ASUHAN KEPERAWATAN PADA PASIEN DENGAN LUKA TUSUK YANG TERPASANG VENTILATOR DI RUANG HCU RSUPN CIPTO MANGUNKUSUMO

JAKARTA

I. (1)

KONSEP DASAR LUKA TUSUK

Luka tusuk merupaka !a"#a $ar# trauma ta%am &a " ma a 'uka tusuk masuk ke $a'am %ar# "a tu!u( $e "a 'uka sa&ata &a " ser# " sa "at ke)#' pa$a ku'#t* m#sa' &a 'uka tusuk p#sau+ ,erat r# "a &a 'uka tusuk ter"a tu " $ar# $ua -akt.r &a#tu / 1+ L.kas# a at.m# # %ur& 0+ Kekuata tusuka * per'u $#pert#m!a "ka pa %a " &a !e $a &a " $#"u aka u tuk me usuk $a ara( tusuka + 1#ka a!$.me me "a'am# 'uka tusuk* usus &a " me empat# se!a"#a !esar r. ""a

a!$.me aka sa "at re ta u tuk me "a'am# trauma pe etras#+ Se)ara umum .r"a 2.r"a pa$at !eresp. ter(a$ap trauma $e "a per$ara(a + Se$a "ka .r"a !er. ""a !#'a pe)a( me "e'uarka #s# &a $a'am (a' # # !#'a usus pe)a( aka me "e'uarka #s# &a ke $a'am r. ""a per#t. ea' se(# ""a aka me "ak#!atka pera$a "a atau # -eks#+ Pe &e!a! kemat#a pa$a trauma a!$.me a$a'a( pe uru a 3.'ume )a#ra kare a

per$ara(a (s&.k (#p.3.'em#k)+ Se)ara r# "kas pr.ses terse!ut $apat $#"am!arka s!! / 4akt.r pe &e!a! (pe uru a 3.'ume )a#ra ) Pe uru a arus !a'#k 3e a Pe uru a #s# seku )up Pe uru a )ura( %a tu " Pe uru a per-us# %ar# "a

A$apu ta $a $a "e%a'a $ar# (#p.3.'em#) s&.k me "ara( pa$a !er!a"a# s#stem &a#tu / 1+ S#stem kar$#.3asku'er / tak#kar$#* pe uru a teka a $ara( s#st.'#k 0+ Ku'#t / $# "# * 'em!a!* pu)at* s#a .t#k 5+ S#stem Sara- Pusat / a s#etas* keresa(a * peru!a(a kesa$ara 6+ S#stem Re a' / pe uru a (a'uara ur# e* "a"a' "# %a' akut atau kr. #s 7+ S#stem Per a-asa / tak#p ea* pe # "kata perm#a!#'#tas kap#'er pu'm. a' (ARDS) 8+ S#stem Hepat#k / pe uru a pem!e tuka -akt.r2-akt.r pem!ekua * pe uru a s# tes#s pr.te# 2pr.te# p'asma* pe uru a a'!um# serum* pe uru a ka$ar "'uk.sa serum 9+ S#stem Gastr. I test# a' / #'eus a$# am#k* u')eras#* pe uru a pe # "kata masuka t.ks# $ar# 'ume usus ke $a'am a'#ra $ara( :+ S#stem 3asku'er (0) KONSEP GAGAL NA4AS De-# #s# / Ga"a' a-as akut $#art#ka se!a"a# ke"a"a' pertukara "as $a'am paru* $#ta $a# $e "a turu &a ka$ar .ks#"e $# arter# ((#p.ksem#a) atau a#k &a ka$ar kar!. $#.ks#$a ((#perkar!#a) atau k.m!# as# ke$ua &a+ Kr#ter#a $#a" .s#s pa$a pas#e pemer#ksaa a a'#sa "as $ara( / 1+ PaO0 kura " $ar# 7; mmH" 0+ Pa<O0 'e!#( $ar# 7;mmH" ta pa a$a "a ""ua a'ka'.s#s meta!.'#k pr#mer Ga"a' a-as $apat $#ak#!atka .'e( !erma)am pe &ak#t !a#k akut maupu kr. #k= set#ap "a ""ua pa$a ke'#ma ta(ap resp#ras# $apat me &e!a!ka "a"a' a-as+ !) Pat.-#s#.'."# >eka #sme &a " me &e!a!ka ter%a$# &a "a"a' a-as me'#put# / 1+ H&p.3e t#'as# / kea$aa $#ma a sese.ra " t#$ak $apat memperta(a ka 3e t#'as# a'3e.'ar &a " )ukup* se(# ""a ter%a$# ke a#ka ka$ar <O0 $a'am $ara( 2. Gangguan perfusi dan difusi A$a &a em!.'# $# sa'a( satu )a!a " arter# pu'm. a'# aka me # "katka rua " ru"# kare a !a &ak a'3e.'# &a " (a &a me "a'am# 3e t#'as# ta pa per-us# 5+ P# tasa # tra pu'm. er $a "a ""ua per!a $# "a 3e t#'as# per-us# P# tasa # trapu'm. er (S(u t) $#art#ka se!a"a# $ara( &a " memper-us# paru &a " t#$ak me "a'am# pertukara ate'e)tas#s "as kare a a'3e.'#&a t#$ak ter3e t#'as# sepert# pa$a &a " !er a-as pa$a u$ara kamar $#$apatka (as#' a!s.rps# utr#e * se s.r#um* pe uru a t# "kat

)) Ta $a $a "e%a'a "a"a' a-as akut D#a" .sa past# "a"a' a-as akut $#te"akka $e "a pemer#ksaa a a'#sa "as $ara(+ Namu "e%a'a k'# #s "a"a' a-as akut $apat $#te"akka $e "a me "amat# (a'2(a' s!! / P.'a per a-asa / 'a%u per a-asa me # "kat* per a-asa $a "ka' mu "k# a$a per a-asa )up# " (#$u " $a ter'#(at .t.t per a-asa tam!a(a mu'a# akt#War a ku'#t / pa$a kea$aa a?a' mu "k# mas#( mera(* !#'a pr.ses !er'a %ut@!ertam!a( !erat ku'#t !er?ar a pu)at@!#ru &a " me a $aka (#p.ksem#a &a " !ertam!a( !erat+ Te s#@'a%u a$# / umum &a a$# )epat* !#'a a$a ar#tm#a mu "k# $#se!a!ka (#perkar!#a ($a (#p.ks#a) Na$# &a " me'ema( $a !ertam!a( 'am!at me a $aka kea$aa !ertam!a( para(* &a " memer'uka t# $aka se"era+ Teka a $ara(* pa$a kea$aa &a " mas#( r# "a mu "k# mas#( $a'am !atas .rma'+ ,#'a kea$aa !ertam!a( !erat* teka a $ara( mu'a2mu'a kare a # # merupaka ta $a per!uruka + Ga"a' a-as $e "a ta $a2ta $a &a " &ata sa "at mu$a( $#ke a'#+ Ya " su'#t a$a'a( a?a' $ar# a$a &a "a"a' a-as* &a " 'uput $ar# pe "a?asa ketat &a " mu "k# $a'am ?aktu re'at#- s# "kat $apat mem!uruk+ Pe "a?asa @.!ser3as# ketat meme"a " pera a pe t# " se(# ""a !#'a t(erap# k. 3e s#. a' t#$ak me .'. " $a kea$aa mem!uruk* $apat se"era $#am!#' t# $aka 'a# sepert# # tu!as# $a pemaka#a a'at !a tu a-as@3e t#'at.r+ $) Pe ata'aksa aa $a pe ".!ata Dasar pe ".!ata $#!a"# &a " . spes#-#k $a spes#-#k* umum &a $#per'uka k.m!# as# ke$ua &a+ Pe ".!ata . spes#-#k $#tu%uka 'a "su " u tuk memper!a#k# pertukara "as* a-as $a -#s#.t(erap# $a$a serta usa(a2usa(a sepert# pem!er#a .ks#"e * pem!ers#(a %a'a se$as#+ Se$a "ka pe ".!ata spes#-#k $#tu%uka kepa$a pe &e!a! "a"a' a-as = !#'a "a"a' a-as $#se!a!ka kare a a$a &a !e $a as# " $# !r. k(us maka $#'akuka !r. k.sk.p# u tuk me "atas# sum!ata kare a !e $a as# " terse!ut %u"a me'akuka pu "s# p'eura $a WSD pa$a e-us# p'eura &a " mas#- $''+ e) I $#kas# 3e t#'as# !a tu@art#-#s#a' Pa$a kea$aa &a " ekstrem sepert# pe $er#ta ap eu atau per a-asa &a " amat 'ema(* # $#kas# 3e t#'as# !a tu@art#-#s#a' mu$a( $#te"akka + Namu pa$a kea$aa $# 'apa "a ser# " $#%umpa# kasus &a " su'#t !a"# k#ta u tuk memutuska apaka( su$a( merupaka a#k kare a pe'epasa katek.'am# * !#'a teka a $ara( mu'a# turu (a' # # (arus se"era $#atas#

'a# u tuk me uru ka ke!utu(a .ks#"e sepert# me uru ka pa as !a$a $a pem!er#a

# $#kas# u tuk 3e t#'as# art#-#s#a'* se!a! pe u $aa a'at !a tu a-as &a " !er'arut $apat !erak#!at -ata'+ Se!a'#k &a t# $aka ter'a'u $# # $a a"res#- t#$ak se'a'u me "u tu "ka !a(ka $apat meru"#ka + ,e!erapa pat.ka u tuk me e tuka # $#kas# 3e t#'as# a$a'a( / Parameter 1+ >eka #k La%u apas V.'ume t#$a' Kapas#tas 3#ta' Teka a # sp#ras# Indikasi Le!#( 57@me #t Kura " 7 m'@k",, Kura " 17 m'@k",, Kura " 07 )mH0O Nilai Normal 1; A 0; ($e?asa) 7A9 87 A 97 97 A 1;;

maks#ma' 0+ Oks#"e as# 2 PaO0 5+ Ve t#'as# Pa<.0 Kura " 8; mmH" (4#O0 B ;*8) Le!#( 8; mmH" 97 A 1;; (u$ara kamar) 57 A 67

Le!#( ;*8 ;*5 - V$@Vt Pemaka#a a'at !a tu a-as (resp#rat.r@3e t#'at.r) !uka 'a( u tuk me ""a t#ka -u "s# paru $a %a tu "* me'a# ka (a &a !er-u "s# se!a"a# a'at 3e t#'as# &a " mem.mpaka u$ara@.ks#"e ke $a'am paru $e "a taka a p.s#t#-+ 4u "s# &a 'e!#( !ers#-at memperta(a ka a"ar pe $er#ta tetap (#$up sam!#' me u ""u pr.ses reparat#- !a$a $apat me "am!#' a'#( -u "s# 3e t#'as# &a kem!a'#+ -) O!at &a " $#paka# pa$a "a"a' a-as Pa$a pe $er#ta "a"a' a-as kare a asma* $#!er#ka .!at !r. k(.$#'at.r !a#k per # -us maupu per # (a'as#* pa$a kea$aa !erat !#asa &a $#tam!a(ka k.rt#k.ster.#$+ U tuk # -eks# !#asa &a $#!er#ka a t#!#.t#ka !er spektrum 'uas+ U tuk pe $er#ta $e "a 3e t#'at.r* $#!er#ka se$at#3 sepert# $#aCepam (3a'#um)* $.rm#kum $a ".'. "a sepert# pa3u'. ark.t#k u tuk me eka per a-asa $a !#'a pere'u .!at pe'umpu( .t.t $'' a"ar pe $er#ta $apat me "#kut#@se#rama per!a-asa &a $e "a a'at

3e t#'at.r terse!ut+

PENGKA1IAN I #t#a' K'#e Umur A"ama A'amat Pe $#$#ka Peker%aa Ta ""a' >asuk RS Ta ""a' Pe "ka%#a D#a" .sa >e$#s (1) / Tua >+Y+ / 0; Ta(u / Is'am / <e "kare " T#mur* 1akarta / S>A / Kar&a?a / 0D N.3em!er 1DD: / 1 Desem!er 1DD: / P.st Op Laparat.m& e)+ Luka tusuk tem!us a!$.me

Per%a'a a Pe &ak#t

Pas#e masuk ke IGD ta ""a' 09 N.3em!er 1DD: Pk+ 19+07 WI, $#ma a sek#tar 0; me #t se!e'um &a pas#e terke a trauma tusuk $# perut kemu$#a $#'akuka .peras# 'aparat.m& ta ""a' 0D N.3em!er 1DD: $e "a 'ama .peras# 6 E %am $e "a t# $aka pem!e$a(a / Laparat.m# eksp'.ras# Ne-rekt.m& k#r# Sp'e ekt.m& %a(#t $ua 'ap#s "aster* %e%e um $a mese ter#um Dra# pa$a "# %a' k#r#

Hasil Laboratorium : (a) Ta ""a' 5; N.3em!er 1DD: W,< 5*7 R,< 5*69 HG, 1;*; PLT 58 H<T 0D*1 Tr.m!.)&t 58+;;; Ureum $ara( 5; m"@DL <reat# # ur# e 1*17 m"@DL Ur# a'#sa Se$#me F Ke%er #(a %er #( Leuk.)&t 1 A 5 @LP, Er#tr.s#t G1;;@LP, Kr#sta' ( 2 )

,erat %e #s 1;1; +pH 7 G'uk.sa 0F Pr.te# ( 2 ) Ket. ( 2 ) ,#'#ru!# ( 2 ) Ur.!#'# ."e ;*1 N#tr#t ( 2 ) (!) A a'#sa Gas Dara( Ta ""a' 5; N.3em!er 1DD: Pk+ ;8+6D Ve t#'at.r ). tr.' TV / 67; 4#O0 / 6;H +pH 5*:6 P<O0 59*9 PO0 185*6 H<O5 00*0 T<O0 05*5 ,E A 0*5 S,E A 0*0 SAT DD*0 S,< 00*6 ()) A a'#sa Gas Dara( Ta ""a' 1 Desem!er 1DD: Pk+ ;7+16

Ve t#'at.r Ass#st <. tr.' RR 10* TV 67; 4#O0 6;H PH 9*7;: P<O0 5:*5 PO0 119*5 H<O5 5;*7 T<O0 51*9 ,E F 8*D S,E F 8*: SAT D:*9 S,< 5;*9 Na 15: K 5*D <' ( 2 )

($)

A a'#sa Gas Dara( Ta ""a' 0 Desem!er 1DD:

Ve t#'at.r SI>V 4#O0 57H PH 9*677 P<O0 56*9 PO0 109*: H<O5 05*0 T<O0 06*0 ,E A ;*5 S,E A ;*5 SAT D:*: S,< 06*1 Na 158 K 5*D (e) Has#' La!.rat.r#um Dara( 0 Desem!er 1DD:

Ht 06 3.' H H! :*9 "r@DL Leuk. 10+9;; Tr.m!. 1;7+;;; Pengukuran CVP / T"'+ 121021DD: F 11 )mH0O* T"' 021021DD: 1;*7 )mH0O (-) <a#ra I -us Ta ""a' 121021DD:

KaE> >G5 7;; )) Pa Am# 8;; / 7;; )) RL 44P 0 I 5;; )) (") <a#ra I -us Ta ""a' 021021DD:

KaE> >G5 Pa Am# Tra -us# Dara( 7;; )) 44P 0 I 5;; )) RL

(()

<a#ra I -us Ta ""a' 521021DD:

KaE> >G5 Pa Am# RL 44P 5 I 5;; )) (#) O!at2.!ata Ta ""a' 5; s@$ 021021DD:

<#met#$# e 5 I 1 A'# am# 4 5 I 1 V#t K 5 I 1 Kem#)#t# 5 I 1 "r ( Ta ""a' 521021DD: $#"a t# $e "a Pe #)#''# Pr.ka# ) N.3a'"# 5 I 7; m" (0) Kepa'a >ata H#$u " >u'ut Le(er mur #* "a''.p (2) A!$.me Ekstrem#tas / 'uka 'aparat.m&* !a'uta rap#* ker# "* !#s# " usus (2) / ta "a ka a terpasa " tr#?a& # -us* <VP KaE> >G5* RL* Pa Am# = kak# ka a terpasa " # -us Na<' sp..'# " tra -us# (5) D#a" .sa Kepera?ata &a " mu "k# mu )u' a-as !er(u!u "a $e "a pe # "kata pr.$uk muk.sa ak#!at a$a &a !e $a as# " pa$a tra)(ea (# tu!as#) 0+ Res#k. t# ""# "a ""ua $e-#)#t 3.'ume )a#ra !er(u!u "a $e "a per$ara(a * puasa 5+ Res#k. "a ""ua peme u(a utr#s# = kura " $ar# ke!utu(a tu!u( !er(u!u "a $e "a pe # "kata meta!.'#sme* NPO 6+ Res#k. t# ""# ter%a$# &a # -eks# !er(u!u "a $e "a trauma a!$.me * 'uka .peras#* pr.se$ur # 3as#- (<VP* kateter#sas#* ETT) 7+ Ga ""ua m.!#'#tas -#s#k !er(u!u "a $e "a ke'ema(a 8+ Ga ""ua k.mu #kas# 3er!a' !er(u!u "a $e "a terpasa " &a ETT Pemer#ksaa 4#s#k / <.mp.s >e t#s / S#metr#s / <. %u )t#3a t#$ak a em#s* sk'era t#$ak #kter#k / terpasa " NGT* )a#ra ?ar a ).k'at tua / terpasa " ETT* muk.sa ker# " / ke'e %ar "eta( !e # " t#$ak mem!esar

Kesa$ara

Da$a / ausku'tas# paru* r. )(# !asa( r# "a F@F* ?(eeC# " (2) = ausku'tas# %a tu " ,1 I* II

1+ Ga ""ua pem!ers#(a %a'a

ASUHAN KEPERA ATAN PASIEN TN. M.! DI RUANG HCU RSUPN CIPTO MANGUNKUSUMO JAKARTA N

DI+ Pera?ata . 1+ Ga ""ua pem!ers#(a %a'a a-as !er(u!u "a $e "a pe # "kata pr.$uk ak#!at muk.sa a$a &a

Tu%ua Ke!ers#(a %a'a a-as 0+ $apat ter%a"a 1+

I ter3e s# Ka%# kepate a %a'a a-as pas#e E3a'uas# pe "em!a "a $a ka%# suara ke$ua !e'a( paru $a$a* 0+ a-as 1+

Ras#. a' O!struks#

Imp'eme tas# $apat 1+ >e "ka%# %a'a a-as kepate a S/2 O/

E3a'uas#

$#se!a!ka $ar# pe umpuka %a'a a-as

sekres#* per$ara(a * spasme 0+ >e "e3a'uas# pe "em!a "a $a a-as+ $a'am suara me "ka%# Has#' !atas Pe "em!a "a $a$a &a " s#metr#s $a suara a-as &a " se#m!a " pa$a ke$ua !e'a( paru me u %ukka O!struks# ETT paru $apat suara r. k(# &a " $## tu!as# !era$a tepat $a .!struks#+ (ak#!at ate'ektas#s) me #m!u'ka 5+ <atat a$a &a !atuk &a " pe # "kata !er'e!#(a * 5+ $#sp eu* $a ?(eeC# " Pas#e me "a'am# !atuk &a " t#$ak t#$ak a$a

S#a .s#s (2) $a$a <VP / F 11 )m suara H0O* N / 90I@me #t* / TD / 1;:@87 mmH"* $a$a RR / 1: I@me #t .rma'* (3e t#'at.r 10) A a'#sa Gas Dara( / P<O0

pe "em!a "a

!e $a as# " pa$a tra)(ea (# tu!as#) D#ta $a# $e "a / s#stem !er!u &# suara sputum a-as / pe umpuka a'arm

a-as ausku'tas# Ku'#t (a "at

r. )(# !asa( r# "a F@F

p eum. #a* 5+ >e )atat a$a &a !atuk PH 9*677 = a'arm* sekret

&a " !er'e!#(a * !u &# 56*0 = PO0 109*: = ETT* H<O5 05*0 = SAT r. )(#+ D:*: pe # "kata

Has#' / !atuk !er'e!#( A / >asa'a( teratas# (2)* !u &# a'arm (2)* P /

ter$e "ar suara me uru (pa$a .!struks# %a'a a-as@k.'aps paru) pas#e "e'#sa( usa(a k'#e me # "kat pe ""u aa .t.t tam!a(a per a-asa (F) AGD / P <O0 me # "kat* P O0 $a PH me uru :+ 9+ / a-as 8+ 7+ 6+ a-as

!u &# a'arm* a$a &a sekret pa$a ETT* s#stem $a sesua# 7+ 6+ pe # "kata r. )(# >. #t.r (um#$#-#kas# temperatur Su)t#. ke!utu(a A%arka te( #k !atuk e-ekt#-* purse$ !reat(# "!#'a k..perat#U!a( p.s#s# se)ara per#.$#k 9+ a-as $a'am 8+ '#p pas#e

e-ekt#- se(# ""a pe umpuka sekret ter%a$#

sekret ETT (F) se$#k#t* Tetap pe # "kata r. )(# (2) 6+ >em. #t.r (um#$#-#kas# $a Has#'

.!ser3as#

a$a &a sekret a-as / O!ser3as# a a'#sa

s#stem 1a"a kepate a %a'a

Pe "e ta'a t#m!u'

sekret $apat s#stem

temperatur+ (um#$#-#kas#

ak#!at

)ukup* "as $ara( su)t#. ke!utu(a +

(um#$#-#kas# kura " Su)t#. t#$ak !.'e( rut# kare a !a &ak mem#'#k# e-ek e"at#>e # "katka kemampua sekret eksp#ras# >e # "katka sekret se'uru( $a !a"#a me #m!u'ka me "e'uarka se)ara e-ekt#-* se(# ""a $ra# ase ke paru* res#k.

temperatur 59J< 7+ >e'akuka sesua# put#(* e )er 8+ >e "u!a( p.s#s# se)ara per#.$#k p.stura' $ra# ase

Has#' / sekret (F)* ?ar a

retar"e$ 9+ >e'akuka

me uru ka k.'aps paru 3e t#'as#

A %urka

pas#e

me uru ka ate'ektas#s

u tuk m# um !a &ak

sesua# k. $#s# K.'a!.rat#1+ Lakuka ?as(# "* $a$a $ra# ase) 0+ ,er#ka !r. k(.$#'at.r @muk.'#t#k # $#kas#+ e-ekt#-#tas &a+ sesua# !r. k(#a'

:+

>e # "katka sekret

kee )era

-#s#.t(erap# K.'a!.rat#- / (perkus#* 1+ >em!a tu me "e )erka * me # "katka sekret se(# ""a $#ke'uarka E3a'uas# 0+ >e # "katka sekret $a a-as kee )era %a'a m.!#'#sas# mu$a(

3#!ras#*p.stura'

me'e!arka

0+ Res#k. "a ""ua 3.'ume !er(u!u "a $e "a

t# ""# Ga""ua $e-#)#t $e-#)#t )a#ra 3.'ume )a#ra ter%a$# t#$ak

1+ >. #t.r teka a .!ser3as# temperatur

ta $a

3#ta'* 1+ Peru!a(a me a $aka pe &ak#t* me "eta(u# )a#ra t(erap# $a $ara(*

ta $a <VP $e-#s#t resp. )a#ra

3#ta' 1+ >em. #t.r ta $a 3#ta'* S / 2 <VP* Teka a Su(u+ 1;6@80 9DI@me #t* Has#' S Dara(* O / / TD Ta $a 3#ta' TD S N 1;9@87 mmH"* N 59*0J<* <VP F1; E u tuk 3.'ume ter(a$ap

<VP = )atat peru!a(a ke a#ka

perkem!a "a

mmH"*

59J<* 9;I@me #t*

per$ara(a * puasa+

pe ""a t#+

<VP 9 )mH0O

"a#$%r

resi#%

&

Demam

ter%a$#

kare a 0+ >empa'pas#

a$# )mH0O 586; 5:07 ))* ))*

Tr%'(%si$%penia

pe # "kata meta!.'#sme $a ke(#'a "a )a#ra 0+ K. $#s# 0+ Pa'pas# )atat a$# )ap#''ar& per#-er* re-#''* me &e!a!ka $e-#)#t )a#ra t#$ak

per#-er* )ap#''ar& re-#''* I take ?ar a ku'#t* temperatur+ .utput

Has#' / a$# per#-er (F)* !a'a )e (F) 1:7 )) )ap#'arr& re-#'' K 0LL* <ap#'arr& re-#'' K 0M* ?ar a )&a .s#s* $# "# 5+ >em. #t.r ku'#t t#$ak muk.sa !a#k+ .utput Per$ara(a $ra# 7 mu'ut temperatur )ukup* tur".r ku'#t

a$ekuat &a per-us# .r"a $a mu "k# me &e!a!ka s&.k 5+ Pe ""a t#a )a#ra %um'a( )a#ra !er$asarka &a " (#'a "

?ar a ku'#t* temperatur 5+ >. #t.r .utput ur# e* ukur $a ke(#'a(a "a est#mas#ka )a#ra

ur# e* !a'a )e )a#ra + ))* NGT (2) Has#' / ur# e .utput D#).!a m# um 187;* !a'a )e (F) 87 ))* ANua 6 I 1;; )) @

$ar# 'am!u "* $ra# ase 'uka atau $#p(.res#s 6+ T#m!a " !erat !a$a t#ap (ar#* (#tu " !a'a )e )a#ra * 7+ ,er#ka mu'ut* pas#e )atat a$a &a .e$ema pa$a tu "ka# pera?ata mema $#ka set#ap (ar# $a 7+ >uk.sa mu'ut $a )e $eru " ker# " 6+ Peru!a(a $a'am 3asku'ar !erat peru!a(a !a$a # tra merupaka ta $a t#$ak akurat

# take 09D; ))* NGT NGT 5;;* Dra# 7;; K.'a!.rat#- / 097* IWL Kem!u " $#ste s# (2)* mua' (2) Has#' 'a!.rat.r#um / (as#' H! :*9 "@DL* Ht 06 tr.m!. (2)* a!$.me

!#!#r 1+

>em. #t.r

'a!.rat.r#um+ Has#' / t"' 3.'H* H* Ht 0D1+;;* tr.m!.s#t 5*D

5;21121DD: H! 1;*; "r 1;7+;;;* Na 158* K

!er#ka '.t#.

8+ Ka%# a$a &a $#sp eu* 8+ >e # "kat &a )&a .s#s* me # "kat &a ke)emasa * "e'#sa( 9+ >. #t.r !atuk pr.$ukt#-* p'ate'et

a"re"as# mu "k# 0+

58+;;;*

e'ektr.'#t

Na A / T#$ak ter%a$# masa'a(* tap# res#k. mu "k#

15;* K 5*D >em!er#ka )a#ra

me &e!a!ka em!.'# s#stem#k ter(a$ap kekura "a me &e!a!ka kar$#.pu'm. ar&* u tuk )a#ra k.'.#$ )a#ra terutama

ta $a2ta $a 9+ K.reks# &a " ter'a'u )epat "a ""ua 5+ 6+ meta!.'#k mem!utu(ka

# -us sesua# # $#kas#+ t# ""# KaE> >G5* Pa Am# * ter%a$# RL* 44P* Na<' P/ tra -us# Tetap 3#tam# (spp.'# " tra -us#) >em!er#ka (44P) 0 I 5;; )) >em!er#ka K 5 I 1 amp+

$#sp eu* )rak'es

.!ser3as#

!a'a )e )a#ra >. #t.r tr.m!.s#t >. #t.r (em.$# am#k status

II+

K.'a!.rat#-

K.'a!.rat#- / ,a'a )e e'ektr.'#t k.reks#

1+

(as#' 1+ 'a!.rat.r#um H!* Ht* Tr.m!.s#t* e'ektr.'#t* "'uk.sa* PH* P<O0

>. #t.r

0+
-

,er#ka )a#ra # -us sesua# # $#kas#

<a#ra #s.t. #s sepert# Na<' ;*D* DeItr.se 7H

0+

<a#ra / #s.t. #s merupaka kr#sta'.#$ &a " mem!er#ka per!a#ka k.'.#$ s#rku'as# u tuk se)ara tepat* RL a$a'a( (#p.t. #s* me ".reks# k. se tras# kekura "a

<a#ra ;*67H* RL <a#ra k.'.#$ / DeItra * P'asma* A'!um#

Dara( / ?(.'e !'..$ (tra -us# $ara()

pr.te# $#!er#ka

p'asma* !#'a

$ara(

ter# $#kas#

ke(#'a "a $ara( &a " akt#-+ 5+ Res#k. "a ""ua peme u(a = kura " ke!utu(a !er(u!u "a $e "a pe # "kata meta!.'#sme* NPO 0+ $ar# Ga ""ua utr#s# t#$ak
1+ >ere3#e? # $#3#$ua' ter(a$ap pe )er aa (NPO)* para'#t#k+ &a " -akt.r !ere-ek maka a + puasa #'eus ausea* kemampua 1+ >empe "aru(# p#'#(a # ter3e s#

1+ >em. #t.r pem!er#a

# $#kas# S / 2 utr#s#+ O /

utr#s# peme u(a tu!u( ter%a$#

Has#' / NGT ?ar a NGT )a#ra !e # "* ).k'at tua* !#s# " usus per$ara(a (2) (F) 'ema(* k'#e mas#( >u ta( 0+ >e "#$e t#-#kas# status )a#ra NPO kem!u " (2) ,#s# " usus (F) sama pe t# " &a u tuk 0+ >e )atat # take $a (2)*

<. t.( / kea$aa

T#m!a " .utput

!erat

!a$a * )atat # take $a

memast#ka meta!.'#k 5+ >e e tuka

ke!utu(a kem!a'# &a

.utput+ Has#' / # take Pr."ram pem!er#a 09D; ))* .utput 1907 )a#ra per NGT 6 I )) 1;; )) !#s# " <a#ra # -us /

per#sta't#k usus 0 A 6 (ar# 5+ >e "au'kutas# 5+ Ausku'tas# !#s# " sete'a( .peras# usus* pa'pas# a!$.me * 6+ U tuk me # "katka )atat a$a &a -'atus ker%asama pas#e $a'am (a' I$e t#-#kas# $#et pr.te# $a 3#tam# < maka a &a " $#suka# mem!a tu per!a#ka $a atau &a " t#$ak $#suka# peme'#(araa %ar# "a

usus* -'atus+ Has#' / KaE>G5 (7;; )))* !#s# " usus (F) 'ema(* Pa Am# (7;; ))) -'atus (2) A K.'a!.rat#- / 1+ >e %a"a kepate a / Ga ""ua utr#s# t#$ak ter%a$#

6+

pas#e * !er# $.r. "a u tuk maka a 7+ mem#'#( &a " t# ""# 7+ S# $r.ma ma' a!s.r!s# $apat ter%a$# sete'a( .peras# usus ke)#' mem!utu(ka se'a %ut &a $a 'emak K.'a!.ras# / 1+ K.'a!.ras# / 1+ >e %a"a kepate a $ar# NGT 0+ >e %a"a $a $ek.mpres# #st#ra(at #m!a'a )e ter(a$ap 'am!u "* usus (a'us me # "katka atau pe &em!u(a $ar# usus >e ".reks# )a#ra $a e'ektr.'#t 0+ ,er#ka # -us )a#ra 5+ >asa'a( ter"a ""u $a 6+ A t#emet#k u tuk me )e"a( # test# a' $apat m.$#-#kas# a$a &a

NGT 0+ >em!er#ka Am# * RL per IV <#met#$# e 5 I O )a#ra # -us KaEm >G5* Pa

P/ Tetap .!ser3as# # $#kas# pem!er#a maka a per NGT teruska )a#ra pem!er#a pare tera' sesua# # $#kas# T#m!a " ,, !#'a memu "k# ka O!ser3as# (as#' 'a!.rat.r#um $ara( (a'!um# * "'u!.'# * "'uk.sa* ,UN)

pr.te# atau 3#tam# < O!ser3as# $#are

e3a'uas# 5+ >em!er#ka 3#tam# K Tetap@

$#et+ <. t.( / $#et re $a( 6+ >em!er#ka

sepert# a'!um# * '#p#$ $a e'ektr.'#t 5+ ,er#ka 3#tam#

me &e!a!ka a!s.r!s# )a#ra

terutama 6+ ,er#ka

3#tam#

mu ta(* me uru ka u tuk muk.sa u'kus 7+ >e e tuka pas#e

a tas#$a me )e"a( $a

u tuk er.s#

se)ara pare tera' .!at2.!at 'a# sesua# # $#kas# A t#emet#k A tas#$a@(#stam# # (#!#t.r (a ta"ame$) 7+ K. su'tas# $e "a $#et 8+ ,er#ka !erta(ap $e "a $ar# )a#ra * )a#r a('# 8+

-.rmas# asam kemu "k# a

ke!utu(a

$#et

D#mu'a# &a )a#ra pe t# " me "em!a'#ka $a

pem!er#a $#et a$a'a( u tuk -u "s# u tuk utr#s# # take

sampa# -u'' $#et sesua# t.'era s# sete'a( NGT $#)a!ut

.rma' # test# a' $a me # "katka &a " a$ekuat