R SES Qe LAPORAN PRAKTEK PROFESI ASUHAN KEPERAWATAN MENINGITIS DI RUANG GBST LT II RSUD ARIFIN ACHMAD PEKANBARU Oleh: Rachmat Isthadi, S.kep NIM: 1911438055 Preceptor Akademik: Ns. Gamya Tri Utami, M.Kep. Preceptor Klinik: Ns. Dipa Handra, S.Kep PROGRAM PROFESI NERS B 2018 FAKULTAS KEPERAWATAN UNIVERSITAS RIAU PEKANBARU 2020R SES Qe LAPORAN PENDAHULUAN ASUHAN KEPERAWATAN MENINGITIS DI RUANG GBST LT I RSUD ARIFIN ACHMAD PEKANBARU Oleh: Rachmat Isthadi, S.kep NIM: 1911438055 Preceptor Akademik: Ns. Gamya Tri Utami, M.Kep Preceptor Klinik: Ns. Dipa Handra, S.Kep PROGRAM PROFESI NERS B 2018 FAKULTAS KEPERAWATAN UNIVERSITAS RIAU PEKANBARU 2020Degnst . $ Pho i rere gete fpf f oS Menmgrges adaruny Meee Jauy * Qaereee Dreweniic Seiccan Sie eoeterl Keryast Neda Seapot gta. q i Choe Nereus guys Leben ening pebeas, j ‘ | Weneo conn, Bt tulwenze 7 | eae eon put QWeametcr ameumerd, den areder) 2. vey D Orgemine seme Datel isioreg, ( Ktastences We Gocroe Reena Ss Aseiy & Seu f+ Wheeborey a 2. 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Yesves Crdeenr pb leesarg Gurats tues Jegreron unlvensiny Kesqeter( >Faktor- faktor predisposisi mencakup : infeksi jalan napas bagian atas, otitis media, mastoiditis, anemia sel sabit da hemoglobinopatis lain, prosedur bedah saraf baru, trauma kepala, dan pengaruh imunologis) a Invasi kuman ke jaringan serebral via saluran vena nasofaring posterior, telinga bagian tengah, dan saluran mastoid v ‘Reaksi peradangan jaringan serebral v v Eksudat meningen Gangguan metabolisme serebral Hipoperfusi Ls, 7 ‘Trombus daerah Korteks dan aliran darah serebral__ | <——————— v Kerusakan adrenal, kolaps sirkulasi, kerusakan endotel, dan nekrosis pembuluh darah v Infeksi/septikemia jaringan otak v Iritasi meningen Vv Ketidakefektifan pola napas Ketidakefektifan bersihan jalan ‘napas ‘Sakit kepala dan demam, Perubahan fisiologis intrakranial v pe darah otak Hipertermi 5 Nyed ‘Edema serebral dan peningkatan TIK Peningkatan permeabilitas Penekanan area Agpesi Perubahan Perubahan Pemubahan fokal kortikal Kelunpuhan tingkat gastrointestinal em sara kesadaran, Pernapasan Ty baie cheyne-stokes Rigiditas nukal v ene Maat dan untah_ | ————— tana ins | LSP fsa pe m7 Sekresi ADER Gangguan — vo Kematian keseimbangan kejang cairan v v Resiko eidera Takut Kecemasan Pe permeabilitas Prosedurinvansit, |{” Kelemahan fisik | kapiler dan etensi airan Jumbal fungsi v Gangguan ADL. risiko kelebihan volume cairanCONCEPT MAP MENINGITIS ‘Meningitis adalah : inflamasi akut pada meningens. Organisme penyebab meningitis bakterial memasuki area secara langsung sebagai akibat cedera teraumetk atau secara tidak Jangsung bila dipindahkan dari tempat lain di dalam tubuh ke dalam cairan serebropinal (CSS). Berbagi agens dapat menimbulkan inflamasi pada meningens termasuk bakteri, virus, jamur, dan zat kimia (Betz, 2009) ‘Btiologi : 1. bakteri piogenik yang disebabkan oleh bakteri pembentuk pus, tentama meningokokus, pneumokokus, dan basil influenza 2. vimus yang disebabkan oleh agen-agen viru yang sangat bervariasi 3. organisme jamur Infeksi/septikemia jaringan otak Perubahan fisiologis intrakranial Edema serebral dan peningkatan TIK Peningkatan permeal Penekanan area re Perubahan Perubahan fokal kortikal ae gastrointestinal “setoms pperubaban pemapasan : ee perilaku > cheyne-stokes na ae = tase desist xi jaringan son kembali fotofabia pe efisit cairan = pasion kembali ¥ Sekresi ADH Ketidakefelaifan ‘sexehaal pada keadaan status Noc weaecidae neurologis sblm = Psien bebas dari injuri ya j walt Gisebabkan oleh Kejang dan napas penurunana kesadaran NIC: ~ — meningkatnya esadaran pasion NOC: + Kebutuhan cairan terpenubi NIC: NOC: ~ jalan napas pasien kembali ‘Monitor kejang Persiapkan lingkungan yang aman + Ukur dan catat pemasukan dan pengeluaran efektif monitor tanda-tanda Pertahankan bedrest total = Monitor vital sign NIC: . status neurologis Kolaborasi pemberian terapi sesuai } | - Kaji balutan luka, rainage secara teratur Kaji fungsi paru iba advis dokter ‘Atur posisi fowler dan = monitor AGD. semifowler Ajarkan batuk efektifR SES Qe EVIDENCE BASED OF NURSING PRACTICE MENINGITIS Oleh: Rachmat ‘NIM: 1911438055 thadi, S.key Preceptor Akademik: Ns. Gamya Tri Utami, M.Kep Preceptor Klinik: Ns. Dipa Handra, S.Kep PROGRAM PROFESI NERS B 2018 FAKULTAS KEPERAWATAN UNIVERSITAS RIAU PEKANBARU 2020PROCEEDINGS LU: Proceedings on Heath and Mena Vol 42018 ‘on Health and Medicine AUDITORY STIMULATION OF QUR’ANIC MUROTTAL ON PATIENT WITH TUBERCULOUS MENINGITIS Raudha Timi Farid’, Sri Yona” 1. Faculty of Nursing, University of Indonesia, Citayam, Bojong Gede, West Java, 16922, Indonesia 2. Faculty of Nursing Universitas Indonesia, Prof. Bahder Djohan Street, Depok, West Java, 16424, Indonesia E-mail: raudha.jlmi@ui.ac.id, sriyona@uiacid Abstract Objective:One of serious complications of tuberculosis is wberculous meningitis that affects the brain. Headache and pain are among clinical signs manifesting in patient with TB meningitis. Modification of interventions to treat pai in clients with TB meningitis is necessary, Providing stimulation of Qur‘anic Murottal as an effort to relieve pain may be used as a modification of intervention, ‘Methods: This study used case study analysis of patient with meningitis TB in Neurology Ward of RSCM for 7 days. Patient was provided with murottal al quan stimulation for seven days and the level of pain was evaluated by using ‘Adult Nonverbal Pain Scale instrument. Results: The study result indicated that there was a decrease in pain level according to Adult Non-Verbal Pain Scale (ANVPS) score from 7 0 1 Conclusion: The development of further research in audio stimulation application of murotial al quran on client with ‘TB meningitis should be conducted as an innovation of nursing intervention for client affected by pain, especially TB. meningitis Keywords: meningitis, murottal al qur‘an, pain, tuberculosis Introduction Indonesia is one of developing countries with high density population. The population density is not evenly distributed throughout Indonesia, but is concentrated in several major cities. Unequal population density is caused by urbanization. It is projected that by 2035 the level of ational urbanization in Indonesia will reach 66.6%, with DKT Jakarta claimed the highest percentage of urbanization in 2035 reaching above 80'. The high rate of urbanization will certainly have ite ewn impact or impact on the life of big cities in Indonesia, one of which will have an impact on the health aspects of urbaa society. One of the health problems caused by population density that spread through the respiratory tract is TB (uberculosis). The most severe complication of tuberculosis that may affect human brain is called tuberculous meningitis. TB meningitis is one of the International Nursing Studert Symposium and Festival 2018, ‘efious complications due to invasion of TH bacteria into brain tissue. TR meningitis occurs when M. tuberculosis bacteria enters the brain causing inflammation and the brain will show a decline in function. Inflammation also results in pain due to increased pressure within the brain. Meanwhile, decreased bruin fu tion can cause an altered Some interventions that could be provided include providing a stimulus that wiggers brain work or stimulation that prevents worsening of the brain's functions. The stimulations include touch, sound and light activity. Several previous studies suggested that ‘one of the interventions that could be applied in neurological rehabilitation was music-based intervention, These interventions include listening to singing, or playing a musical instrument. The results of previous studies showed the influence of ‘music-based intervention on cognitive function, amotoric and emotional function in patients with several neurological disorders, Music-based interventions provide positive impact on motor movements, speech, and cognitive abilities in clients”, Music-based therapy is also an effective intervention to be applied to clients with chronic pain, migraine, and clients with chronic tinnitus *, Several experimental studies have heen conducted to analyze music therapy for pain. One of the study suggested that there were statistical differences that showed clients provided with music therapy had a 70% greater likelihood of a 50% reduction in pain than Clients who did not listen to music’. ‘Music therapy can be modified according to the characteristics of the patient and family. One of the music therapies that can also be applied by prioritizing the spiritual aspect is listening to al-quran, Previous studies related to audio stimulation analysis of murottal al-qur‘an Ar-rahman’s letter was performed at maternal labor when 1™ phase was active. Based on the aforementioned phenomena and descriptions, authors were concerned to analyze the application of the intervention of music stimulation ‘modification by using murotal al-qur’an in nursing clinical practice with a health approach to urban problems. Audio stimulation intervention with murottal al-qur'an was applied to client with TR meningitis affected by headache and treated in neurology ward of Cipto Mangunkusumo Hospital. Method This study method was case study. This study was conducted by conducting a literature study on pain intervention modification, then applying it to client for seven days. After seven consecutive days of iervention, an evaluation of murattal al qur'an audio stimulation of TB meningitis client pain was carried out, Result After initial assessment, data analysis was obtained with three main nursing problems, The three main nursing problems based on data analysis included ineffectiveness of airway clearance, ineffectiveness of cerebral tissue perfusion, and acute pain. Then, the intervention of nursing care was provided to client for seven days. One modification of the intervention was applied on the problem of headache felt by the client. In the initial assessment of pain using the Adult International Nursing Stodert Symposium and Festival 2018 U Proceedings on Health and Medicine Val 4 2019 ‘Nonverbal Pain Scale, the client's pain score was 7 or severe pain. Interventions were provided with the fallowing conditions: 8. The intervention was applied whether the client dil ordi not fet pain b. The simulation provided was mot a- quran ofdur2, «The stimulation is proved by using a rotating device vias celphone connected tothe headset tothe clients ear Pain assessment was performed atthe initia assessment an every day afer the intervention The stimulation was given for 30 minutes, The simulation was given st 1000 WIB and 16.00 WIB,wvice in one day ‘fier the intervention was applied for 7 consecutive ays, the client showed development on the seventh day as indicated by no signs of headache both during the day and at night In addition, stiffness in both client extremities after observation appeared to be reduced. Following is the able of client development after being provided with audio stimulation intervention of ‘muroital al-qur'an. Table 4.2 Evaluation jate Face Activ fp Total ity tion ‘Score se _ T os 22 2 0 Oo 6 ous 2 1 2 0 O 3 oss 2 2 0 9 5 os 2 1 1 0 0 4 oss 1 1 0 4 3 0905 0 I 1 0 0 2 1005 0 oo o 1 Discussion Based on the results of the intervention, the client experienced a decrease in pain level after provided with intervention for the past 7 days. On the last day, the client showed no signs of grimacing and decreased stiffness in the extremities. Both client extremities were more relaxed than previous position which suggested abnormal flexion, but on the last day of intervention the upper limb was straight along the body line. The client's fingers were more flexible and the range of movement of the client joint increased. The family also said that clients did not show signs and ‘symptoms of pain at night and could sleep soundly. During the intervention procedure, the client seemed calm, responding occasionally to the eye followed by eye movements that have not followed the response.He was also asleep during the intervention. The client's facial expression generally showed a calm expression out grimace or frown. Based on the results of the 7-day intervention process, murottal al-qur'an therapy was effective on pain in recovery phase characteristics. ‘The client had gone through the critical phase of the main pathological condition which generated headache with a scale of severe headache with a scale of 7 points to mild (score 3-6). Client with severe pain scale 8-10, especially in the critical phase require additional intervention including the medication and primary lweatment of the main pathological conditions of the client which caused by inflammation of the brain. Murottal al-qur'an audio stimulation is also effective as one of the programs planned for home care, so that it may included as a point of education in discharge planning to the families before client is discharged and «doing home-care. Decreasing level of pain can also be explained through hormonal mechanisms. A study was conducted ‘experimentally on two intervention and control groups. In the intervention group given music therapy there was a decrease in cortisol levels, while in the control group that did not use music therapy there was an increase in consol levels, ‘The same thing was also applied in studies. that analyzed the effect of murottal quran therapy on pain in ts with burns. The results of the study showed that, the treatment of listening to the Qur'an reduced pain scale up to 2 scales®. An investigation also revealed that the effects of music therapy on clients with bun and showed positive correlation between music stimulation and lower level of pain, anxiety, and pulse in patient with bum’. This indicates that the provision of audio stimulation of music or murottal alquran to the clients provides great benefits for client’s comfort. ‘The application of musie stimulation can be explained scientifically and evidenced by evidence-based through the explanation that gate control theory can reduce the level of pain. This theory explains that somatosensory stimblation (such as palpation, joint stiulation) in the five senses can generate nerve impulses that will be transmitted by three systems located on the spinal cord. ‘The three systems include subantia gelatinosa on the dorsal horn, dorsal coloumn fibers, and the center of cell transmission that affects the nociceptor impulse. Pain stimulation is influenced by the ‘gate mechanism’ When the gate closes, stimulation of large nerve fibers International Nutsing Student Symposium and Festiva! 2018 U. Proceedings on Health and Medicine Val 4 2019 will inhibit the transmission of pain. However, stimulation of small nerve fibers makes the gate open. ‘This gate mechanism is affected by descending nerve impulses from the brain. This theory explains that large nerve fibers can activate selective cognitive processes through the modulation properties ofthe spinal cord®. ‘The theory also proposes that sensory modulation of pain depends on stimulation of intemeurone inhibitors becween first-order nociceptive neurons of peripheral- onler nociceptive neurons and second-order spinal tacts. When stimulation is given by A-delta fibers, the fate will open, and interneurons allow the transmission Of pain to the brain. The interneuron is also stimulated by a neurotransmitter glutamate from the large- diameter A-beta sensory fibers that transmit sensations such as touch or pressure. When stimulated by A-beta fibers transmission of the sensation of pain through the interneuron is inhibited and the ‘gate’ is said to be closed”. That way, inhibitory interneurons can affect the descending inhibitory pathways of the brain. These descending neurons secrete neurolransmitters, such as serotonin and adrenaline which will suppress pain. Inhibitory inhibitors also secrete peptides such as endorphins and encephalians which are natural opioids and inhibit pain. This explains that psychosocial support for clients with pain will have a major influence on decreasing client's pain levels. The action of rubbing the area hit on the body, relaxation with touch, relaxation with audiovisual stimulation are some efforts that utilize the gale control theory to reduce the level of pain with rnon-pharmacological management. Therefore, giving the intervention of audio stimulation of music to client ‘with pain can be done as an effort to reduce the level of pain. In addition, somatosensory stimuli on clients ean also be applied through passive ROMs and touches from nearby families. Listening to music scientifically is also able to improve the connectivity of brain neurons in healthy individuals. Meanwhile, musical activities can also increase neuronal plasticity and induce white matter 2 changes and gray matter in some parts of the brain ‘An experiment also indicated that thatthe level of p in the intervention group experienced a significant decrease compared to the control group", ‘Audio or auditory stimulation is not only in the form of | murottal quran. Previous research has also been conducted by analyzing audio stimulation with various, 6types of music. One research that analyzes music therapy as one of neurologic therapies revealed that listening to music may reduce the level of stress, anxiety, and pain in clients, so itis also recommended for neurological rehabilitation interventions”. In addition, the provision of murotial qur‘an stimulation interventions can be done by listening to certain letters and verses. Some choices of verses of letters that ate used can be in the form of verses that explain the motivation of life, patience through life, or other verses that can emotionally provide a therapeutic effect for the client, Murottal stimulation ean alsa be combined wit ng sequential stimulation from 1-30 juz ean also be done. ‘This makes the client more varied in listening to the verses of the Qur'an. listening to the translation of the verse. Provi Conclusion Based on the scientific work that the author has described above, it can be concluded that tuberculous meningitis is one of the complications of the pathological conditions of pulmonary tuberculosis, Which many people experience with dense populations and less clean environments. Tuberculous meningitis, results in an increase in intracranial pressure caused by inflammation that occurs in the meninges membrane. Increased intracranial pressure can then affect level of Loss of consciousness due to meningitis increases client's need for special care. One of the most common linical manifestations experienced by individuals with meningitis is severe headache. The author analyzed jerventions that can be implemented to relieve the level of pain in the form of audio stimulation of rmurotial quran. The results of the analysis of interventions carried out for 7 days in a row found that the client experienced a decrease in pain level which also had an impact on joint mobility and increased seep time from before. Based on this study, giving music stimulation in the form of muroutal quran may be implemented in a neurological rehabilitation program. Recommendation ‘The author hopes that the results of the analysis serve 1s inspiration and innovation in providing nursing care for clients with neurological disorders, especially meningitis. Modification to the intervention is required according to the characteristics of the client and family. Nurses may implement an evidence-based practice, especially in modifying audio stimulation to pain clients in a neurology ward. International Nursing Stadert Symposium and Festival 2018, U. Proceedings on Health and Medicine Va. 4 2019 ‘The author realizes that there are many limitations in thie study. ‘Therefore, the authors hope that further research will be carried out on the analysis of the relationship of interventions to clients with neurological disorders with a larger sample population. In addition, the provision of audio stimulation as an intervention that the author did on this scientific work, can be modified to the variable according to the characteristics of the existing client. References 4. Cental Bureau of Statistics. Badane Pusat Sis. (2013), Proyetat Pond Indonesia 2010-2035 Inks Badan Pusat Statistik 2. Sivonen Aly SusinoTLeo. V, Tervenoms Malisauller ESoinla $017)» Msicchsed interventions fs neurological ebabiltaie, Te Lance eulogy te 8) potted. Ips ora/t00L6 1474-44227 30688 a, Neel, AK. Hilecke, Arpt, Hoey, 1. V. (2005) Outcome research in use therapy: a step on he Tong road to an evidence-besedtetmen. Annals of the New "Yor Acsemy of Selneen 1050, 282-293 pore. lata 360.05, 4, The Joanna Riggs Iie Rest Prsctce Infomation Shea Masi a intervention in hogpial. Narang & Health Sciences, 150 99-102. dor10.1N11§.1483- 20182011 00583etesol”Seand, 57!" 1O1G-1016 (11a. 13100 5. Graversen, M. and Sommer, T. (2013), Soft music in laparoscopic cholcysnaomy. Aca Ana Tha onan ‘Brig. Intute, 2011. 6 Ramiyan, tl 017). Pengsah Terai Mural AL Quran Teshadap Nyert pais Pasion Lok ala al Repent din Kebanan VoL3, Noo, AST? "Dh, Le Wang. 2017), The effets of music Intervention brn plicnts dsing etn procednes 2 oyrematic review and meta-analysis of randomized Conioled wal. BANC Complementary and ‘Aamatve Medicine, 17.138. fd 10.1 18812905 017 1665-8 8 Les. SL GOL). Aedical surgical nursing seston ad management of clic problems. 3. tens Misoar: Ehevier 4. Soe Wi 2011) Netonlence Norsing Evidence Bised Pragices UK: Wiley Blaskwel. 10.Kilie PS. Karadg,G. Oye, . Kale, 0. Ze S., Onder, and Resan, EA. O13), emergency deprient. pan Joural of Nursing Scene, Tatde83 de 0.11 jes 12087 7R SES Qe STANDAR OPERASIONAL PROSEDUR (SOP) Oleh: Rachmat Isthadi, S.kep ‘NIM: 1911438055 Preceptor Akademik: Ns. Gamya Tri Utami, M.Kep Preceptor Klinik: Ns. Dipa Handra, S.Kep PROGRAM PROFESI NERS B 2018 FAKULTAS KEPERAWATAN UNIVERSITAS RIAU PEKANBARU 2020SOP EVIDANCE BASED NURSING TERAPI MUROTAAL AL-QUR’AN. Pengertian Terapi Murotaal adalah rekaman suara Al-Qur’an yang dilagukan oleh seorang qori (pembaca Al-Qur'an), Iantunan Al-Qur’an secara_fisik ‘mengandung unsur-unsur suara manusia Tajuan Menurunkan hormon-hormon stress, mengaktifkan hormon endrofin alami, ‘meningkatkan perasaan rileks, dan mengalihkan perhatian dari rasa takut, ‘cemas dan tegang, memperbaiki sistem kimia tubuh sehingga memurunkan tekanan darah serta memperlambat pernafasan, detak jantung, denyut na dan aktivitas gelombang otak ‘lat dan Bahan = Earphone - MP3/Tablet berisikan murotal (Al-fatihah) Kebijakan Prosedur ini dilakukan oleh peneliti dalam mengurangi rasa nyeri yang dirasakan oleh klien tuberkulosis meningitis Prosedur Persiapan : 1. Menyiapkan alat dan mendekatkan kearah pasien 2. Meneuci tangan 3. Persiapan lingkungan 4, Menutup sampiran 5. Memastikan privasi pasien terjaga Pelaksanaan : 1, Mencuci tangan 2. Menghubungkan earphone dengan MP3/ablet berisikan murottal (Al- fatihah) 3. Pasien berbaring diatas tempat tidur 4, Letakkan earphone di telinga kiri dan kanan 5. Dengarkan murottal (Al-Fatihah) selama 15 menit 62 detik Terminasi : 1. Evaluasi hasil kegiatan ‘Simpulkan hasil kegiatan Berikan umpan balik positif Kontrak pertemuan selanjutnya Akhiri kegiatan dengan cara yang baik Bereskan alat-alat 2 awe ED Cuci tangan ‘Ruang GBST Cantal IRSUD Anifin Ahmad