documents.tips asuhan keperawatan klien dengan gangguan sistem pencernaan

8/18/2019 Documents.tips Asuhan Keperawatan Klien Dengan Gangguan Sistem Pencernaan

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ASU H AN KEPERAW ATAN

KLIEN D EN G AN

G AN G G UA N SISTEM

PENCERNAAN


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SIROSIS HEPATIS

DEFINISI : PENYAKIT KRONIK DENGANKARAKTERISTIK PENGGANTIAN JARINGANNORMAL HATI DENGAN FIBROSIS YANG

DIFUSE YANG AKAN MERUBAH STRUKTURDAN FUNGSI HEPAR ( BRUNNER ANDSUDDARTH, 2000).

PENYAKIT KRONIK DAN PROGRESIF YANGDICIRIKAN DENGAN PERLUASAN FIBROSISDAN PEMBENTUKAN NODUL( BLACK ANDMATASSARIN-JACOBS,1!).


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ANATOM I DAN FISIOLOGI HEPAR

FUNGSI HEPAR

- "#"$%&'*+ #"$#'

-"#&/+*"# %&+'%

( /+&##*+*,/+&#&/+*+*,"#3+"$/+&#,"# /&* ' 4%&*"#5'+ /+&#)

-"#&/+*"# /#"( &*+'*+ *" /#""#5'+ ##%+,"#"#/+$&$%&#+,"#*+#* &/#*#%&/,'4&*4&/+$+',"#*+#* /#" '%+ $%&#+ '%&+'%).


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Lanjutan fungsi hepar,…

- "#&/+*"# $%&#+ : '#"+*+*" "+&,"#"# %# '%+"&+ 3 '+ '%+ ,"#"# $/*"$%&#+,+&%*4&%"*+ &%"&,&-& ' 6 /+.)

F*+ *+%/*+ : "#"$%&*#* /#+'%+ 1000 "/ '% $#%"#+ "#//+*+*&+'3 '%+ 7# $&%/.


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Eti!gi "an fa#tr resi#

F&% %#*+& :

1.$#3/ /&&/.

2.%+83 #/% '# /&&/+*"#.

9.*+%&*+* +//+%3 : $%+"#% +%#$+;&/#**+*.

*#'#% &*%*+ */%

#"$#' #*%#$+.


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Lanjutan,…

>.&#*+ #$% + / 5 .

!./ 5 3 /".

?.$#3+ $.

S+%&*+* /##; *+%&*+* "+;%&&'/%

D++ &/# "/%+*+ '%+

$#3/ /&&/ + '%+"/%+*+ " #%# /#" '/" *#/+ *#+ "#"# *+%+ 3"#3#% /*.


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Lanjutan,…

S+%&*+* $&* #%&+ :

#%&*+* "*+4 '+*# &/#

#$&&*+ 3 +*3 ";/*##/ "#'#%+ $#3+ #$++*.

S+%&*+* +//+%3 :

S+%&*+* ++ "#;$ 5%+ @%&*+*'+4* ' *+%+ *#+ + '%+&*%*+ ' +4#*+ +/+#% 3%&+*.


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Sirsis $ar"ia$

A'/ : "#%$ *#'#% '%+ / 5 '# &#*+ 7# #$% 3#%#$5.

PEMERIKSAAN LABORATORIUM DANDIAGNOSTIK

1.$#+ #63" + : SGOT,SGPT,LDH.

2.$#% *#%" /"+.

9.$#+ $%&%&"+ +"#.


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Lanjutan,…

.$' CT *; '$ '+/+ #,#*% ' '#*+* #$%.

>.+&$*+ +*&/&+* "+%&*&$+ '+&*+* '#@++4 ' *##/#.

P#/* "#'+* 1. "#&%&/ &"$/+*+, *$ *+#*,

$#%'% 7%+*#*#*&4*,#;#$/&$3

#$+",*+'%&"


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Lanjutan,…

2. "#"*+"/ 4*+ #$%, '#'+# 3 #%+*+,+*+% 3 '#,'$#"#%+ &%+&*#%&+' "#%+

"+4#**+ *+%&*+* ' "#"$#%++ 4*+#$% ( *+%&*+* $&*#%&+).

9."#&+ $#3#3,*#$#%+$#"$% 6 #$&&*+

'++/,+' "+" /&&/,&*%*+#"$#' '++/.


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%& p!i#asi sirsis

H+$#%#*+ $&%/

P#/* "#'+* $' $#%'%7%+;#* "#/+$+ :

-7*&&*%+&%( 7*&$%#*+,$+%#*+ *&"&*+), "#% # $&%/*#"#%.

-/&#% # '%##%+( $%&$&/&/,"#&$%&/&/,#&/) #4#+@*3 #%*% "#%+ '#3 5 5# '% ' "#$+ "+4#**+8/ +$&/+#"+.


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Lanjutan,…

- //& "$&'# , "#"#%+ $##$' 7%+*#* 3 %$% * '$"##+ $#%'%. M#

*#*#-/#"&%# # 3 '+"*# /" ' /& 3 '+#*&$* '*#% '+$&"$, /& #*&4* +' &/#'++% '/" #' "##" /#+'%+ 2< 5" ' $#%/ '+/#$* *#;% $#%+&'+* +' #%5'+ #%&*+*,*#/+ + 5 $#%/ "##/% *#%#*+ */+7 3#%"/*+ '&* /&, "#;#*$+%*+.


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Lanjutan,…

S;/#%&#%$+ ( */#%&*+* 7%+;#*"#/#/+ #'&*&$+),"#3+ 6*/#%&+ *$ "&%%# *&'+" #7%+;#*. P' 8/3 "#3#+"*+ '+'+ 7# ' #"'+@%&*+*. D+/ #%/ /+

'/" ##%$ "+. L+*+ 7%+*#* "#//+ #'&*&$+


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Tin"a#an pe& 'e"ahan

H3 '+/ $' $*+# 3 +'#%#*$& ' %#"# 3 /+ $'$*+# 3 *' #%//+ '+ */#%&#%$+

#$+ "*+ #$ #%5'+ $#%'%.

M5#"# $%# &$#%*+

M#+/+ &'+*+ @*+&/&+ ' #*+$ &$#%*+,

"#/+$+ $#5+ #%&/&+*, %#*$+%*+ '*+*#" %#/, $= /,%+/+*,AGD,$#"# '%,"&+,#/#%&/+,$%&#+,#63",*#% ** %+*+.


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Tin"a#an pe& 'e"ahan

M#/ *&"&*+* '%+ *+*#"$&%/ 3 #3 ++ # *+*#"7# *+*#"+ 3 # %#',5

+' ++ '/,: 1."#%+ /+% '% $&%/ *

'$ "#;# $#%'% 7%+;#*.

2."#"$#% /+% '% ##$% "#;# #;#$/&$+#$+" ' #%* #$%.

9."#+ %* 3" /+#.


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M anaje& en pst perasi

- "#/ "&+&% #%5'+3$#%'% ' +$&7&/#"+.

-#+'*#+" ;+% ' #/#%&/+.

- +%" ' 4%##*+ $#%4*.

- +$&/"+#"+.

-+$&/+#"+

M+4#*#*+ +4#*+ ( '#"", /#&*+&*+* ) -$#+ %* 3#%+.

-$#% + #*'%.


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#& p!i#asi

- ;#%+"+

- DIC ( '+**#"+#' +%7*;/%

;&/+& ). - CHF

- $#"# $' *

- #;#$/&$+ #$+".


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%& p!i#asi,…

A*;+#* '/ "/*+ ;+% '+%&$#%+&#/.

9 "#+*"# 3 "#5#/* #%5'+3 *;+#*:

1.+$#%#*+ $&%/ "#+ $#+# +'%&*+.

2.$#% $%&'*+ /"+ "#3#$#% # &*"&+ &/&+'.

9.$#% 7&/"# *+%/*+ "#3#+$#%/'&*#%&+*" 3 "#+ %##*+%+" ' +%.


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Peng#ajian (

- $#%*+ '&"# ( *+4+ '//#* )

-"#% /+% $#%.

-"##$ $#% ( $$+ '&"#) "#/+ #/&" ;+%.

T#* '+&*+ :$%;##*+*,USG,CT *;.


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Penata!a#sanaan & e"is

T5 : "#"$#%++ #+'*#+" ;+%' #/#%&/+ ' "#"$#%++ N "#//+ %#/' "#"*+ ;+% ' %+".

T#%$+ '+%#+ : *$+%&&/;&#( /'&#),/"+ 10 % "#+ +$ /+#%;+% *+#* 3 +/.

T#%$+ '+# : %#' %+" '# $#"*;+%, +# $%&#+ 3 *#', #;/+ '

"+4#**+ #;#$/&$3 #$+". K&"$/+*+ $#% $&/ 4*, %$%

"+/+".


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En$epa!fat) hepati#u&

T#%5'+ $' +5%+ #$% 3 #%, /+,.

P#3# : #+'""$ #$%

"#"#&/+*"# "&+ "#5'+ %#","&+ '$ "## *+*#" *%4 $*.

D+'+ '# : $#+ "&+ '+'/" '% ' ;+% *#%#%&*$+/.

S#+$ $%&*#* 3 "#+ $%&#+ '+'/" ** *#$#%+ $#+ +# $%&#+ $#%'% GI * "#+ "&+ '/" '%.


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M anifestasi #!inis

P#% + #*'%, $#%"#"&%+, $#%+,&*#%*+,%#*$&,$#% $+/ +'%.

T5 $#/*

-"#&%&/ "#%+ $%&*#*

'###%*+ /#+ /5. - "#"$#%++ "#;# 4&%

$#;#* #;#$/&$3.

-"#"$#% 4*+ @*+&/&+*.


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Prinsip penata!a#sanaan pa"a en$epa!pati

1. "#%+ $%&#+ '+ +#*+.

2."#;# $#%'% GI %* 5+#%5'+ *##% '+#/%.

9."#%+ #%+ 3 "#"$%&'*+"&+ ' #&"+;3 +' '+*&%*+ #*+%/*+ ' //&* "#%+ *&%*+"&+.


24/45

Lanjutan,…

>."#;# +4#*+.

!.+' "# &- &

#$&&*+. ?. %#*%+*+ $%&#+ 20-


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M asa!ah #epera* atan

1.$#% %+*+ % '%+#.

2.$#% ( #/#+ ) 7&/"# ;+%.

9.%#*+& ++ #%5'+3 #%*+#%+* /+.


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K%+#%+ *+/

I#%7#*+

E7/*+ D&"#*+.


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AS+HAN %EPERA ATAN %LIEN DENGAN%EGANASAN %OLORE%T+M

M#%$ #"$ #*

#%*#%+ '%+ */% ;#%. P#3# # 9 '%+ *#" #"+

+ #% '+ USA.


28/45

eti!gi

T+' '+#+ *#;% $*+.

F&% $%#'+*$&*+*+ :

-&/++* /;#%*+,$&/+$*,#+*" ++ /#",' %#'*#%, %+83 #/% '#%*+&" &/&, *+


29/45

%!asifi#asi hist!gi

A'#&%*+&" #%'+#%#*++,*#',%.

A'#&;%*+&" "*+&*"( #%/#'+%)

K%*+&" *#/ *"&*.


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Penentuan sta"iu&

-siste& D+%E.S / A. : #%* $' '+'+ **.

B. : "##"* /$+* "*/%+*

"&*. C : "#**# #/#5% /+"4#

C1 : ##%$ #/#5% /+"4# '#

"&%, C2 : '/" #/#5% /+"4# 5 '%+

"&%.

D. : "**# 5


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Pe& ge!& p#an sta"iu&

S'+"

0 TIS ,N0,M0

I

T1,T2,N&,M&

A II T9,T


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T N M 0T+M OR NOD+L

M ETASTASE T"&% $%+"#% (T) T= : "&% $%+"#% ' '$ '++/+.

T& : +' ' "&% $%+"#%.

T+* : %*+&" +*+

T1 : +7*+ "&% '+ /$.* "&*

T2 : +7*+ "&% '+ /$.&& $%&$%+

T9 : +7*+ "&% "#/#8+ && $%&$%+ #* *#%&*.

T< :+7*+ "&% # &% *%%*#+%3 '$#%+&+" 7+*;#%/.


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%e!enjar !i& fe regina! -N/

N : #/#5% /+"4# %#+&/ +' '$'++/+.

NO : +' '+'$ #/#5% /+"4# %#+&/.

N 1 : "#**# '+ 1-9 #/#5% /+"4# $#%+;&/+; $#%+ %#;/.

N2 : "#**# '+ < /#+ # /+"4#$#%+;&/+ $#%+ %#;/.

N 9 : "#**# $' #/#5% /+"4# *#*+" $#"/ '% ' $' #/.A$+/.


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M ETASTASE 1A+H -M /

M : METASTASE JAUH TIDAK DAPAT

DINILAI.

M0 : TIDAK ADA METASTASE JAUH M 1 : TERDAPAT METASTASE JAUH.


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PATOLOGI

9 +$# %*+&" &/& ' %#;"

( "%&*&$+ )

1. +$# $&/+$&+' 7##+4

#%" '+ *#" ' &/&*;#'#.

2.+$# *+%*

&/& '#*#'#,*+"&+', ' %#;".

9. +$# /*#%+4

%#;".


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M anifestasi #!ini#

K&/& :

P#% BB

A&%#*+ N*#

&"++

N3#%+ '+* "+/+* A#"+

T#% "**


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M anifestasi #!ini#

K&/& +%+

P#%'% %#;"

P#% $&/ BAB T##*"*

O*%*+

N3#%+ '+8 "+/+*.


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Pe& eri#saan penunjang

C&/& '%

F&& %&# '# %+"

K&/&&*&$+ USG '&"#

CEA ( ;%*+"%3&+ +# )


39/45

Penata!a#sanaan & e"is

P#"#'

R'+*+

K#"&#%$+ T#% '%+ 5#+* %*+&".


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Penata!a#sanaan #epera* atan

P#5+ :

N3#%+ '&"#

K%#%+*+ 4#*#* R+83 &/++* /;#%+4,$&/+$

&/&%#;/.

R+83 #/% K#+* "

P#% BB

P#"#%+* @*+


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Diagnsa #epera* atan

R#*+& '#4#*+ 7&/"# ;+% '"

P#% %+*+ % '%+# ' *# '&%#*+.

C#"* ' $#"#' ' '=

#% G &'3 +"# ' ;&/&*&"+


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tujuan

M#"$#% ;+% '#/#%&/+

M#;$+ $#"* %+*+ 3&$+"/.

M#% #;#"*.

M#+ $## #$%&*#'% $#"#', '+&*#%.

M#"$#/5%+ $#%8 ;&/&*&"+,

$#%+ #%'$ $#%* /+#.


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Pasien "engan #!st& i

H+'%+ " 3 #%"#3# ' "#' *.

B /+# "#+'#+@*+" 3 '$ "#3#'+%#.

A5% /+# "+" "++"/

2 /% % (5+ +' ' &% +'+*+).


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I#%7#*+ #$#%8

I"$/#"#*+

E7/*+ '&"#*+


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Terimakasih dan wassalamu’laikum

wr. Wb.