shock} (hipotensi) atau edema paru. Edema paru dapat terjadi karena paru-paru
ggembang terlalu cepat. \par
}
Komplikasi lain torakosentesis adalah pneumotoraks, ini yang paling seri
ng,
\par}{\phpg\posx2522\pvpg\posy3520\absw7991\absh5828 \sl-413 \f20 \fs21 \cf0 uda
ra masuk melalui jarum), hemotoraks (karena trauma pada pembuluh darah
\par}{\phpg\posx2522\pvpg\posy3520\absw7991\absh5828 \sl-414 \f20 \fs21 \cf0 int
erkostalis), emboli udara (ini agak jarang terjadi). Dapat juga terjadi laserasi
ura viseralis, tapi biasanya ini akan sembuh sendiri dengan cepat. Bil
a
\par}{\phpg\posx2522\pvpg\posy3520\absw7991\absh5828 \sl-414 \f20 \fs21 \cf0 las
erasinya cukup dalam, dapat menyebabkan udara dari alveoli masuk ke
\par}{\phpg\posx2522\pvpg\posy3520\absw7991\absh5828 \sl-414 \f20 \fs21 \cf0 ven
a pulmonalis sehingga terjadi emboli udara. Untuk mencegah emboli udara
\par}{\phpg\posx2522\pvpg\posy3520\absw7991\absh5828 \sl-413 \f20 \fs21 \cf0 ini
menjadi emboli pulmoner atau emboli sistemik, penderita dibaringkan pada
\par}{\phpg\posx2522\pvpg\posy3520\absw7991\absh5828 \sl-414 \f20 \fs21 \cf0 sis
i kiri di bagian bawah, posisi kepala lebih rendah daripada leher, sehingg
a
\par}{\phpg\posx2522\pvpg\posy3520\absw7991\absh5828 \sl-413 \f20 \fs21 \cf0 uda
ra tersebut dapat terperangkap di atrium kanan.
\par}{\phpg\posx2522\pvpg\posy3520\absw7991\absh5828 \sl-413 \f20 \fs21 \cf0 Unt
uk diagnostic caiaran pleura dilakukan pemeriksaan:
\par}{\phpg\posx2522\pvpg\posy3520\absw7991\absh5828 \sl-413 \f20 \fs21 \cf0 1)
Warna cairan
360 Biasanya cairan pleura berwarna agak kekuning-kuningan ({\i serous-xantho- }
360 {\i chrome}). Bila agak kemerah-merahan,ini dapat terjadi pada trauma, infar
k
360 paru,
keganasan,
adanya
kebocoran
aneurisma
aorta.
Bila
kuning
360 kehijauan dan agak perulen, ini menunjukan adanya empiema. B
ila

360 merahtengguli, ini menunjukan adanya abses karena amoeba. \par
}
2) Biokimia
360 Secara biokimia efusi pleura terbagi atas transudat dan eksudat yan
g
360 perbedaannya dapat dilihat pada tabel berikut ini: \par
}
7 \par
}
ffd8ffe000104a46494600010100000100010000ffdb004300010101010101010101010101010101
01010101010101010101010101010101010101010101010101010101010101010101010101010101
010101010101010101ffdb0043010101010101010101010101010101010101010101010101010101
0101010101010101010101010101010101010101010101010101010101010101010101010101ffc0
001108034a025303012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028a28a0028af803fe0ac5ff28b2ff8
2967fd9807ed91ff00acebf11abe00ff00885c7fe0851ff4633ff9b33fb61fff004415007eff0051
5f803ff10b8ffc10a3fe8c67ff003667f6c3ff00e882a3fe2171ff0082147fd18cff00e6ccfed87f
fd105401fbfd457e00ff00c42e3ff0428ffa319ffcd99fdb0fff00a20a8ff885c7fe0851ff004633
ff009b33fb61ff00f4415007eff515f803ff0010b8ff00c10a3fe8c67ff3667f6c3ffe882a3fe217
1ff82147fd18cffe6ccfed87ff00d105401fbfd457e00ffc42e3ff000428ff00a319ff00cd99fdb0
ff00fa20a8ff00885c7fe0851ff4633ff9b33fb61fff004415007eff00515f803ff10b8ffc10a3fe
8c67ff003667f6c3ff00e882a3fe2171ff0082147fd18cff00e6ccfed87ffd105401fbfd457e00ff
00c42e3ff0428ffa319ffcd99fdb0fff00a20a8ff885c7fe0851ff004633ff009b33fb61ff00f441
5007eff515f803ff0010b8ff00c10a3fe8c67ff3667f6c3ffe882a3fe2171ff82147fd18cffe6ccf
ed87ff00d105401fbfd457e00ffc42e3ff000428ff00a319ff00cd99fdb0ff00fa20abf207f634ff
00820aff00c127be2bff00c158bfe0b41fb3478fff00653fedff00825fb26ffc3ba7fe19ff00c15f
f0bcff00692d2ffe101ff85eff00b36f8a3c7ff15bfe2a3d17e3169de2df157fc255e2dd3acf56ff
008ad75ef11ff61f93f60f0e7f63e9924b64e01fdbe515f803ff0010b8ff00c10a3fe8c67ff3667f
6c3ffe882a3fe2171ff82147fd18cffe6ccfed87ff00d105401fbfd457e00ffc42e3ff000428ff00
a319ff00cd99fdb0ff00fa20a8ff00885c7fe0851ff4633ff9b33fb61fff004415007eff00515f80
3ff10b8ffc10a3fe8c67ff003667f6c3ff00e882a3fe2171ff0082147fd18cff00e6ccfed87ffd10
5401fbfd457e00ff00c42e3ff0428ffa319ffcd99fdb0fff00a20a8ff885c7fe0851ff004633ff00
9b33fb61ff00f4415007eff515f803ff0010b8ff00c10a3fe8c67ff3667f6c3ffe882a3fe2171ff8
2147fd18cffe6ccfed87ff00d105401fbfd457e00ffc42e3ff000428ff00a319ff00cd99fdb0ff00
fa20a8ff00885c7fe0851ff4633ff9b33fb61fff004415007eff00515fca17fc1427fe0dc3ff0082
31fc0efd817f6e1f8d7f0b7f636ff845fe26fc1ffd903f696f8a5f0ebc4dff000d0dfb55eb7ff08e
f8efe1ff00c17f1af8b3c23aeff63788be396afe1fd5ff00b23c41a469fa87f666bba56a7a3dff00
d9fecba9e9f7b652cf6d29ff0004f6ff008370ff00e08c7f1c7f605fd87be35fc52fd8dbfe128f89
bf183f640fd9a7e297c45f137fc3437ed57a27fc245e3bf881f05fc15e2cf176bbfd8de1df8e5a47
87f48fed7f106afa86a1fd99a1695a668f61f68fb2e99a7d9594505b4401fd5ed15f803ff10b8ffc
10a3fe8c67ff003667f6c3ff00e882a3fe2171ff0082147fd18cff00e6ccfed87ffd105401fbfd45
7e00ff00c42e3ff0428ffa319ffcd99fdb0fff00a20a8ff885c7fe0851ff004633ff009b33fb61ff
00f4415007eff515f803ff0010b8ff00c10a3fe8c67ff3667f6c3ffe882a3fe2171ff82147fd18cf
fe6ccfed87ff00d105401fbfd457e00ffc42e3ff000428ff00a319ff00cd99fdb0ff00fa20a8ff00
885c7fe0851ff4633ff9b33fb61fff004415007eff00515f803ff10b8ffc10a3fe8c67ff003667f6
c3ff00e882a3fe2171ff0082147fd18cff00e6ccfed87ffd105401fbfd457e00ff00c42e3ff0428f
fa319ffcd99fdb0fff00a20a8ff885c7fe0851ff004633ff009b33fb61ff00f4415007eff515fcb1
7ed6bff06f4ffc11d3f66bf00fc25f8bbf08bf62df0fe93e36d27f6dff00f826ef84e393c59f16bf
681f8a9e15d4bc2bf153fe0a17fb307c28f889e19f137c3bf8aff167c6df0efc5fe1ff0017fc3bf1
b78abc2bace8de2af0aeb3a75c69dacdc916c97296f710ff0053b400514514005145140051451400
51451400514514005145140051451400514514005145140051451400514514005145140051451400
5145140051451401f007fc158bfe5165ff00052cff00b300fdb23ff59d7e2357c01ff11477fc10a3
fe8f9bff00359bf6c3ff00e87dafbfff00e0ac5ff28b2ff82967fd9807ed91ff00acebf11abeff00
a00fc01ff88a3bfe0851ff0047cdff009acdfb61ff00f43ed1ff0011477fc10a3fe8f9bff359bf6c
3ffe87dafdfea2803f007fe228eff82147fd1f37fe6b37ed87ff00d0fb47fc451dff000428ff00a3
e6ff00cd66fdb0ff00fa1f6bf7fa8a00fc01ff0088a3bfe0851ff47cdff9acdfb61fff0043ed1ff1
1477fc10a3fe8f9bff00359bf6c3ff00e87dafdfea2803f007fe228eff0082147fd1f37fe6b37ed8
7ffd0fb47fc451dff0428ffa3e6ffcd66fdb0fff00a1f6bf7fa8a00fc01ff88a3bfe0851ff0047cd
ff009acdfb61ff00f43ed1ff0011477fc10a3fe8f9bff359bf6c3ffe87dafdfea2803f007fe228ef
f82147fd1f37fe6b37ed87ff00d0fb47fc451dff000428ff00a3e6ff00cd66fdb0ff00fa1f6bf7fa
8a00fc01ff0088a3bfe0851ff47cdff9acdfb61fff0043ed1ff11477fc10a3fe8f9bff00359bf6c3
ff00e87dafdfea2803f007fe228eff0082147fd1f37fe6b37ed87ffd0fb5f903fb1a7fc17abfe093
df0a3fe0ac5ff05a0fda5fc7ff00b567f607c12fdacbfe1dd3ff000cff00e35ff8519fb496a9ff00
09f7fc288fd9b7c51e00f8adff0014e68bf07751f16f857fe115f16ea367a4ff00c56ba0f873fb73
cefb7f873fb634c8e5bd4fedf2bf007fe09e1ff29d7ff838abfef11bff00ac79e36a003fe228eff8
2147fd1f37fe6b37ed87ff00d0fb47fc451dff000428ff00a3e6ff00cd66fdb0ff00fa1f6bf7fa8a
00fc01ff0088a3bfe0851ff47cdff9acdfb61fff0043ed1ff11477fc10a3fe8f9bff00359bf6c3ff
00e87dafdfea2803f007fe228eff0082147fd1f37fe6b37ed87ffd0fb47fc451dff0428ffa3e6ffc
d66fdb0fff00a1f6bf7fa8a00fc01ff88a3bfe0851ff0047cdff009acdfb61ff00f43ed1ff001147
7fc10a3fe8f9bff359bf6c3ffe87dafdfea2803f007fe228eff82147fd1f37fe6b37ed87ff00d0fb
47fc451dff000428ff00a3e6ff00cd66fdb0ff00fa1f6bf7fa8a00fc01ff0088a3bfe0851ff47cdf
f9acdfb61fff0043ed1ff11477fc10a3fe8f9bff00359bf6c3ff00e87dafdfea2803f942ff008284
ff00c1c79ff0463f8e3fb02fedc3f053e16fed93ff000947c4df8c1fb207ed2df0b7e1d7867fe19e
7f6abd13fe122f1dfc40f82fe35f09f84742fed9f117c0dd23c3fa47f6bf88357d3f4ffed3d7755d
3347b0fb47dab53d42caca29ee623fe09edff071e7fc118fe077ec0bfb0f7c14f8a5fb64ff00c22f
f137e0ff00ec81fb34fc2df88be19ff8679fdaaf5bff008477c77f0ffe0bf82bc27e2ed0bfb67c3b
f03757f0feaffd91e20d2350d3ff00b4f42d5753d1effecff6ad3350bdb2960b997f6fbfe0ac5ff2
8b2ff82967fd9807ed91ff00acebf11a8ff824effca2cbfe09a7ff006601fb1bff00eb3afc39a00f
803fe228eff82147fd1f37fe6b37ed87ff00d0fb47fc451dff000428ff00a3e6ff00cd66fdb0ff00
fa1f6bf7fa8a00fc01ff0088a3bfe0851ff47cdff9acdfb61fff0043ed1ff11477fc10a3fe8f9bff
00359bf6c3ff00e87dafdfea2803f007fe228eff0082147fd1f37fe6b37ed87ffd0fb47fc451dff0
428ffa3e6ffcd66fdb0fff00a1f6bf7fa8a00fc01ff88a3bfe0851ff0047cdff009acdfb61ff00f4
3ed1ff0011477fc10a3fe8f9bff359bf6c3ffe87dafdfea2803f007fe228eff82147fd1f37fe6b37
ed87ff00d0fb47fc451dff000428ff00a3e6ff00cd66fdb0ff00fa1f6bf7fa8a00fc01ff0088a3bf
e0851ff47cdff9acdfb61fff0043ed1ff11477fc10a3fe8f9bff00359bf6c3ff00e87dafdfea2803
f982fda23fe0bd5ff049efdb474bfd9fff00668fd9a3f6acff008595f1b7e257edff00ff0004c4ff
00842bc15ff0a33f692f077f6d7fc21dff00051dfd95fc7fe24ff8a8fc7ff077c2be12d3bfb3bc25
e15d7b56ff0089b6bd61f6cfb07d82c3ed5a9dd59595c7f4fb5f007fc14b3fe4dd7e1cff00d9ff00
ff00c1277ff5e9bfb1bd7dff00400514514005145140051451400514514005145140051451400514
514005145140051451400514514005145140051451400514514005145140051451401f007fc158bf
e5165ff052cffb300fdb23ff0059d7e2357dff005f007fc158bfe5165ff052cffb300fdb23ff0059
d7e2357dff004005145140051451400514514005145140051451400514514005145140057e00ff00
c13c3fe53aff00f07157fde237ff0058f3c6d5fbfd5f803ff04f0ff94ebffc1c55ff00788dff00d6
3cf1b5007eff00514514005145140051451400514514005145140051451401f007fc158bfe5165ff
00052cff00b300fdb23ff59d7e2351ff00049dff0094597fc134ff00ecc03f637ffd675f87347fc1
58bfe5165ff052cffb300fdb23ff0059d7e2351ff049dff94597fc134ffecc03f637ff00d675f873
401f7fd14514005145140051451400514514005145140051451401f007fc14b3fe4dd7e1cffd9fff
00fc1277ff005e9bfb1bd7dff5f007fc14b3fe4dd7e1cffd9fff00fc1277ff005e9bfb1bd7dff400
51451400514514005145140051451400514514005145140051451400514514005145140051451400
5145140051451400514514005145140051451401f007fc158bfe5165ff00052cff00b300fdb23ff5
9d7e2357dff5f007fc158bfe5165ff00052cff00b300fdb23ff59d7e2357dff40051451400514514
00514514005145140051451400514514005145140057e00ffc13c3fe53afff0007157fde237ff58f
3c6d5fbfd5f803ff0004f0ff0094ebff00c1c55ff788dffd63cf1b5007eff5145140051451400514
51400514514005145140051451401f007fc158bfe5165ff052cffb300fdb23ff0059d7e2351ff049
dff94597fc134ffecc03f637ff00d675f87347fc158bfe5165ff00052cff00b300fdb23ff59d7e23
51ff00049dff0094597fc134ff00ecc03f637ffd675f873401f7fd14514005145140051451400514
514005145140051451401f007fc14b3fe4dd7e1cff00d9ff00ff00c1277ff5e9bfb1bd7dff005f00
7fc14b3fe4dd7e1cff00d9ff00ff00c1277ff5e9bfb1bd7dff004005145140051451400514514005
14514005145140051451400514514005145140051451400514514005145140051451400514514005
145140051451401f007fc158bfe5165ff052cffb300fdb23ff0059d7e2357dff005f007fc158bfe5
165ff052cffb300fdb23ff0059d7e2357c01ff0011477fc10a3fe8f9bff359bf6c3ffe87da00fdfe
a2bf007fe228eff82147fd1f37fe6b37ed87ff00d0fb47fc451dff000428ff00a3e6ff00cd66fdb0
ff00fa1f6803f7fa8afc01ff0088a3bfe0851ff47cdff9acdfb61fff0043ed1ff11477fc10a3fe8f
9bff00359bf6c3ff00e87da00fdfea2bf007fe228eff0082147fd1f37fe6b37ed87ffd0fb47fc451
dff0428ffa3e6ffcd66fdb0fff00a1f6803f7fa8afc01ff88a3bfe0851ff0047cdff009acdfb61ff
00f43ed1ff0011477fc10a3fe8f9bff359bf6c3ffe87da00fdfea2bf007fe228eff82147fd1f37fe
6b37ed87ff00d0fb47fc451dff000428ff00a3e6ff00cd66fdb0ff00fa1f6803f7fa8afc01ff0088
a3bfe0851ff47cdff9acdfb61fff0043ed1ff11477fc10a3fe8f9bff00359bf6c3ff00e87da00fdf
ea2bf007fe228eff0082147fd1f37fe6b37ed87ffd0fb47fc451dff0428ffa3e6ffcd66fdb0fff00
a1f6803f7fabf007fe09e1ff0029d7ff00838abfef11bffac79e36a3fe228eff0082147fd1f37fe6
b37ed87ffd0fb5f903fb1a7fc17abfe093df0a3fe0ac5ff05a0fda5fc7ff00b567f607c12fdacbfe
1dd3ff000cff00e35ff8519fb496a9ff0009f7fc288fd9b7c51e00f8adff0014e68bf07751f16f85
7fe115f16ea367a4ff00c56ba0f873fb73cefb7f873fb634c8e5bd400fedf28afc01ff0088a3bfe0
851ff47cdff9acdfb61fff0043ed1ff11477fc10a3fe8f9bff00359bf6c3ff00e87da00fdfea2bf0
07fe228eff0082147fd1f37fe6b37ed87ffd0fb47fc451dff0428ffa3e6ffcd66fdb0fff00a1f680
3f7fa8afc01ff88a3bfe0851ff0047cdff009acdfb61ff00f43ed1ff0011477fc10a3fe8f9bff359
bf6c3ffe87da00fdfea2bf007fe228eff82147fd1f37fe6b37ed87ff00d0fb47fc451dff000428ff
00a3e6ff00cd66fdb0ff00fa1f6803f7fa8afc01ff0088a3bfe0851ff47cdff9acdfb61fff0043ed
1ff11477fc10a3fe8f9bff00359bf6c3ff00e87da00fdfea2bf007fe228eff0082147fd1f37fe6b3
7ed87ffd0fb47fc451dff0428ffa3e6ffcd66fdb0fff00a1f6803eff00ff0082b17fca2cbfe0a59f
f6601fb647feb3afc46a3fe093bff28b2ff8269ffd9807ec6fff00acebf0e6bf107fe0a13ff071e7
fc118fe38fec0bfb70fc14f85bfb64ff00c251f137e307ec81fb4b7c2df875e19ff8679fdaaf44ff
00848bc77f103e0bf8d7c27e11d0bfb67c45f03748f0fe91fdafe20d5f4fd3ff00b4f5dd574cd1ec
3ed1f6ad4f50b2b28a7b988ff827b7fc1c79ff000463f81dfb02fec3df053e297ed93ff08bfc4df8
3ffb207ecd3f0b7e22f867fe19e7f6abd6ff00e11df1dfc3ff0082fe0af09f8bb42fed9f0efc0dd5
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0088a3bfe0851ff47cdff9acdfb61fff0043ed1ff11477fc10a3fe8f9bff00359bf6c3ff00e87da0
0fdfea2bf007fe228eff0082147fd1f37fe6b37ed87ffd0fb47fc451dff0428ffa3e6ffcd66fdb0f
ff00a1f6803f7fa8afc01ff88a3bfe0851ff0047cdff009acdfb61ff00f43ed1ff0011477fc10a3f
e8f9bff359bf6c3ffe87da00fdfea2bf007fe228eff82147fd1f37fe6b37ed87ff00d0fb47fc451d
ff000428ff00a3e6ff00cd66fdb0ff00fa1f6803f7fa8afc01ff0088a3bfe0851ff47cdff9acdfb6
1fff0043ed1ff11477fc10a3fe8f9bff00359bf6c3ff00e87da00fdfea2bf007fe228eff0082147f
d1f37fe6b37ed87ffd0fb47fc451dff0428ffa3e6ffcd66fdb0fff00a1f6803eff00ff0082967fc9
bafc39ff00b3ff00ff00824eff00ebd37f637afbfebf982fda23fe0bd5ff00049efdb474bfd9ff00
f668fd9a3f6acff8595f1b7e257edfff00f04c4ff842bc15ff000a33f692f077f6d7fc21dff051df
d95fc7fe24ff008a8fc7ff00077c2be12d3bfb3bc25e15d7b56ff89b6bd61f6cfb07d82c3ed5a9dd
59595c7f4fb400514514005145140051451400514514005145140051451400514514005145140051
451400514514005145140051451400514514005145140051451401f007fc158bfe5165ff00052cff
00b300fdb23ff59d7e2357dff5f007fc158bfe5165ff00052cff00b300fdb23ff59d7e2357dff400
5145140051451400514514005145140051451400514514005145140057e00ffc13c3fe53afff0007
157fde237ff58f3c6d5fbfd5f803ff0004f0ff0094ebff00c1c55ff788dffd63cf1b5007eff51451
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1 \cf0 Kadar protein
am
efusi
\par}{\phpg\posx4210\pvpg\posy1748\absw1458\absh2732 \sl-414 \f20 \fs21 \cf0 efu
si (g/dl)
\par}{\phpg\posx4210\pvpg\posy1748\absw1458\absh2732 \sl-285 \f20 \fs21 \cf0 Kad
ar protein
am serum
kadar
tein dalam
\par}{\phpg\posx4210\pvpg\posy1748\absw1458\absh2732 \sl-414 \f20 \fs21 \cf0 ser
um \par
}
{\phpg\posx4210\pvpg\posy4804\absw696\absh2989 \f20 \fs21 \cf0 \f20 \fs21 \cf0 K
adar
\par}{\phpg\posx4210\pvpg\posy4804\absw696\absh2989 \sl-414 \f20 \fs21 \cf0 dala
m
\par}{\phpg\posx4210\pvpg\posy4804\absw696\absh2989 \sl-413 \f20 \fs21 \cf0 (I.U
.)
\par}{\phpg\posx4210\pvpg\posy4804\absw696\absh2989 \sl-286 \f20 \fs21 \cf0 Kada
r
m

\par}{\phpg\posx4210\pvpg\posy4804\absw696\absh2989 \sl-413 \f20 \fs21 \cf0 LDH
\par}{\phpg\posx4210\pvpg\posy4804\absw696\absh2989 \sl-413 \f20 \fs21 \cf0 seru
m
\par}{\phpg\posx4210\pvpg\posy4804\absw696\absh2989 \sl-286 \f20 \fs21 \cf0 Bera
t \par
}
\cf0 LDH
20 efusi
\fi92 LDH
20 efusi
\par}{\phpg\posx4959\pvpg\posy4804\absw684\absh2989 \sl-414 \f20 \fs21 \cf0 Kada
r
m
\fi134 jenis \par
}
{\phpg\posx6842\pvpg\posy1462\absw975\absh496 \f20 \fs21 \cf0 \f20 \fs21 \cf0 tr
ansudat
\par}{\phpg\posx6842\pvpg\posy1462\absw975\absh496 \sl-286 \f20 \fs21 \cf0 < 3 \
par
}
{\phpg\posx9018\pvpg\posy1462\absw860\absh496 \f20 \fs21 \cf0 \f20 \fs21 \cf0 Ek
sudat
\par}{\phpg\posx9018\pvpg\posy1462\absw860\absh496 \sl-286 \f20 \fs21 \cf0 > 3 \
par
}
{\phpg\posx6842\pvpg\posy2862\absw595\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 <
0,5 \par
}
{\phpg\posx9018\pvpg\posy2862\absw595\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 >
0,5 \par
}
200 \par
}
200 \par
}
0,6 \par
}
0,6 \par
}
{\phpg\posx4210\pvpg\posy8274\absw1186\absh496 \f20 \fs21 \cf0 \f20 \fs21 \cf0 c
airan efusi
\par}{\phpg\posx4210\pvpg\posy8274\absw1186\absh496 \sl-286 \f20 \fs21 \cf0 Riva
lta \par
}
1, 016
\par}{\phpg\posx6842\pvpg\posy7860\absw932\absh869 \sl-350 \par\f20 \fs21 \cf0 n
egatif \par
}

1, 016
\par}{\phpg\posx9018\pvpg\posy7860\absw932\absh869 \sl-350 \par\f20 \fs21 \cf0 P
ositif \par
}
{\phpg\posx2882\pvpg\posy9398\absw3231\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 (
dikutip dari Asril Bahar: 2001) \par
}
Di samping pemeriksaan tersebut di atas, secara biokimia di periksakan
\par}{\phpg\posx2882\pvpg\posy10226\absw7568\absh2102 \sl-414 \f20 \fs21 \cf0 ju
ga pada cairan pleura:
i360 A.
Kadar pH dan glukosa. Biasanya merendah pada penyakit\par}{\phpg\posx2882\pvpg\posy10226\absw7568\absh2102 \sl-414 \f20 \fs21 \cf0 \f
i360 penyakit infeksi, arthritis rheumatoid dan neoplasma
i360 B.
Kadar amylase. Biasanya meningkat pada pankreatitis
dan
i360 metastasis adenokarsinoma. \par
}
3) Sitologi
i360 Pemeriksaan sitologi terhadap cairan pleura amat penting untuk diagnostic
i360 penyakit pleura, terutama bila ditemukan patologis atau dominasi sel -se
l
i360 tertentu.
i840 a) Sel neutrofil: menunjukan adanya infeksi akut \par
}
8 \par
}
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05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
00ffd9
1 \cf0 b) Sel limfosit: menunjukan adanya infeksi kronik seperti pleuri
tis
360 tuberkulosa atau limfoma malignum.
\par}{\phpg\posx3362\pvpg\posy1450\absw7116\absh2474 \sl-414 \f20 \fs21 \cf0 c)
Sel
mesotel:
bila
jumlahnya
meningkat
adanya
infark
360 paru.biasanya juga ditemukan banyak sel eritrosit.
\par}{\phpg\posx3362\pvpg\posy1450\absw7116\absh2474 \sl-414 \f20 \fs21 \cf0 d)
Sel mesotel maligna: pada mesotelioma.
\par}{\phpg\posx3362\pvpg\posy1450\absw7116\absh2474 \sl-414 \f20 \fs21 \cf0 e)
Sel-sel besar dengan banyak inti: pada arthritis rheumatoid.
\par}{\phpg\posx3362\pvpg\posy1450\absw7116\absh2474 \sl-413 \f20 \fs21 \cf0 f)
Sel L.E: pada lupus eritematosus sistemik. \par
}
1 \cf0 4) Bakteriologi
660 Biasanya cairan pleura steril, tapi kadang-kadang dapat mengan
dung
660 mikroorganisme, apalagi bila cairanya purulen.Efusi yang purulan dapa
t
660 mengandung kuman-kuman yang aerob ataupaun anaerob. Jenis kuman
660 yang sering ditemukan dalam cairan pleura adalah pneumokokus, E, col
i,
660 Klebsiella, Pseudomonas, Enterobacter.
Biopsi pleura
300 Pemeriksaan histology stu atau beberapa contoh jaringan pleura
dapat
300 menunjukan 50-75 persen diagnosis kasus-kasus pleuritis tuberkolosa d
an
300 tumor pleura. Komplikasi adalah pneumotoraks, hemotoraks, penyeb
arab
300 infeksi atau tumor pada dinding dada. \par
}
4. Pendekatan pada efusi yang tidak terdiagnosis
300 Analisis terhadap cairan pleura yang dilakukan satu kali kadang-kadang tidak
300 dapat
menegakkan
diagnosis.Dalam
hal
ini
dianjurkan
asppir
asi
dan
300 anakisisnya diulang kembali sampai diagnosis menjadi jelas. \par
}
Jika fasilitas memungkinkan dapat dilakukan pemeriksaan tambahan seperti:
i720 a) Bronkoskopi, pada kasus-kasus neoplasma, korpus alienum dalam
i1080 paru, abses paru.
i720 b){\i
Scanning}{\i isotop}, pada kasus-kasus dengan emboli paru.
i720 c) Torakoskop({\i fiber-optic-pleuroscopy})
pada
kasus-kasus
den
gan
i1080 neoplasma atau tuberculosis pleura.
i720 (Asril Bahar,. 2001: 786-789) \par
}
9 \par
}
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00ffd9
\cf0 20 \par
}
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}}\par}{\phpg\posx4458\pvpg\posy1450\absw3000\absh611 \b \f20 \fs21 \cf0 \fi1189
\b \f20 \fs21 \cf0 BAB 2
\par}{\phpg\posx4458\pvpg\posy1450\absw3000\absh611 \sl-413 \b \f20 \fs21 \cf0 A
SUHAN KEPERAWATAN \par
}
{\phpg\posx1802\pvpg\posy3106\absw376\absh239 \b \f20 \fs21 \cf0 \b \f20 \fs21 \
cf0 2.1 \par
}
\cf0 Pengkajian Keperawatan \par
}
{\phpg\posx1082\pvpg\posy3520\absw263\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 1)
\par
}
engkajian Pre Tindakan
970 Pengkajian
184 a.
Riwayat keperawatan \par
}
}
}
}
}
}
}
}
1 \cf0 Efusi Pleura
482 kaji adanya penyakit yang
dasari terjadinya efusi pleura
\par}{\phpg\posx6800\pvpg\posy3944\absw3391\absh7948 \sl-414 \f20 \fs21 \cf0 (mi
sal: TB, pneumonia,
\par}{\phpg\posx6800\pvpg\posy3944\absw3391\absh7948 \sl-413 \f20 \fs21 \cf0 neo
plasma, dll)
482 kaji emosi yang timbul
\par}{\phpg\posx6800\pvpg\posy3944\absw3391\absh7948 \sl-414 \f20 \fs21 \cf0 aki
bat pola nafas tidak efektif
482 kaji koping (kecemasan)
\par}{\phpg\posx6800\pvpg\posy3944\absw3391\absh7948 \sl-414 \f20 \fs21 \cf0 kli
en mengenai penyakitnya
482 kaji apakah klien pernah
\par}{\phpg\posx6800\pvpg\posy3944\absw3391\absh7948 \sl-413 \f20 \fs21 \cf0 kon
tak langsung dengan penderita
\par}{\phpg\posx6800\pvpg\posy3944\absw3391\absh7948 \sl-413 \f20 \fs21 \cf0 TB
dan infeksi lain yang
dasari efusi pleura
482 kaji tempat kerja klien.
\par}{\phpg\posx6800\pvpg\posy3944\absw3391\absh7948 \sl-413 \f20 \fs21 \cf0 Mis
al: pabrik bahan-bahan kimia
\par}{\phpg\posx6800\pvpg\posy3944\absw3391\absh7948 \sl-413 \f20 \fs21 \cf0 (as
bes)
482 kaji pola makanan misal
\par}{\phpg\posx6800\pvpg\posy3944\absw3391\absh7948 \sl-413 \f20 \fs21 \cf0 mak
anan yang mengandung
\par}{\phpg\posx6800\pvpg\posy3944\absw3391\absh7948 \sl-414 \f20 \fs21 \cf0 bah
an karsinogenik
482 kaji keluhan utama yang
\par}{\phpg\posx6800\pvpg\posy3944\absw3391\absh7948 \sl-414 \f20 \fs21 \cf0 pal
ing dirasakan klien. Misal
\par}{\phpg\posx6800\pvpg\posy3944\absw3391\absh7948 \sl-414 \f20 \fs21 \cf0 ses
ak nafas \par
}
b. B1 (Breathing) \par
}
. \par
}
pola nafas \par
}
tidak teratur (dispneu/ sesak
\par}{\phpg\posx6980\pvpg\posy14166\absw2853\absh611 \sl-414 \f20 \fs21 \cf0 naf
as) \par
}
. \par
}
nafas pendek \par
}
1 \par
}
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\cf0 3. \par
}
{\phpg\posx8722\pvpg\posy1460\absw1470\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 k
etidaksimetri \par
}
{\phpg\posx6980\pvpg\posy1874\absw2221\absh611 \f20 \fs21 \cf0 \f20 \fs21 \cf0 s
an dada saat ekspansi

\par}{\phpg\posx6980\pvpg\posy1874\absw2221\absh611 \sl-414 \f20 \fs21 \cf0 (per
gerakan dada) \par
}
\par}{\phpg\posx6980\pvpg\posy2702\absw991\absh611 \sl-414 \f20 \fs21 \cf0 area
efusi \par
}
{\phpg\posx8722\pvpg\posy2702\absw1439\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 e
gofoni diatas \par
}
{\phpg\posx6202\pvpg\posy3530\absw2655\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 f
rekuensi nafas meningkat \par
}
\par
}
{\phpg\posx8722\pvpg\posy3944\absw1139\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 b
unyi nafas \par
}
{\phpg\posx2986\pvpg\posy5048\absw1543\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 c
.
B2 (Blood) \par
}
{\phpg\posx6980\pvpg\posy4358\absw3201\absh984 \f20 \fs21 \cf0 \f20 \fs21 \cf0 m
enghilang/ tidak terdengar
\par}{\phpg\posx6980\pvpg\posy4358\absw3201\absh984 \sl-413 \f20 \fs21 \cf0 diat
as bagian yang terkena efusi
\par}{\phpg\posx6980\pvpg\posy4358\absw3201\absh984 \sl-414 \f20 \fs21 \cf0 pleu
ra \par
}
\par
}
{\phpg\posx8722\pvpg\posy5600\absw1394\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 p
erkusi pekak \par
}
an penurunan fremitus raba \par
}
.
\par}{\phpg\posx6980\pvpg\posy6428\absw1023\absh611 \sl-413 \f20 \fs21 \cf0 inad
ekuat \par
}
kspansi paru \par
}
. B3 (Brain) \par
}
\par
}
{\phpg\posx8722\pvpg\posy7670\absw1366\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 t
ekanan darah \par
}
an denyut nadi meningkat \par
}

\par
}
{\phpg\posx8722\pvpg\posy8498\absw1034\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 n
yeri dada \par
}
.
B4 (Bladder) \par
}
.
B5 (Bowel) \par
}
{\phpg\posx6980\pvpg\posy8912\absw2613\absh611 \f20 \fs21 \cf0 \f20 \fs21 \cf0 s
etempat ketika dilakukan
\par}{\phpg\posx6980\pvpg\posy8912\absw2613\absh611 \sl-413 \f20 \fs21 \cf0 perk
usi \par
}
.
\par}{\phpg\posx6980\pvpg\posy9740\absw1080\absh611 \sl-413 \f20 \fs21 \cf0 suhu
tubuh \par
}
eningkatan \par
}
tidak ada masalah \par
}
Tidak ada masalah \par
}
g. B6
360 (Bone/musculoskeletal/inte
360 gumen) \par
}
{\phpg\posx9322\pvpg\posy12638\absw795\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 k
ehilan \par
}
gan nafsu makan \par
}
enurun \par
}
an masukan makanan \par
}
enurun \par
}
an masukan makanan \par
}
2 \par
}
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\cf0 h. Aktivitas/istirahat \par
}
enurunan berat badan
77 5. \par
}
{\phpg\posx9322\pvpg\posy1874\absw795\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 ke
tidak \par
}
{\phpg\posx2986\pvpg\posy2702\absw3055\absh611 \f20 \fs21 \cf0 \f20 \fs21 \cf0 i
.
Pemeriksaan laboratorium
60 dan diagnostic \par
}
ampuan untuk makan karena
\par}{\phpg\posx6980\pvpg\posy2288\absw3003\absh611 \sl-413 \f20 \fs21 \cf0 dist
res pernapasan \par
}
\par
}
\par
}
21 \cf0 turgor kulit
\par}{\phpg\posx6838\pvpg\posy3530\absw2709\absh1356 \sl-413 \f20 \fs21 \cf0 sek
itar abdomen buruk
1524 bentuk dada
\par}{\phpg\posx6838\pvpg\posy3530\absw2709\absh1356 \sl-413 \f20 \fs21 \cf0 (ba
rrel chest) \par
}
. ukuran dada tidak mengalami
60 perubahan \par
}
{\phpg\posx9082\pvpg\posy6842\absw975\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 ke
sulitan \par
}
idur
\par}{\phpg\posx6202\pvpg\posy7256\absw2044\absh611 \sl-413 \f20 \fs21 \cf0 kele
tihan meningkat \par
}
}
eriksaan sinar dada, \par
}
ditemukan : sudut kostrofenik
\par}{\phpg\posx6838\pvpg\posy8912\absw3303\absh1729 \sl-413 \f20 \fs21 \cf0 tum
pul, obstruksi diafragma
\par}{\phpg\posx6838\pvpg\posy8912\absw3303\absh1729 \sl-413 \f20 \fs21 \cf0 seb
agian, dan "putih" komplet
\par}{\phpg\posx6838\pvpg\posy8912\absw3303\absh1729 \sl-413 \f20 \fs21 \cf0 (op
aque densitas) pada area yang
\par}{\phpg\posx6838\pvpg\posy8912\absw3303\absh1729 \sl-414 \f20 \fs21 \cf0 sak
it \par
}
{\phpg\posx6838\pvpg\posy10982\absw110\absh984 \f20 \fs21 \cf0 \f20 \fs21 \cf0 \par}{\phpg\posx6838\pvpg\posy10982\absw110\absh984 \sl-414 \f20 \fs21 \cf0 \par}{\phpg\posx6838\pvpg\posy10982\absw110\absh984 \sl-414 \f20 \fs21 \cf0 - \p
ar
}
Torasentesis
\par}{\phpg\posx7282\pvpg\posy10982\absw2838\absh984 \sl-414 \f20 \fs21 \cf0 Bio
psi pleura
\par}{\phpg\posx7282\pvpg\posy10982\absw2838\absh984 \sl-414 \f20 \fs21 \cf0 Pem
eriksaan cairan sitologi \par
}
untuk sel-sel malignan
\par}{\phpg\posx6838\pvpg\posy12224\absw3202\absh2474 \sl-414 \f20 \fs21 \cf0 Pewarnaan gram, kultur,
\par}{\phpg\posx6838\pvpg\posy12224\absw3202\absh2474 \sl-413 \f20 \fs21 \cf0 ba
sil tahan asam, dan sensivitas
iran pleura
\par}{\phpg\posx6838\pvpg\posy12224\absw3202\absh2474 \sl-414 \f20 \fs21 \cf0 Hitung sel darah merah dan
\par}{\phpg\posx6838\pvpg\posy12224\absw3202\absh2474 \sl-413 \f20 \fs21 \cf0 pu
tih
\par}{\phpg\posx6838\pvpg\posy12224\absw3202\absh2474 \sl-414 \f20 \fs21 \cf0 Pemeriksaan kimiawi \par
}
3 \par
}

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\cf0 (glukosa, amylase, laktat
\par}{\phpg\posx6838\pvpg\posy1460\absw3046\absh611 \sl-413 \f20 \fs21 \cf0 dehi
drogenase, LDH, protein) \par
}
) Pengkajian Post tindakan
250 Pengkajian
36 a. Riwayat keperawatan \par
}
21 \cf0 Efusi Pleura

kaji keluhan utama yang paling
360 dirasakan menggangu klien
360 selama dan setelah tindakan
kaji pengetahuan/pendidikan
360 tentang prosedur tindakan
emosi yang meningkat akibat
360 tindakan
kaji pola makan klien selama dan
360 setelah tindakan \par
}
5. kaji koping (kecemasan) klien
360 selama dan sesudah tindakan
kaji mobilitas yang menurun
360 selama tindakan
kaji kondisi klien selama tindakan \par
}
b. B1 (breating) \par
}
1. ekspansi paru adekuat
sesak napas berkurang
pola napas teratur
frekuensi napas normal
gerakan dada simetris saat
i900 ekpansi
adanya fremitus raba
terdengarnya bunyi napas (sonor
i237 pada paru ketika perkusi) \par
}
c. B2 (Blood) \par
}
1. tekanan darah normal
nyeri dada saat tindakan \par
}

4 \par
}
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00137401fbfd457e00ff00c382ff00eb351ff05feffc58dfff0089ba3fe1c17ff59a8ff82ff7fe2c
6fff00c4dd007eff0057c01ff0562ff94597fc14b3fecc03f6c8ff00d675f88d5f007fc382ff00eb
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8a0028a28a0028a28a0028a28a00ffd9
\cf0 3. suhu tubuh normal \par
}
. B3 (Brain) \par
}
idak ada masalah \par
}
{\phpg\posx2986\pvpg\posy3116\absw210\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 e.
\par
}
4 (Bladder) \par
}
idak ada masalah \par
}
. B5 (Bowel) \par
}
.
\par}{\phpg\posx6800\pvpg\posy3944\absw1245\absh984 \sl-414 \f20 \fs21 \cf0 nafs
u makan
7 2. \par
}
eningkatan \par
}
eningkatan \par
}
{\phpg\posx2878\pvpg\posy5600\absw3243\absh984 \f20 \fs21 \cf0 \f20 \fs21 \cf0 g
. B6
88 (Bone/musculoskeletal/integ
88 umen) \par
}
asukan makanan dan berat
\par}{\phpg\posx6838\pvpg\posy5186\absw2778\absh611 \sl-414 \f20 \fs21 \cf0 bada
n \par
}
\par
}
danya tanda \par
}
{\phpg\posx2626\pvpg\posy7670\absw2025\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 h
. Aktifitas/istirahat \par
}
{\phpg\posx6838\pvpg\posy6842\absw3005\absh984 \f20 \fs21 \cf0 \f20 \fs21 \cf0 i
ritasi (kulit sekitar perlukaan
\par}{\phpg\posx6838\pvpg\posy6842\absw3005\absh984 \sl-413 \f20 \fs21 \cf0 akib
at pemasangan WSD
\par}{\phpg\posx6838\pvpg\posy6842\absw3005\absh984 \sl-413 \f20 \fs21 \cf0 berw
arna merah) \par
}
\par
}
eradangan/in \par
}
1 \cf0 flamasi di sekitar pemasangan
360 WSD
\par}{\phpg\posx6478\pvpg\posy8498\absw3680\absh1356 \sl-413 \f20 \fs21 \cf0 ket
erbatasan rentang gerak pada area
asangan WSD \par
}
1 \cf0 2.2 Diagnosa Keperawatan
\fi360 {\b0 Diagnosa}{\b0 keperawatan}{\b0 yang}{\b0 timbul}{\b0 menurut}{\
b0 Carpenito}{\b0 (1995)}{\b0 adalah: }
\fi540 {\b0 a)}{\b0
Diagnosa}{\b0 Keperawatan}{\b0 Pre}{\b0 Tindakan }
\fi1080 {\b0 1.}{\b0
Ketidakefektifan}{\b0 pola}{\b0 pernafasan}{\b0 yang
}{\b0 berhubungan}{\b0 dengan }
\fi1080 {\b0 menurunnya}{\b0 ekspansi}{\b0 paru}{\b0 sekunder}{\b0 terhadap
}{\b0 penumpukan}{\b0 cairan}{\b0 dalam }
\fi1080 {\b0 rongga}{\b0 pleura}{\b0 ditandai}{\b0 dengan}{\b0 sesak}{\b0
nafas }
\fi1080 {\b0 2.}{\b0
Ansietas}{\b0 berhubungan}{\b0 dengan}{\b0 kurang}{\
b0 pengetahuan}{\b0 tentang}{\b0 tindakan }
\fi1080 {\b0 medis}{\b0 pemasangan}{\b0 WSD}{\b0 ditandai}{\b0 dengan}{\b0
palpitasi,}{\b0 gemetar,}{\b0 gelisah, }
\fi1080 {\b0 gugup,}{\b0 ketakutan,}{\b0 terkejut }\par
}
5 \par
}
ffd8ffe000104a46494600010100000100010000ffdb004300010101010101010101010101010101
01010101010101010101010101010101010101010101010101010101010101010101010101010101
010101010101010101ffdb0043010101010101010101010101010101010101010101010101010101
0101010101010101010101010101010101010101010101010101010101010101010101010101ffc0
001108034a025303012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
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0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
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5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
00ffd9
\cf0 b) \par
}

21 \cf0 3. Nyeri berhubungan dengan inflamasi sekunder terhadap efusi pleura
1080 ditandai dengan klien mengeluh nyeri, wajah tampak menahan nyeri,
1080 menangis dan merintih
1080 4. Gangggun pola tidur berhubungan dengan sering terbangun sekunder
1080 terhadap efusi pleura ditandai dengan kesulitan untuk jatuh tertidur
1080 5. Resiko terhadap perubahan nutrisi kurang dari kebutuhan tubuh yang
1080 berhubungan dengan anoreksia akibat nyeri
1080 6. Ansietas berhubungan dengan prosedur pemeriksaan diagnostic
1080 ditandai dengan klien menghindar, pucat, palpitasi dan gemetar
Diagnosa Keperawatan Post Tindakan
1080 1.
Nyeri berhubungan dengan truma jaringan sekunder terhada
p
1080 pemasangan WSD
1080 2.
Resiko terhadap infeksi berhubungan dengan truma jaringa
n
1080 sekunder terhadap pemasangan WSD \par
}
\cf0 2.3 Perencanaan
\fi360 {\b0 a).}{\b0 Rencana}{\b0 Tindakan}{\b0 Pre}{\b0 Tindakan }
\fi900 {\b0 1.}{\b0
Ketidakefektifan}{\b0 pola}{\b0 pernafasan}{\b0 ya
ng}{\b0 berhubungan}{\b0 dengan }
\fi900 {\b0 menurunnya}{\b0 ekspansi}{\b0 paru}{\b0 sekunder}{\b0 terhadap}{
\b0 penumpukan}{\b0 cairan}{\b0 dalam }
\fi900 {\b0 ronga}{\b0 pleura}{\b0 ditandai}{\b0 dengan}{\b0 sesak}{\b0 naf
as. }
\fi900 {\b0 Tujuan}{\b0 : }
\fi900 {\b0 Pasien}{\b0 memperlihatkan}{\b0 pola}{\b0 pernafasan}{\b0 yang}{
\b0 efektif}{\b0 dalam}{\b0 waktu}{\b0 2}{\b0 hari }
\fi900 {\b0 setelah}{\b0 pemasangan}{\b0 WSD. }\par
}
Kriteria evaluasi hasil \par
}
. \par
}
Pasien memperlihatkan/ mempertahankan pola pernafasan yang efektif

mengalami perbaiakn pertukaran gas pada paru, meliputi : \par
}
.
\par}{\phpg\posx3242\pvpg\posy12868\absw228\absh984 \sl-414 \f20 \fs21 \cf0 3. \
par
}
Frekuensi, irama, dan kedalaman pernafasan normal
i360 Penurunan nyeri dada/dispneu
i360 Pada pemeriksaan sinar-x, cairan rongg pleura kembali
\par}{\phpg\posx3962\pvpg\posy12868\absw5887\absh1729 \sl-414 \f20 \fs21 \cf0 no
rmal, baik jumlah maupun konsistensinya
i360 Klien menyatakan factor penyebab, jika diketahui dan \par
}
. \par
}
menyatakan cara adaptif mengatasi factor tersebut \par
}
6 \par
}
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\cf0 3. \par
}
engutarakan pentingnya latihan paru setiap hari \par
}
encana Tindakan \par
}
{\phpg\posx2072\pvpg\posy3116\absw368\absh496 \f20 \fs21 \cf0 \f20 \fs21 \cf0 No
\par}{\phpg\posx2072\pvpg\posy3116\absw368\absh496 \sl-285 \f20 \fs21 \cf0 1 \pa
r
}
\cf0 Rencana Tindakan
\par}{\phpg\posx2582\pvpg\posy3116\absw2812\absh496 \sl-285 \f20 \fs21 \cf0 Posi
sikan fowler. \par
}
\par
}
{\phpg\posx2582\pvpg\posy4516\absw3213\absh611 \f20 \fs21 \cf0 \f20 \fs21 \cf0 D
orong atau bantu pasien dalam
\par}{\phpg\posx2582\pvpg\posy4516\absw3213\absh611 \sl-414 \f20 \fs21 \cf0 mela
kukan nafas dalam. \par
}
21 \cf0 Rasional
\par}{\phpg\posx6580\pvpg\posy3116\absw3423\absh2616 \sl-285 \f20 \fs21 \cf0 Dud
uk tinggi memungkinkan
pansi paru dan memudahkan
napasan
\par}{\phpg\posx6580\pvpg\posy3116\absw3423\absh2616 \sl-285 \f20 \fs21 \cf0 Dap
at meningkatkan banyaknya
\par}{\phpg\posx6580\pvpg\posy3116\absw3423\absh2616 \sl-414 \f20 \fs21 \cf0 spu
tum dimana gangguan ventilasi
ditambah ketidaknyamanan
\par}{\phpg\posx6580\pvpg\posy3116\absw3423\absh2616 \sl-414 \f20 \fs21 \cf0 upa
ya bernafas. \par
}
7 \par
}
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800a28a2803fffd9
\cf0 3 \par
}
iapkan untuk bantu pemasangan
\par}{\phpg\posx2582\pvpg\posy1460\absw3271\absh611 \sl-413 \f20 \fs21 \cf0 WSD
\par
}
emudahkan upaya pernafasan
m, dimana dapat lebih
\par}{\phpg\posx6580\pvpg\posy1460\absw3123\absh984 \sl-414 \f20 \fs21 \cf0 memp
ercepat penghisapan \par
}
\par
}
Pantau kepatenan pemasangan dan
\par}{\phpg\posx2582\pvpg\posy2702\absw3918\absh10340 \sl-414 \f20 \fs21 \cf0 ke
efektifan proses drainase dengan
\par}{\phpg\posx2582\pvpg\posy2702\absw3918\absh10340 \sl-414 \f20 \fs21 \cf0 WS
D (Water Seal Drainage),
\par}{\phpg\posx2582\pvpg\posy2702\absw3918\absh10340 \sl-413 \f20 \fs21 \cf0 me
liputi :
i30 1. Observasi klem penghubung klien
i30 dengan system, jika klemnya tidak
i30 terpasang dengan semestinya, maka
i30 pasang kembali (perbaiki posisinya\}
\par}{\phpg\posx2582\pvpg\posy2702\absw3918\absh10340 \sl-413 \f20 \fs21 \cf0 Ob
servasi kebocoran pada system
i30 WSD, jika terjadi :
0 \fi720 {\f0\fs28 \bullet }{\f40 }
Gelembung berkelanjutan
i1080 pada bilik WSD,
i1080 menandakan kebocoran
i1080 antara klien dan water seal,
i1080 maka kencangkan
i1080 sambungan yang kendur
i1080 antara klien dengan water

i1080 seal
0 \fi720 {\f0\fs28 \bullet }{\f40 }
Gelembung berkelanjutan
i1080 dan belum dapat teratas
i1080 menandakan bahwa
i1080 kebocoran tidak berpusat
i1080 pada klien, maka ganti
i1080 system drainase (kolaborasi
i1080 dengan dokter)
Pastikan plester terpasang dan
nghubungkan antara dada dan
lang drinase dengan tepat \par
}
{\phpg\posx6580\pvpg\posy4358\absw3645\absh984 \f20 \fs21 \cf0 \f20 \fs21 \cf0 Klem berfungsi untuk mengisolasi
\par}{\phpg\posx6580\pvpg\posy4358\absw3645\absh984 \sl-413 \f20 \fs21 \cf0 syst
em agar tidak ada udara yang
\par}{\phpg\posx6580\pvpg\posy4358\absw3645\absh984 \sl-414 \f20 \fs21 \cf0 masu
k ke dalam sistem \par
}
{\phpg\posx6580\pvpg\posy6842\absw3063\absh984 \f20 \fs21 \cf0 \f20 \fs21 \cf0 Sambungan yang kendor
\par}{\phpg\posx6580\pvpg\posy6842\absw3063\absh984 \sl-413 \f20 \fs21 \cf0 meny
ebabkan udara memasuki
\par}{\phpg\posx6580\pvpg\posy6842\absw3063\absh984 \sl-413 \f20 \fs21 \cf0 sist
em \par
}
- Gelembung berlanjut sebagai
\par}{\phpg\posx6580\pvpg\posy10154\absw3273\absh1356 \sl-414 \f20 \fs21 \cf0 fi
ksasi dan mengamankan selang
tapi pada WSD dan plester
nghubung \par
}
-Plester berfungsi sebagai fiksasi
\par}{\phpg\posx6580\pvpg\posy13052\absw3395\absh1356 \sl-414 \f20 \fs21 \cf0 da
n mengamankan selang dada ke
\par}{\phpg\posx6580\pvpg\posy13052\absw3395\absh1356 \sl-414 \f20 \fs21 \cf0 si
stem memungkinkan udara yang
rtahan keluar ke atmosfir \par
}
8 \par
}
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\cf0 4. Pastikan patensi ventilasi udara pada
- Memberikan factor keamanan \
par
}
sistem :
\par}{\phpg\posx2582\pvpg\posy1874\absw3620\absh1729 \sl-414 \f20 \fs21 \cf0 a.
Ventilasi harus bebas sumbatan
\par}{\phpg\posx2582\pvpg\posy1874\absw3620\absh1729 \sl-413 \f20 \fs21 \cf0 b.
Ventilasi bilik control penghisap
\par}{\phpg\posx2582\pvpg\posy1874\absw3620\absh1729 \sl-414 \f20 \fs21 \cf0 har
us tanpa sumbatan, saat memakai

ghisap \par
}
danya tekanan negatif berlebihan
\par}{\phpg\posx6580\pvpg\posy1874\absw3395\absh611 \sl-414 \f20 \fs21 \cf0 ke d
alam atmosfir \par
}
. Pantau posisi selang agar tetap
\par}{\phpg\posx2582\pvpg\posy4358\absw3574\absh984 \sl-413 \f20 \fs21 \cf0 meng
gantung dalam garis lurus dari
\par}{\phpg\posx2582\pvpg\posy4358\absw3574\absh984 \sl-414 \f20 \fs21 \cf0 atas
tempat tidur ke bilik drainase \par
}
{\phpg\posx6580\pvpg\posy4358\absw2476\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 Meningkatkan drainase \par
}
6. Pantau selang dada, bila pengkajian
\par}{\phpg\posx2582\pvpg\posy6014\absw3783\absh2102 \sl-414 \f20 \fs21 \cf0 kep
erawatan menandakan obstruksi
a drainase sekunder terhadap
\par}{\phpg\posx2582\pvpg\posy6014\absw3783\absh2102 \sl-413 \f20 \fs21 \cf0 bek
uan atau debris pada selan, maka
\par}{\phpg\posx2582\pvpg\posy6014\absw3783\absh2102 \sl-413 \f20 \fs21 \cf0 lak
ukan pemencetan atau urut selang
\par}{\phpg\posx2582\pvpg\posy6014\absw3783\absh2102 \sl-413 \f20 \fs21 \cf0 dad
a tersebut \par
}
- Pemijatan menimbulkan tingkat
\par}{\phpg\posx6580\pvpg\posy6014\absw3427\absh1729 \sl-414 \f20 \fs21 \cf0 tek
anan negatif tinggi dan
punyai potensi penarikan
\par}{\phpg\posx6580\pvpg\posy6014\absw3427\absh1729 \sl-413 \f20 \fs21 \cf0 jar
ingan paru atau pleura ke dalam
\par}{\phpg\posx6580\pvpg\posy6014\absw3427\absh1729 \sl-413 \f20 \fs21 \cf0 lub
ang drainase selang dada \par
}
. Pastikan posisi botol WSD terletak
\par}{\phpg\posx2582\pvpg\posy8912\absw3843\absh984 \sl-413 \f20 \fs21 \cf0 di b
awah tempat tidur klien (posisi
\par}{\phpg\posx2582\pvpg\posy8912\absw3843\absh984 \sl-413 \f20 \fs21 \cf0 lebi
h rendah dari paru klien) \par
}
- Mempermudah drainase dan
pertahankan tekanan negatif
mempunyai potensi penarikan
\par}{\phpg\posx6580\pvpg\posy8912\absw3424\absh1729 \sl-413 \f20 \fs21 \cf0 jar
ingan atau pleura ke dalam
\par}{\phpg\posx6580\pvpg\posy8912\absw3424\absh1729 \sl-414 \f20 \fs21 \cf0 lub
ang drainase selang dada \par
}
8. Pastikan drainase berjalan dengan
\par}{\phpg\posx2582\pvpg\posy10982\absw3652\absh611 \sl-414 \f20 \fs21 \cf0 sem
estinya \par
}
6 \par
}
Pertahankan tirah baring untuk
gambil posisii yang nyaman \par
}
Memberikan rasa nyaman pada
en \par
}
Pastikan pada individu bahwa tindakan
Melakukan pelatihan pernafasan
\par}{\phpg\posx2582\pvpg\posy14236\absw7288\absh984 \sl-414 \f20 \fs21 \cf0 lat
ihan pernafasan dilakukan untuk
jamin keamanan \par
}
9 \par
}
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a28a2800a28a2803ffd9
\cf0 7 \par
}
\par
}
Jelaskan alasan, demonstrasikan, dan
\par}{\phpg\posx2582\pvpg\posy1460\absw3708\absh2359 \sl-413 \f20 \fs21 \cf0 ins
truksikan klien untuk batuk saat
pirasi
Bantu dan ajarkan klien untuk :
\par}{\phpg\posx2582\pvpg\posy1460\absw3708\absh2359 \sl-413 \f20 \fs21 \cf0 -Be
rbalik, batuk dan nafas setiap 2-4
\par}{\phpg\posx2582\pvpg\posy1460\absw3708\absh2359 \sl-414 \f20 \fs21 \cf0 jam
\par
}
Batuk saat ekspirasi mencegah
ingkatan tekanan.pleura,
ingga drainase dapat berjalan
gan lancer
- Melatih pernafasan klien \par
}
{\phpg\posx2582\pvpg\posy4644\absw3469\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 Memberikan spirometer insentif \par
}
\cf0 - Memberikan oksigenasi yang
\par}{\phpg\posx6580\pvpg\posy4644\absw3168\absh611 \sl-414 \f20 \fs21 \cf0 yang
adekuat \par
}
{\phpg\posx2582\pvpg\posy5886\absw2462\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 Bebat dada ketika batuk \par
}
\par
}
\par
}
1 \par
}
- Lakukan latihan rentang gerak pasif
a semua ekstremitas klien setiap 2\par}{\phpg\posx2582\pvpg\posy7128\absw3922\absh3992 \sl-413 \f20 \fs21 \cf0 4 j
am
\par}{\phpg\posx2582\pvpg\posy7128\absw3922\absh3992 \sl-286 \f20 \fs21 \cf0 Ber
ikan obat-obatan sesuai pesanan
pastikan bahwa klien
inumnya
\par}{\phpg\posx2582\pvpg\posy7128\absw3922\absh3992 \sl-286 \f20 \fs21 \cf0 Tin
gkatkan aktivitas sesuai toleransi,
\par}{\phpg\posx2582\pvpg\posy7128\absw3922\absh3992 \sl-413 \f20 \fs21 \cf0 jel
askan bahwa fungsi pernafasan akan
ingkat dan dispneu akan menurun
gan melakukan latihan
Pantau TD, S, N, dan P setiap 4jam \par
}
- Mengurangi guncangan pada
\par}{\phpg\posx6580\pvpg\posy5886\absw3665\absh5482 \sl-414 \f20 \fs21 \cf0 ron
gga pleurayang dapat
gakibatkan nyeri
\par}{\phpg\posx6580\pvpg\posy5886\absw3665\absh5482 \sl-414 \f20 \fs21 \cf0 - M
engurangi kekakuan pada sendi
\par}{\phpg\posx6580\pvpg\posy5886\absw3665\absh5482 \sl-413 \f20 \fs21 \cf0 ger
ak akibat tirah baring
Mencegah terjadinya salah memberi
\par}{\phpg\posx6580\pvpg\posy5886\absw3665\absh5482 \sl-413 \f20 \fs21 \cf0 oba
t dan mempercepat proses
yembuhan
gurangi intoleransi aktivitas
a klien mengurangi ansietas pada
\par}{\phpg\posx6580\pvpg\posy5886\absw3665\absh5482 \sl-413 \f20 \fs21 \cf0 saa
t latihan dan memberi motivasi
a klien untuk melakukan latihan
nafasan
\par}{\phpg\posx6580\pvpg\posy5886\absw3665\absh5482 \sl-286 \f20 \fs21 \cf0 Unt
uk mengetahui perkembangan
en setiap 4 jam \par
}
. \par
}
Ansietas berhubungan dengan kurang pengetahuan tentang tindakan medis \par
}
pemasangan. WSD ditandai dengan palpitasi , gemetar, gelisah, gugup,
\par}{\phpg\posx2342\pvpg\posy12826\absw7063\absh611 \sl-414 \f20 \fs21 \cf0 kat
akutan, terkejut. \par
}
Tujuan :
\par}{\phpg\posx2342\pvpg\posy14068\absw7870\absh984 \sl-413 \f20 \fs21 \cf0 Ind
ividu akan mengetahui penyebab ansietasnya dan mampu menunjukkan pola
\par}{\phpg\posx2342\pvpg\posy14068\absw7870\absh984 \sl-414 \f20 \fs21 \cf0 kop
ing yang baik, maupun saat tindakan medis dilakukan. \par
}
0 \par
}
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\cf0 Kriteria evaluasi hasil : \par
}
\par}{\phpg\posx2702\pvpg\posy1864\absw228\absh611 \sl-414 \f20 \fs21 \cf0 2. \p
ar
}
lien mengatakan bahwa ia mengetahui penyebab ansietasnya
\par}{\phpg\posx3242\pvpg\posy1864\absw6190\absh611 \sl-414 \f20 \fs21 \cf0 Klie
n mengatakan bahwa ia menyadari pantingnya atau alasan \par
}
tindakan tersebut dilakukan
Palpitasi, gemetar, gelisah, gugup, terkejut, ketakutan menurun atau
\par}{\phpg\posx2702\pvpg\posy2692\absw7363\absh1729 \sl-414 \f20 \fs21 \cf0 tid
ak ada pada saat pra, pasca, dan waktu tindakan medis dilakukan
Klien mengungkapkan apa yang diharapkannya atau optimisme
hadap tindakan tersebut \par
}
encana tindakan : \par
}
\par
}
\par
}
\par
}
\par
}
1 \cf0 Rencana Tindakan
\par}{\phpg\posx3526\pvpg\posy6014\absw3367\absh8090 \sl-286 \f20 \fs21 \cf0 Seb
elum melakukan tindakan
\par}{\phpg\posx3526\pvpg\posy6014\absw3367\absh8090 \sl-413 \f20 \fs21 \cf0 jel
askan terlebih dulu mengenai :
\par}{\phpg\posx3526\pvpg\posy6014\absw3367\absh8090 \sl-414 \f20 \fs21 \cf0 - J
enis tindakan yang akan
\par}{\phpg\posx3526\pvpg\posy6014\absw3367\absh8090 \sl-413 \f20 \fs21 \cf0 dil
akukan
\par}{\phpg\posx3526\pvpg\posy6014\absw3367\absh8090 \sl-413 \f20 \fs21 \cf0 - A
lasan dan hasil tindakan yang
\par}{\phpg\posx3526\pvpg\posy6014\absw3367\absh8090 \sl-413 \f20 \fs21 \cf0 dih
arapkan
\par}{\phpg\posx3526\pvpg\posy6014\absw3367\absh8090 \sl-413 \f20 \fs21 \cf0 -Re
siko yang akan terjadi
\par}{\phpg\posx3526\pvpg\posy6014\absw3367\absh8090 \sl-414 \f20 \fs21 \cf0 Jen
is anesthesia
kiraan lama tindakan,
asangan, pencabutan, dan
ulihan
\par}{\phpg\posx3526\pvpg\posy6014\absw3367\absh8090 \sl-413 \f20 \fs21 \cf0 Keb
utuhan partisipasi dalam
\par}{\phpg\posx3526\pvpg\posy6014\absw3367\absh8090 \sl-414 \f20 \fs21 \cf0 keg
iatan, peralatan, lingkungan,
\par}{\phpg\posx3526\pvpg\posy6014\absw3367\absh8090 \sl-413 \f20 \fs21 \cf0 pet
ugas, sensasi pasca operasi
\par}{\phpg\posx3526\pvpg\posy6014\absw3367\absh8090 \sl-286 \f20 \fs21 \cf0 Jik
a terjadi ansietas ringan ulangi
\par}{\phpg\posx3526\pvpg\posy6014\absw3367\absh8090 \sl-413 \f20 \fs21 \cf0 kem
bali penjelasan awal
Jika ansietas sedang, Bantu klien
\par}{\phpg\posx3526\pvpg\posy6014\absw3367\absh8090 \sl-414 \f20 \fs21 \cf0 unt
uk mengungkapkan pengertian
alsan ansietas. Bantu unutk
ilai kembali adanya ancaman
belajar cara baru untuk \par
}
21 \cf0 Rasional
\par}{\phpg\posx7126\pvpg\posy6014\absw3304\absh1986 \sl-286 \f20 \fs21 \cf0 Pen
jelasan lebih awal dapat
urunkan atau menghilangkan
\par}{\phpg\posx7126\pvpg\posy6014\absw3304\absh1986 \sl-414 \f20 \fs21 \cf0 ans
ietas klien. Klien mengetahui
ses dan tujuan, tindakan
sebut dilakukan \par

}
Penjelasan dapat menenangkan
\par}{\phpg\posx7126\pvpg\posy11968\absw3259\absh1986 \sl-413 \f20 \fs21 \cf0 kl
ien dan meminimalisir atau
ngeliminasi ansietas tersebut
\par}{\phpg\posx7126\pvpg\posy11968\absw3259\absh1986 \sl-285 \f20 \fs21 \cf0 Pa
da tingkat ini, perlu usaha
mbahan atau bantuan untuk
mahami ansietas yang terjadi \par
}
1 \par
}
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a2803fffd9
\cf0 4 \par
}
engatasinya
\par}{\phpg\posx3526\pvpg\posy1460\absw3097\absh869 \sl-285 \f20 \fs21 \cf0 Jika
terjadi ansietas berat, beri
\par}{\phpg\posx3526\pvpg\posy1460\absw3097\absh869 \sl-414 \f20 \fs21 \cf0 tahu
dokter \par
}
\par
}
Beri informasi di samping tempat
ur mengenai sensai serta
\par}{\phpg\posx3526\pvpg\posy3274\absw3407\absh2102 \sl-413 \f20 \fs21 \cf0 gam
baran (menggunakan selang)
jelaskan bahwa klien dan
\par}{\phpg\posx3526\pvpg\posy3274\absw3407\absh2102 \sl-414 \f20 \fs21 \cf0 kel
uarganya dapat menghadapinya
a pasca operasi \par
}
Pada tingkat ini persepsi sangat
urun, tidak dapat
konsentrasi, tindakan
\par}{\phpg\posx7126\pvpg\posy1746\absw3335\absh3477 \sl-414 \f20 \fs21 \cf0 kol
aboratif diperlukan
\par}{\phpg\posx7126\pvpg\posy1746\absw3335\absh3477 \sl-285 \f20 \fs21 \cf0 Inf
ormasi dapat membantu klien
uk mengetahui gambaran
\par}{\phpg\posx7126\pvpg\posy1746\absw3335\absh3477 \sl-413 \f20 \fs21 \cf0 tin
dakan yang akan dilakukan.
\par}{\phpg\posx7126\pvpg\posy1746\absw3335\absh3477 \sl-414 \f20 \fs21 \cf0 Key
akinan dapat membantu klien
ik lebuh siap menghadapi
\par}{\phpg\posx7126\pvpg\posy1746\absw3335\absh3477 \sl-413 \f20 \fs21 \cf0 tin
dakan \par
}
\par
}
Jelaskan pentingnya penyluhan
demonstrasi serta instruksikan
en untuk mengulangi
\par}{\phpg\posx3526\pvpg\posy6172\absw3496\absh2847 \sl-413 \f20 \fs21 \cf0 dem
onstrasi
\par}{\phpg\posx3526\pvpg\posy6172\absw3496\absh2847 \sl-414 \f20 \fs21 \cf0 - L
atihan aktivitas, dan cara
\par}{\phpg\posx3526\pvpg\posy6172\absw3496\absh2847 \sl-413 \f20 \fs21 \cf0 lat
ihan rentang gerak pasif
\par}{\phpg\posx3526\pvpg\posy6172\absw3496\absh2847 \sl-413 \f20 \fs21 \cf0 - D
uduk, bangun, dan ambulasi
\par}{\phpg\posx3526\pvpg\posy6172\absw3496\absh2847 \sl-413 \f20 \fs21 \cf0 - P
entingnya perawatan diri \par
}
Penyuluhan, demonstrasi
dorong atau membantu klien
uk melaksanakan latihan pasca
\par}{\phpg\posx7126\pvpg\posy6172\absw3531\absh2102 \sl-413 \f20 \fs21 \cf0 ope
rasi untuk mempercepat
ulihan dan meminimalisir efek
nnya yang tidak diharapkan \par
}
2 \par
}
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00ffd9
\cf0 3. Nyeri berhubungan dengan inflamasi sekunder terhadap efusi pleura dit
andai
60 dengan klien mengeluh nyeri, wajah tampak menahan nyeri, menangis dan
60 merintih \par
}
Tujuan :
\par}{\phpg\posx2342\pvpg\posy3520\absw7977\absh2102 \sl-413 \f20 \fs21 \cf0 Nye
ri teratasi seiring dengan berkurangnya akumulasi cairan pleura
\par}{\phpg\posx2342\pvpg\posy3520\absw7977\absh2102 \sl-414 \f20 \fs21 \cf0 Kri
teria evaluasi hasil :
Klien mengetahui penyebab nyeri
klien menyatakan nyeri yang dirasakannya berkurang atau hilang
Klien tidak lagi menunjukkan wajah menahan nyeri, menangis, dan merintih \par
}
}
3 \par
}
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ffd9
\cf0 No
r
}
\par
}
\par
}
\par
}
\par
}
21 \cf0 Rencana Tindakan
\par}{\phpg\posx2920\pvpg\posy1974\absw3543\absh11586 \sl-286 \f20 \fs21 \cf0 Ba
ntu klien untuk menetukan
nyebab nyeri dan tentukan
\par}{\phpg\posx2920\pvpg\posy1974\absw3543\absh11586 \sl-414 \f20 \fs21 \cf0 ti
ngkatannya, diukur dengan skala
\par}{\phpg\posx2920\pvpg\posy1974\absw3543\absh11586 \sl-413 \f20 \fs21 \cf0 ny
eri dan rentang 0-10
rikan analgesic pada penurunan
\par}{\phpg\posx2920\pvpg\posy1974\absw3543\absh11586 \sl-413 \f20 \fs21 \cf0 ra
sa nyeri yang optimal :
\par}{\phpg\posx2920\pvpg\posy1974\absw3543\absh11586 \sl-414 \f20 \fs21 \cf0 Lihat advice dokter
\par}{\phpg\posx2920\pvpg\posy1974\absw3543\absh11586 \sl-414 \f20 \fs21 \cf0 Jelaskan rute yang digunakan per\par}{\phpg\posx2920\pvpg\posy1974\absw3543\absh11586 \sl-413 \f20 \fs21 \cf0 or
al, inhalasi, IM, atau IV
\par}{\phpg\posx2920\pvpg\posy1974\absw3543\absh11586 \sl-414 \f20 \fs21 \cf0 Konsultasikan dengan apoteker
ngenai kemungkinan reaksi
mbahan akibat interaksi denga
\par}{\phpg\posx2920\pvpg\posy1974\absw3543\absh11586 \sl-413 \f20 \fs21 \cf0 no
bat lain
\par}{\phpg\posx2920\pvpg\posy1974\absw3543\absh11586 \sl-286 \f20 \fs21 \cf0 Ku
rangi ayau turunkan efek

\par}{\phpg\posx2920\pvpg\posy1974\absw3543\absh11586 \sl-413 \f20 \fs21 \cf0 sa
mping umum dari narkotik, jika
gunakan jelaskan bahwa narkotik
\par}{\phpg\posx2920\pvpg\posy1974\absw3543\absh11586 \sl-414 \f20 \fs21 \cf0 bi
sa menyebabkan konstipasi,
dasi, adiksi, mual- muntah, dan
\par}{\phpg\posx2920\pvpg\posy1974\absw3543\absh11586 \sl-413 \f20 \fs21 \cf0 mu
lut kering
\par}{\phpg\posx2920\pvpg\posy1974\absw3543\absh11586 \sl-286 \f20 \fs21 \cf0 Ko
laborasi dengan klien untuk
lakukan tindakan pengurangan
\par}{\phpg\posx2920\pvpg\posy1974\absw3543\absh11586 \sl-414 \f20 \fs21 \cf0 ny
eri noninvasive :
\par}{\phpg\posx2920\pvpg\posy1974\absw3543\absh11586 \sl-413 \f20 \fs21 \cf0 Aj
arkan dan instruksikan
nggunaan tehnik relaksasi (nafas
\par}{\phpg\posx2920\pvpg\posy1974\absw3543\absh11586 \sl-413 \f20 \fs21 \cf0 be
rirama, lambat, dan dalam),
straksi dan masase
ri informasi akurat untuk
nurunkan rasa nyeri mengenai
nyebab nyeri dari kemungkinan
pan nyeri akan hilang serta
\par}{\phpg\posx2920\pvpg\posy1974\absw3543\absh11586 \sl-414 \f20 \fs21 \cf0 ya
kinkan klien bahwa ia mampu
ngatasi rasa nyeri \par
}
21 \cf0 Rasional
dakan yang dapat dilakukan jika
yebab dan tingkatan nyeri telah
\par}{\phpg\posx6686\pvpg\posy1974\absw3905\absh2616 \sl-414 \f20 \fs21 \cf0 dik
etahui
Analgesik dapat menurunkan atau
ghilangkan sensasi nyeri dan harus
\par}{\phpg\posx6686\pvpg\posy1974\absw3905\absh2616 \sl-414 \f20 \fs21 \cf0 dil
akukan secara kolaboratif \par
}
arkotik dapat menyebabkan adiksi dan
\par}{\phpg\posx6686\pvpg\posy7386\absw3980\absh611 \sl-413 \f20 \fs21 \cf0 efek
samping lain yang membahayakan \par
}
olaborasi dapat mempermudah
\par}{\phpg\posx6686\pvpg\posy9742\absw4160\absh984 \sl-413 \f20 \fs21 \cf0 pela

ksanaan tindakan dan tehnik relaksasi
\par}{\phpg\posx6686\pvpg\posy9742\absw4160\absh984 \sl-414 \f20 \fs21 \cf0 mamp
u mengurangi sensasi nyeri \par
}
Informasi dan dukungan keyakinan dapat
enangkan klien sehingga sensai nyeri
ak terlalu dirasakan \par
}
4 \par
}
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\cf0 4. Gangguan pola tidur berhubungan dengan sering terbangun sekunder terh
adap
60 gangguan pernafasan ditandai dengan kesulitan untuk jatuh tertidur \par
}
{\phpg\posx2162\pvpg\posy2692\absw7561\absh984 \f20 \fs21 \cf0 \f20 \fs21 \cf0 T
ujuan :
\par}{\phpg\posx2162\pvpg\posy2692\absw7561\absh984 \sl-414 \f20 \fs21 \cf0 Memp
erbaiaki pola tidur klien hingga kembali teratur tanpa terganggu oleh
\par}{\phpg\posx2162\pvpg\posy2692\absw7561\absh984 \sl-414 \f20 \fs21 \cf0 kond
isi terapinya \par
}
Kriteria hasil evaluasi :
Klien mengetahui dan mengerti factor-faktor yang menghambat untuk tertidur
Klien mengetahui dan menerapkan teknik-teknik untuk mempermudah tidur
Klien segera tertidur dalam waktu kuran dari 30 menit \par
}
}
r
}
2
3
4 \par
}
1 \cf0 Rencana tindakan
\par}{\phpg\posx2426\pvpg\posy7256\absw3682\absh7230 \sl-286 \f20 \fs21 \cf0 - K
urangi atau hilangkan distraksi
\par}{\phpg\posx2426\pvpg\posy7256\absw3682\absh7230 \sl-413 \f20 \fs21 \cf0 lin
gkungan seperti kebisingan dan
\par}{\phpg\posx2426\pvpg\posy7256\absw3682\absh7230 \sl-413 \f20 \fs21 \cf0 sti
mulus yaitu : tutp pintu ruangan,
\par}{\phpg\posx2426\pvpg\posy7256\absw3682\absh7230 \sl-413 \f20 \fs21 \cf0 gor

den atau tirai, lepaskan hubungan
\par}{\phpg\posx2426\pvpg\posy7256\absw3682\absh7230 \sl-414 \f20 \fs21 \cf0 tel
epon, kurangi stimulus (seperti
bicaraan staf), hindari prosedur
g tidak penting selama klien
tidur, batasi pengunjung
\par}{\phpg\posx2426\pvpg\posy7256\absw3682\absh7230 \sl-413 \f20 \fs21 \cf0 - T
utup kebisingan lingkungan
gan kebisingan putih misalnya
\par}{\phpg\posx2426\pvpg\posy7256\absw3682\absh7230 \sl-413 \f20 \fs21 \cf0 kip
as angin, musik lembut, rekaman
\par}{\phpg\posx2426\pvpg\posy7256\absw3682\absh7230 \sl-414 \f20 \fs21 \cf0 huj
an
Beri posisi fowler pada klien
Relaksasi atau latihan nafas sebelum
ur
\par}{\phpg\posx2426\pvpg\posy7256\absw3682\absh7230 \sl-285 \f20 \fs21 \cf0 Lak
ukan ritual sebelum tidur (bagi
g terbiasa) :
\par}{\phpg\posx2426\pvpg\posy7256\absw3682\absh7230 \sl-413 \f20 \fs21 \cf0 - M
andi air hangat \par
}
1 \cf0 Rasional
\par}{\phpg\posx6200\pvpg\posy7256\absw3727\absh869 \sl-286 \f20 \fs21 \cf0 Kebi
singan dan stimulus dapat
\par}{\phpg\posx6200\pvpg\posy7256\absw3727\absh869 \sl-413 \f20 \fs21 \cf0 meng
ganggu istirahat atau tidur klien \par
}
Posisi fowler mempermudah drainase
\par}{\phpg\posx6200\pvpg\posy12796\absw3847\absh1871 \sl-414 \f20 \fs21 \cf0 pl
eura
\par}{\phpg\posx6200\pvpg\posy12796\absw3847\absh1871 \sl-285 \f20 \fs21 \cf0 Re
laksasi mempermudah untuk tidur
0 Ritual sebelum tidur dapat membantu
\par}{\phpg\posx6200\pvpg\posy12796\absw3847\absh1871 \sl-414 \f20 \fs21 \cf0 kl
ien untuk cepat tidur \par
}
5 \par
}
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\cf0 5 \par
}
\par
}
\par
}

\par
}
- Makan makanan kecil sebelum
ur
\par}{\phpg\posx2426\pvpg\posy1460\absw3667\absh9093 \sl-414 \f20 \fs21 \cf0 - b
erdoa
\par}{\phpg\posx2426\pvpg\posy1460\absw3667\absh9093 \sl-413 \f20 \fs21 \cf0 - m
embaca
\par}{\phpg\posx2426\pvpg\posy1460\absw3667\absh9093 \sl-414 \f20 \fs21 \cf0 - d
ipijat
\par}{\phpg\posx2426\pvpg\posy1460\absw3667\absh9093 \sl-414 \f20 \fs21 \cf0 - m
inum susu hangat
\par}{\phpg\posx2426\pvpg\posy1460\absw3667\absh9093 \sl-413 \f20 \fs21 \cf0 - b
unyikan musik yang lembut
Batasi jumlah dan lamanya tidur
\par}{\phpg\posx2426\pvpg\posy1460\absw3667\absh9093 \sl-414 \f20 \fs21 \cf0 sia
ng jika berlebihan (lebih dari 90
it)
gkatkan aktivitas sehari-hari jika
ungkinkan : buat bersama klien
\par}{\phpg\posx2426\pvpg\posy1460\absw3667\absh9093 \sl-414 \f20 \fs21 \cf0 jad
wal program aktivitas sehari-hari
\par}{\phpg\posx2426\pvpg\posy1460\absw3667\absh9093 \sl-413 \f20 \fs21 \cf0 - A
jarkan pentingnya latihan regular
\par}{\phpg\posx2426\pvpg\posy1460\absw3667\absh9093 \sl-413 \f20 \fs21 \cf0 sep
erti berpindah
\par}{\phpg\posx2426\pvpg\posy1460\absw3667\absh9093 \sl-286 \f20 \fs21 \cf0 Kur
angi potensi terhadap cedera
ika tidur :
\par}{\phpg\posx2426\pvpg\posy1460\absw3667\absh9093 \sl-414 \f20 \fs21 \cf0 -Gu
nakan pagar tempat tidur jika
lu
\par}{\phpg\posx2426\pvpg\posy1460\absw3667\absh9093 \sl-413 \f20 \fs21 \cf0 - t
empatkan tempat tidur pada posisi
g rendah
\par}{\phpg\posx2426\pvpg\posy1460\absw3667\absh9093 \sl-413 \f20 \fs21 \cf0 - B
erikan pengawasan yang cukup
\par}{\phpg\posx2426\pvpg\posy1460\absw3667\absh9093 \sl-414 \f20 \fs21 \cf0 - t
empatkan bel pada tempat yang
dah
\par}{\phpg\posx2426\pvpg\posy1460\absw3667\absh9093 \sl-286 \f20 \fs21 \cf0 Ber
ikan sedative atau hipnotik \par
}
Tidur siang yang lebih dari 90 menit
\par}{\phpg\posx6200\pvpg\posy4644\absw3904\absh1986 \sl-414 \f20 \fs21 \cf0 dap
at menurunkan stimulus untuk tidur
g lama pada malam hari
\par}{\phpg\posx6200\pvpg\posy4644\absw3904\absh1986 \sl-286 \f20 \fs21 \cf0 Akt

ivitas berupa latihan dapat
urunkan stress dan memudahkan
tidur \par
}
encegahan dapat menghindarkan klien
\par}{\phpg\posx6200\pvpg\posy7700\absw3950\absh984 \sl-413 \f20 \fs21 \cf0 dari
cidera yang memperparah kondisi
\par}{\phpg\posx6200\pvpg\posy7700\absw3950\absh984 \sl-414 \f20 \fs21 \cf0 klie
n \par
}
Sedative atau hipnotik dapat membuat \par
}
dalam dosis seminimal mungkin jika
klien mudah tertidur
\par}{\phpg\posx2426\pvpg\posy11712\absw5995\absh611 \sl-414 \f20 \fs21 \cf0 dip
erlukan (konsul dengan dokter) \par
}
Jelaskan obat-obat hipnotik atau
\par}{\phpg\posx2426\pvpg\posy12412\absw3245\absh984 \sl-414 \f20 \fs21 \cf0 sed
ative tidak boleh digunakan
am jangka waktu yang lama \par
}
Sedative atau hipnotik dapat
yebabkan adiksi bila digunakan
am jangka waktu yang lama \par
}
\par
}
Rencana Tindakan Post Tindakan
720 1.
Nyeri berhubungan dengan truma jaringan sekunder terhadap
720 pemasangan WSD \par
}
6 \par
}
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1 \cf0 Tujuan: Menghilangkan nyeri akibat pemasangan WSD
teria hasil evaluasi:
1080 a.
Pasien menyatakan nyeri hilang atau terkontrol
1080 b. Menunjukkan rileks, istirahat/tidur, dan peningkatan aktivitas
1440 dengan tepat \par
}
encana Tindakan \par
}
\par}{\phpg\posx2086\pvpg\posy5186\absw384\absh869 \sl-350 \par\f20 \fs21 \cf0 1
. \par
}
1 \cf0 Tindakan/Intervensi
\par}{\phpg\posx2626\pvpg\posy5186\absw3332\absh869 \sl-285 \f20 \fs21 \cf0 {\b
Mandiri }
\par}{\phpg\posx2626\pvpg\posy5186\absw3332\absh869 \sl-414 \f20 \fs21 \cf0 Pant
au tanda vital \par
}
\par
}
Berikan tindakan nyaman misalnya pijatan
\par}{\phpg\posx2626\pvpg\posy8656\absw4295\absh1356 \sl-413 \f20 \fs21 \cf0 pun
ggung, perubahan posisi, musik
\par}{\phpg\posx2626\pvpg\posy8656\absw4295\absh1356 \sl-413 \f20 \fs21 \cf0 ten
ang/perbincangan, relaksasi atau latihan
\par}{\phpg\posx2626\pvpg\posy8656\absw4295\absh1356 \sl-414 \f20 \fs21 \cf0 nap
as \par
}
. \par
}
\cf0 Kolaborasi
{\b0 Berikan}{\b0 anlgesik}{\b0 dan}{\b0 antitusif}{\b0 sesuai}{\b0 terapi
}\par
}
1 \cf0 Rasional
Perubahan frekuensi
\par}{\phpg\posx7480\pvpg\posy5186\absw2686\absh7718 \sl-414 \f20 \fs21 \cf0 jan
tung atau TD
unjukkan bahwa
\par}{\phpg\posx7480\pvpg\posy5186\absw2686\absh7718 \sl-414 \f20 \fs21 \cf0 pas
ien mengalami nyeri
\par}{\phpg\posx7480\pvpg\posy5186\absw2686\absh7718 \sl-413 \f20 \fs21 \cf0 khu
susnya bila alasan lain
uk perubahan tanda
\par}{\phpg\posx7480\pvpg\posy5186\absw2686\absh7718 \sl-413 \f20 \fs21 \cf0 vit
al telah terlihat
dakan non analgesik
\par}{\phpg\posx7480\pvpg\posy5186\absw2686\absh7718 \sl-413 \f20 \fs21 \cf0 dib
erikan dengan sentuhan
\par}{\phpg\posx7480\pvpg\posy5186\absw2686\absh7718 \sl-413 \f20 \fs21 \cf0 lem
but dapat
ghilangkan
idaknyamanan dan
perbesar efek terapi
\par}{\phpg\posx7480\pvpg\posy5186\absw2686\absh7718 \sl-414 \f20 \fs21 \cf0 ana
lgesik
Obat ini dapat digunakan
uk menekan batuk non\par}{\phpg\posx7480\pvpg\posy5186\absw2686\absh7718 \sl-414 \f20 \fs21 \cf0 pro
duktif dan untuk
ingkatkan kenyamanan
\par}{\phpg\posx7480\pvpg\posy5186\absw2686\absh7718 \sl-414 \f20 \fs21 \cf0 ist

irahat. \par
}
. \par
}
Resiko terhadap infeksi berhubungan dengan truma jaringan sekunder \par
}
terhadap pemasangan WSD \par
}
7 \par
}
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1 \cf0 Tujuan: Mengurangi faktor infeksi yang berhubungan dengan truma jaringan
720 sekunder terhadap pemasangan WSD

teria Hasil: Mengidentifikasi intervensi untuk mencegah atau menurunkan
1440 risiko infeksi. \par
}
Rencana Tindakan
\fi318 No
931 {\b Mandiri }\par
}
\par}{\phpg\posx2014\pvpg\posy4952\absw228\absh869 \sl-350 \par\f20 \fs21 \cf0 2
. \par
}
\par
}
1 \cf0 Tindakan/Intervensi
Awasi suhu.
Kaji pentingya latihan napas, batuk
\par}{\phpg\posx2734\pvpg\posy4252\absw3905\absh2874 \sl-414 \f20 \fs21 \cf0 efe
ktif, perubahan posisi, dan masukan
ran adekuat.
Observasi warna. \par
}
\par
}
{\phpg\posx2734\pvpg\posy8294\absw3830\absh611 \f20 \fs21 \cf0 \f20 \fs21 \cf0 D
orong keseimbangan antara aktivitas
istirahat. \par
}
. \par
}
. \par
}
Diskusi kebutuhan masukan nutrisi
\par}{\phpg\posx2734\pvpg\posy10236\absw3513\absh1614 \sl-414 \f20 \fs21 \cf0 ad
ekuat.
0 {\b Kolaborasi }
\par}{\phpg\posx2734\pvpg\posy10236\absw3513\absh1614 \sl-413 \f20 \fs21 \cf0 Da
patkan spesimen sputum dengan \par
}
21 \cf0 Rasional
Demam dapat terjadi karena

eksi.
\par}{\phpg\posx6802\pvpg\posy4252\absw3440\absh6999 \sl-285 \f20 \fs21 \cf0 Akt
ivitas ini meningkatkan
\par}{\phpg\posx6802\pvpg\posy4252\absw3440\absh6999 \sl-414 \f20 \fs21 \cf0 mob
ilisasi dan pengeluaran sekret
uk menurunkan resiko
jadinya infeksi paru.
\par}{\phpg\posx6802\pvpg\posy4252\absw3440\absh6999 \sl-286 \f20 \fs21 \cf0 Sek
ret berbau, kuning atau
\par}{\phpg\posx6802\pvpg\posy4252\absw3440\absh6999 \sl-413 \f20 \fs21 \cf0 keh
ijauan menunjukkan adanya
eksi paru.
urunkan konsumsi/kebutuhan
\par}{\phpg\posx6802\pvpg\posy4252\absw3440\absh6999 \sl-414 \f20 \fs21 \cf0 kes
eimbangan oksigen dan
perbaiki pertahanan pasien
hadap infeksi, meningkatkan
yembuhan.
\par}{\phpg\posx6802\pvpg\posy4252\absw3440\absh6999 \sl-286 \f20 \fs21 \cf0 Mal
nutrisi dapat mempengaruhi
\par}{\phpg\posx6802\pvpg\posy4252\absw3440\absh6999 \sl-414 \f20 \fs21 \cf0 kes
ehatan umum dan menurunkan
\par}{\phpg\posx6802\pvpg\posy4252\absw3440\absh6999 \sl-413 \f20 \fs21 \cf0 tah
anan terhadap infeksi.
Dilakukan untuk mengidentifikasi \par
}
batuk atau pengisapan untuk pewarnaan
organisme penyebab dan \par
}
kuman Gram, kultur/sensitivitas.
Berikan antimikrobial sesuai indikasi \par
}
kerentanan terhadap berbagai
\par}{\phpg\posx6802\pvpg\posy12592\absw3333\absh2359 \sl-414 \f20 \fs21 \cf0 an
timikrobial.
\par}{\phpg\posx6802\pvpg\posy12592\absw3333\absh2359 \sl-285 \f20 \fs21 \cf0 Da
pat diberikan untuk organisme
\par}{\phpg\posx6802\pvpg\posy12592\absw3333\absh2359 \sl-414 \f20 \fs21 \cf0 kh
usus yang teridentifikasi
\par}{\phpg\posx6802\pvpg\posy12592\absw3333\absh2359 \sl-414 \f20 \fs21 \cf0 de
ngan kultur dan sensitivitas,
\par}{\phpg\posx6802\pvpg\posy12592\absw3333\absh2359 \sl-413 \f20 \fs21 \cf0 at
au diberikan secara profilaktik
rana resiko tinggi. \par
}
. \par
}
8 \par
}
ffd8ffe000104a46494600010100000100010000ffdb004300010101010101010101010101010101
01010101010101010101010101010101010101010101010101010101010101010101010101010101
010101010101010101ffdb0043010101010101010101010101010101010101010101010101010101
0101010101010101010101010101010101010101010101010101010101010101010101010101ffc0
001108034a025303012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
00ffd9
\fs21 \cf0 DAFTAR PUSTAKA \par
}
{\phpg\posx1802\pvpg\posy9316\absw7981\absh611 \f20 \fs21 \cf0 \f20 \fs21 \cf0 A
lsagaff, Hood dan H. Abdul Mukty. 2002.{\i Dasar-Dasar}{\i Ilmu}{\i Penyakit}
{\i Paru. }
60 Surabaya: Airlangga University Press \par
}
Anonim.{\i Paru-paru}{\i dan}{\i Saluran}{\i Pernapasan.}{\field{\*\fldinst
{\b HYPERLINK}{\b "http://www.medicastore.com/"}}

{\fldrslt{{\cf5 {\ul w}{\ul w}{\ul w}{\ul .}{\ul m}{\ul e}{\ul d}{\ul i}{\ul c}
{\ul a}{\ul s}{\ul t}{\ul o}{\ul r}{\ul e}{\ul .}{\ul c}{\ul o}{\ul m}.}
}}} Diakses
360 tanggal 10 Maret 2008, jam 13.00 WIB \par
}
Bahar, Asril. 2001.{\i Buku}{\i Ajar}{\i Ilmu}{\i Penyakit}{\i Dalam}{\i J
ilid}{\i II.} Ed. 3. Jakarta: Balai
360 Penerbit FK UI \par
}
Brunner & Suddart. 2001.{\i Buku}{\i Ajar}{\i Keperawatan}{\i Medikal}{\i B
edah.} Ed. 8. Jakarta:
360 EGC \par
}
Carpenito, Lynda Juall. 1995{\i Diagnosa}{\i Keperawatan.} Jakarta: EGC \par
}
9 \par
}
ffd8ffe000104a46494600010100000100010000ffdb004300010101010101010101010101010101
01010101010101010101010101010101010101010101010101010101010101010101010101010101
010101010101010101ffdb0043010101010101010101010101010101010101010101010101010101
0101010101010101010101010101010101010101010101010101010101010101010101010101ffc0
001108034a025303012200021101031101ffc4001f00000105010101010101000000000000000001
02030405060708090a0bffc400b5100002010303020403050504040000017d010203000411051221
31410613516107227114328191a1082342b1c11552d1f02433627282090a161718191a2526272829
2a3435363738393a434445464748494a535455565758595a636465666768696a737475767778797a
0101010101010101010000000000000102030405060708090a0bffc400b511000201020404030407
05040400010277000102031104052131061241510761711322328108144291a1b1c109233352f015
6272d10a162434e125f11718191a262728292a35363738393a434445464748494a53545556575859
5a636465666768696a737475767778797a82838485868788898a92939495969798999aa2a3a4a5a6
00ffd9
\cf0 Halim, Hadi. 2001.{\i Buku}{\i Ajar}{\i Ilmu}{\i Penyakit}{\i Dalam}{
\i Jilid}{\i II.} Ed. 3. Jakarta: Balai
60 Penerbit FK UI \par
}
rice, Sylvia A. dan Lorraine M. Wilson. 2005.{\i Patofisiologi}{\i Konsep}{\i
Klinis}{\i Proses- }
40 {\i Proses}{\i Penyakit.} Vol 2. Ed. 6. Jakarta EGC. \par
}
ofiqahmad. 2008.{\i Thorax.} http://www.efusi pleura/080308/thorax/weblog.htm.
40 diakses tanggal 13 Maret 2008 jam 13.20 WIB \par
}
0 \par
}
}

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Menurut Hood Alsagaff dalam bukunya Dasar-Dasar Ilmu Penyakit Da

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{\phpg\posx9866\pvpg\posy15852\absw316\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 2

{\phpg\posx1802\pvpg\posy1450\absw8317\absh5298 \f20 \fs21 \cf0 \fi1080 \f20 \fs

\par}{\phpg\posx3242\pvpg\posy12040\absw7136\absh611 \sl-413 \f20 \fs21 \cf0 dan

\par}{\phpg\posx2582\pvpg\posy2702\absw3918\absh10340 \sl-413 \f20 \fs21 \cf0 \f

us tanpa sumbatan, saat memakai

sebut dilakukan \par

rangi ayau turunkan efek

\par}{\phpg\posx6686\pvpg\posy9742\absw4160\absh984 \sl-413 \f20 \fs21 \cf0 pela

\par}{\phpg\posx2426\pvpg\posy7256\absw3682\absh7230 \sl-413 \f20 \fs21 \cf0 gor

{\phpg\posx1910\pvpg\posy11298\absw165\absh239 \f20 \fs21 \cf0 \f20 \fs21 \cf0 8

\par}{\phpg\posx6200\pvpg\posy4644\absw3904\absh1986 \sl-286 \f20 \fs21 \cf0 Akt

\par}{\phpg\posx7480\pvpg\posy5186\absw2686\absh7718 \sl-414 \f20 \fs21 \cf0 ist

720 sekunder terhadap pemasangan WSD

Demam dapat terjadi karena

{\b HYPERLINK}{\b "http://www.medicastore.com/"}}

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