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com

Background
Metabolism literally means change. In terms, metabolism is all chemical reactions that occur in
organisms, including those that occur in cells. Metabolism is an effort to form energy at the
cellular level so that cells can survive. Metabolism can be divided into 2 categories, namely
anabolism and catabolism. Anabolism is the process of synthesizing complex molecules from
simple molecules, while catabolism is the breakdown or breakdown of large complex molecules
into smaller simpler molecules. Anabolism requires energy to form complex molecules, whereas
catabolism releases energy when breaking down complex molecules into simpler molecules.
Anabolism and catabolism reactions take place in body cells simultaneously and occur
continuously.
Critical patients are patients who are physiologically unstable, so they experience a complex
hypermetabolic response to trauma, pain experienced which can change the body's metabolism,
hormonal, immunological and nutritional homeostasis (Menerez, 2012). Critically ill patients
treated in the ICU mostly experience multi-organ failure and require technological support in
patient management (Schulman, 2012). Patients admitted to the ICU generally vary, namely
elective patients after major surgery, emergency patients due to major trauma, stress due to
trauma, injury, surgery, sepsis or respiratory failure. This situation can lead to an increase in
metabolism and catabolism which can lead to malnutrition (Menerez, 2012).
Critical patients in the ICU are required to undergo bed rest. Stabilization of hemodynamic
conditions, installation of various monitoring tools and life support, postoperative patients and
decreased level of consciousness both physiological and sedation programs are challenges for
nurses to mobilize critical patients. The complexity of the therapy program and monitoring of
critically ill patients requires nurses to be able to continue to focus on stabilizing the condition of
respiration, circulation and other physiological status to maintain the patient's life. This causes
mobilization is sometimes missed by nurses (Menerez, 2012).
Bed rest for critical patients that is too long will cause problems, increase morbidity, mortality,
prolong treatment time, and increase treatment costs. Bed rest or changing positions is an
intervention that nurses can do to minimize these problems. During activity or exercise, it will
maximize 60%-75% oxygen intake and increase antioxidant production (Perme et al.
2009). Early mobilization of critically ill patients on ventilators has benefits significantly increase
muscle strength and breathing in three and six weeks, but it can also improve the patient's
functional outcomes (Ling-ling, 2006).
Positioning is usually accomplished by moving the patient between the right and left laterals
followed by another body position such as the supine or semi-supine position (Kim 2002; Shively
1988). Several body positions can affect the development of the lungs and chest wall. Lung
volume and gas exchange can be affected by changes in position as well as pulse rate (Ignatificius
& Workman, 2006).
This research is a qualitative research with a case study design. Case studies are included in
descriptive analysis research, namely research conducted focused on a particular case to be
observed and analyzed carefully. In the case study, it is necessary to conduct a sharp analysis of
the various factors related to the case so that an accurate conclusion will be obtained. Data
collection in this study was carried out on August 26 - October 4, 2019 at the ICU of Tugurejo
Hospital Semarang. Participants used to carry out early mobilization were 6 patients with criteria
for adult patients (> 18 years) and admitted to the ICU, no signs of increased intracranial
pressure, and stable hemodynamic conditions (blood pressure, heart rate, respiration rate, and
body temperature). ).

DP: http://eprints.ums.ac.id/78535/3/BAB%20I.pdf
https://id.scribd.com/doc/291226674/makalah-metabolisme