Asuhan Keperawatan Sistem Integumen POKOK BAHASAN ; 1.ANATOMI DAN PHYSIOLOGIE KULIT.. 2.PENGKAJIAN KULIT 3.ISTILAH-ISTILAH YANG DIGUNAKAN PD DERMATOLOGIS. 4.DIAGNOSTIK DERMATOLOGIS. 5 PENATLAKSANAAN DAN KEPERAWATAN GANGGUAN PENYAKIT KULIT. 1.ANATOMI KULIT. KULIT meru!"!# $r%!# &!#% !'(#% 'u!!r )!# &!#% !'(#% *e+!r mem*u#%"u+ )!# me'(#)u#%( ,u*u )!r( er*!%!( e#%!ru 'u!r m!uu# )!'!m. Ku'(, ,er+u+u# 3 '!(+!# A. EPIDERMIS. /. DERMIS. 0. SU/0UTANE. HYPODEMIS. A.EPIE!MIS. Meru!"!# '!(+!# +e' e(,e' *er'!(+ mem*e#,u" "er!,(# *!!# u,!m! )!r( e()erm(+ "u"u )!# r!m*u, !%!r +e'-+e' )(*!!#&! me#e%! )!# me'(#)u#%( )!r( *!!&! )e&)r!+(. - Te*!'#&! Te*!'#&! )( "u'(, *(!+! 6 3 mm. - D(,e'!!" ,!#%!# )!# "!"( ,e*!'#&! 1.5 mm. - W!",u W!",u &!#% )(er'u"!# )!r( '!(+!# &!#% !'(#% *!! me#7!)( !'(#% 'u!r 36 !r(. L!(+!#-'!(+!!##&! 8 1. S,r!,um $r#eum +e'#&! +u)! m!,( )!# me#%!#)u#% 9!, "er!,(#. 2. S,r!,um 'u()um *u,(r-*u,(r +e'#&! 7er#(,!#:! (#,( )!# r$,$'!+m! /eru*! me#7!)( r$,e(#. 3. S,r!,um Gr!#u'$+um +e'#&! %ee#%*er(#,( )!# r$,$'!+m! *er*u,(r /e+!r. 4. S,r!,um S(#$+um +e' *e#,u" )!# *e+!r#&! *er*e)! "!re#! r$+e+ M(,$+(+. 5. S,r!,um *!+!'e+e' %erm(#!,(;um e' (#( ,er)!!, !'(#% )!+!r )!r( '!(+!# e()erm(+ - +e' em*e#,u" me'!#(# me'!#$+(, meru!"!# +e'-+e' *er!r#! mu)! me#%!#)u#% (%me# (%me# me'!#$+$m. B. E!MIS " #O!IUM $
/!%(!# *!! )!r( e()erm(+ &!#% "e!)!!##&! 'e*( ,e*!' )!# )('e#%"!( )e#%!# em*u'u )!r!em*u'u '(me)!# ur!, +&!r!: L!(+!# )erm(+ $r(um (#( ,er)(r( )!r( 2 '!(+!# &!(,u 8 1. P!r+ P!('!r(+ S,r!,um P!('!r *!%(!# !,!+ &!#% *er(+( u7u#% +!r!: )!# em*u'u )!r! )!# em*u'u %e,! *e#(#%. 2. P!r+ Re,("u'!r(+ S,r!,um Re,("u'!r(+ *!%(!# *!! &!#% ,er)(r( )!r( +er!*u,-+er!*u, e#u#7!#% m(+!'#&! +er!*u, "$'!%e# +er!*u, e'!+,(# )!# +er!*u, re,("u'(# Ser!*u, "$'!%e# mem*er("!# "e"u!,!# !)! "u'(, +er!*u, e'+!,(+ mem*er("!# "e'e#,ur!# !)! "u'(, +er!*u, re,("u'(# )( +e"(,!r "e'e#7!r )!# r!m*u, mem*er("!# "e"u!,!# !)! !'!,!'!, ,er+e*u,.
#.SUB#UTAN Su*u,!# ,er)(r( )!r( "umu'!#-"umu'!# +e' 'em!" &!#% )(#!m!"!# A)($+! &!#% ,e*!'#&! ,()!" +!m! !)! ,(!-,(! ,em!, !,!u 7u%! !)! '!"(-'!"( m!uu# eremu!#. Gu#! '!(+!# !)($+e !)!'! +e*!%!( *!#,!'!# ,er!)! ,e"!#!# !)! ,r!um! me"!#(+ &!#% me#(m! !)! "u'(, (+$'!,$r !#!+ u#,u" memer,!!#"!# +uu e#(m*u#!# !)!#%!# "!'$r( )!# ,!m*!!# u#,u" "e!#,("!# ,u*u. D('!(+!# (#( 7u%! u7u#%-u7u#% +&!r!: ,e(em*u'u )!r! )!# em*u'u Ge,! *e#(#%. Pem%u&uh 'arah 'an s(ara).
Pem*u'u )!r! "u'(, ,er)(r( )!r( 2 *!%(!# 8 1. A#&!m!# em*u'u #!)( "u'(, 'u!r &!#% ,er)!!, !#,!r! +,r!,um !('!r(+ )!# +,r!,um re,(u'!r(+. 2. A#&!m!# em*u'u #!)( "u'(, )!'!m. Y!#% ,er)!!, !#!,!r! $r#eum )!# +u*u,(+ Pem*u'u- em*u'u )!r! (#( )(er"(r!"!# me#+u'!& 1<3 "e*u,u!# D!r! !)! "u'(,. Peere)!r!# )!r! !)! "u'(, *!#&!" <+e)("(,#&! )(e#%!ru( $'e ;!+$)('!,!+( )!# ;!+$"$#,r!("+( !"(*!, 8 - R!#%+!#%!# )(#%(# !#!+#&er( em$+( - =!+$)('!,!+( m!"! !'(r!# )!r! "e ermu"!!# "u'(, me#7!)( me#(#%"!, +e(#%%! "$#)u"+( !#!+ !"!# ,er7!)(. - Pem*u'u )!r! *er"$#,r("+( !"!# me#uru#"!# !'(r!# )!r! "e Permu"!!# "u'(, )!'!m u!&! memer,!!#"!# !#!+ ,u*u.
Pers(ara)an pa'a *u&it. S&!r!: +(#!' &!#% me#u7u "e ermu"!!# ,u*u ,er)(r( )!r( +&!r!: +e#+$r(" )!# +&!r!: m$,$r(". - S&!r!: +e#+$r(" me#er(m! r!#%+!#%!# )!r( *er*!%!( !"+( &!#% )!,!#% )!r( 'u!r ,er)!!, )( *!%(!# e()erm(+. - S&!r!: m$,$r(" *er%u#! u#,u" me#%er!""!# !'!,-!'!, &!#% ,er)!!, !)! "u'(, . - S&m!,(+ )!# !r! +&m!!,(+. Per'e#%"!!# "u'(,. 1.!am%ut "pi&&i$. Ter)!!, )( +e'uru *!%(!# ,u*u,e,,!( +e*!!%(!# *e+!r !)!'! r!m*u, !'u+ &!#% ,()!" *er!r#! )(+e*u, R!m*u, =e''u+ r!m*u, ,erm(#!' "!+!!r )!# )!!, )('(!,. Ku'(, ,er,!#!m )( "u'(, "e!'! !'(+ )!# *u'u m!,!.!)! m!+! u*er,!+ r!m*u, (#( !"!# me#%%!#,("!# $+(+( r!m*u, =e''u+)( !re! "e,(!")!# u*(+ )!# *!%(!# !7! ,er,e#,u '!"('!"( +e*!%!( *!%(!# )!r( "!r!",er(+,(" Se"+u!' +e"u#)er '!"(-'!"(. Bagian ram%ut + 1./!,!#% r!m*u, &!#% "e'u!r )!r( ermu"!!# "u'(, 2.P$'("e' R!m*u, ,er'(!, )(*!%(!# e()erm(+ )!# ,er,!!#!m )!'!m )erm(+. 3./u'*u+ (''( *!%(!# *!! "e!)!!##&! mem*e#%"!" )!# )('e#%"!( $'e 7!r(#%!# ("!,em*u'u )!r! )!# +&!r!: )(+e*u, !(''! )erm!' &!#% mem*er("!# r!+! )!# #u,r(+( !)! r!m*u,.
Lapisan ram%ut + 1.P!'(#% 'u!r )(*u#%"u+ $'e Ku,("u'! r!m*u, 2.K$r,e". '!(+!# ,e#%! meru!"!# *!%(!# u,!m! )!r( r!m*u, "!re#! me#%!#)u#% (%me# &% me#e#,u"!# !r#! r!m*u,. 3.Me)u''! *!%(!# !"+(+ +e#,r!'&!#% ,er)!'!m. !am%ut 'i&eng*api ,&eh + 1.Ke'e#7!r Ker(#%!, "e'e#7!r +u)$r(:er! ,er)(r( 2 7e#(+ &!(,u 8
!.Ke'e#7!r e"r(#e ,()!" *eru*u#%!# )e#%!# :$'("e' r!m*u,.,er)!!, )(,e'!!" ,!#%!# )!# "!"( %u#!#&! e;!$r!+( +uu ,u*u e#)(#%(#!#. *.Ke'e#7!r !$"r(#e,er)!!, )( "e,(!" )!# %e#(,!'mem('("( )u,u+ &!#% mem*u"! "e *!%(!# $'("e' r!m*u, mu'!( *er:u#%+( m!+! :u*er,!+. Se+u#%%u#&! ,()!" *er*!u. Ker(#%!, *er*!u !!*('! *ere!"+( )e#%!# *!",er(. .Ke'e#7!r +erume#$+! &!#% !)! !)! '(!#% ,e'(#%! me#%!+('"!# +erume# %e,! ,e'(#%!. ).Ke'e#7!r m!m!e &!#% ,erm$)(:("!+( me#7!)( +e+(!'(+!+( me#7!)( "e'e#7!r &!#% me#%!+('"!# !(r +u+u. e.Ke'e#7!r +e*!e!.+u!,u "e'e#7!r &!#% )(!'(r"!# "e $'("e' r!m*u, &% mem('("( !",(:(,!+ *!,er(()e.)!# e'em*u, "u'(,. :.Mu+u'u+ ere,$r ((''((,! ,((+ $,$, $'$+ &!#% *eru*u#%!# )e #%!# :$'("e' r!m*u,. -ungsi *u&it + 1. Per'(#)u#%!# ,er)! (#;!+( *!",er( )!# er'(#)u#%!# )!r( *e#)! !+(#% '!(##&! - +,r!,u+ $r#eum *!r(er !'(#% e:e",(: ,) **!%!( :!,$r '(#%"u#%!#. - Me#e%! e#e,r!+( 9!,-9!, )!r( 'u!r &!#% *er*!!&!. - Me#7!%! "e+e(m*!#%!# !(r!#. - /!r(er ,r!#+:$r,!+( )erm(+ &!#% )(,er(m! $'e e()erm(+ &!#% !;!+u'er. 2. Se#+(*('(,!+. - :u#%+( re+e,$r #&er( +uu )!# ,e"!#!# *er!,. 3. Ke+e(m*!#%!# !(r!# +,r!,um $r#eum mem('("( "em!mu!# me#&er! !(r )!# *eru+!! memer,!!#"!# e'e",r$'(, ,u*u.)!r( "e('!#%!# !(r!# &!#% *er'e*(!# !"(*!, "eru+!"!# "u'(, P!)! 'u"! *!"!r - >u#%+( (merme!*'e ,er!)! !(r.Se7um'! !(r !"!# ('!#% !"(*!, e;!$r!+( ,eru+ me#eru+ )!r( ermu"!!# "u'(,?66 m'<!r( )(+e*u, (#+(+(*'e !,er '$++. 4. Pe#%!,ur!# +uu.Me#%!+('"!# !#!+ +e*!%!( !+(' me,!*$'(+me m!"!# &!#% memr$)u"+( e#er%(. - P!#!+ !"!# ('!#% 'e!, 8 ! Pem(#)!!# r!)(!+( "e m$'e"u' *e#)! '!(# &% +uu#&! 'e*( re#)! *.K$#)u"+( em(#)!!# !#!+ )!r( ,u*u "e *e#)! '!(# &!#% 'e*( )(#%(# 0.K$#;e"+( er%er!"!# m$'e"u' u)!r! !#%!, me#(#%%!'"!# ,u*u.).E;!$r!+( e.Pe#%e'u!r!# "er(#%!,. 5. Pr$)u"+( =(,!m(# Ku'(, &% ,er!7!# +(#!r u',r!;($'e, )!!, meru*! +u*+,!#+( &!#% )(er'u"!# u#,u" me#+(#,e+(+ =(,!m(# D."!'+(:er$' Me#e%! e#&!"(, r(e,+(! me#&e*!*"!# )e:$rm(,!+ Tu'!#%.
?. :u#%+( re+$# (mmu#e+e'-+e' )erm!' +e' '!#%er!#) (#,er'eu"(# 1 &!#% me#%!+('"!# "er!,(#$+(, )!# '(m$+(, T meru!"!# "$m$#e# e#,(#% )!'!m + &+,em (mmu#e.
Peng*aian Ku&it. 1.R(!&!, "e+e!,!#.,!#&!"!# ,e#,!#% 8 - R(!&!, !''er%( "u'(, )!r( m!"!#!# $*!, !,!u 9!, "(m(! - m!+!'! !)! "u'(, r(!&!, "!#"er. - N!m!-#!m! "$+me,("+!*u# +!m$ &!#% )(!"!( !!"! !)! m!+!'! "u'(, +e,e'! mem!"!( r$)u" ,+*. 2.R(!&!, "e+e!,!# ,!#&!"!# ,e#,!#% 8 R(!&!, !+(e# &!#% re'e;!# )e#%!# "e'!(#!# "u'(, - K!!# !#)! er,!m! "!'( #&! me#%e,!u( m!+!'! "u'(,. - A!"! m!+!'! ,er+e*u, er#! ,er7!)( +e*e'um#&!. - A!"! !)! %e7!'! &!#% '!(#. - D(m!#! '$"!+( ,em!, &!#% er,!m! "!'( ,er"e#! - /%!(m!#! ru!m !,!u 'e+( ,er+e*u, ,er'(!, "e,("! mu#u' u#,u" er,!!m! "!'(#&!. - A!"! ,er)!!, r!+! %!,!' ,er*!"!r"e+emu,!# !,!u +eer,( !)! &!#% mer!&!. - A!"! !)! %!#%%u!# "em!mu!# u#,u" mer!+!. - A!"! m!+!'! ,er+e*u, me#7!)( *er,!!m*! !r! !)! mu+(m ,er,e#,u - A!"! !#)! mem('("( r(!&!, !& :e;er!+,m!*()ur!#e9em!!,!u !''er%(e. - A!"! !)! )(!#,!r! "e'u!r%! !)! &!#% me#%!'!m( m!+!'! "u'(,. - A!"! eru+( "u'(, ,er+e*u, mu#u' +e+u)! m!"!# m!"!#!# ,e,e#,u. - A!"! !#)! me#%"$#+um+( m(#um!# !'$$'. - A!"! !)! u*u#%!# !#,!r! "e7!)(!# ,er,e#,u )e#%!# ,e r7!)(#&! ru!m<'e+(. - O*!,-$*!, !! &!#% !#)! %u#!"!# "r(m+!'e'$,($# u," me#%$*!,( Ke'!(#!# "u'(, ,er+e*u, &!#% )!!, )(*e'( )( ,$"$ $*!, *e*!+. - Je#(+ r$)u" "$+me,(" !! u#,u" er!!,!# "u'(, &!#% !#)! %u#!"!# - A"!"! !)! '(#%"u#%!# )( +e"(,!r !#)! ,er)!!, :!,$r-:!",$r,!#!m!#e!#9!,-9!, "(m(!(#:e",(e - A!"! !)! +e+u!,u me#%e#!( "u'(, &!#% me#(m*u'"!# ru!m.
Pemeri*saan pisi*. Ku'(, meru!"!# erm(# )!r( "e+e!,!# +e+e$r!#% +e!r! me#&e'uru )!# Peru*!!# &!#% ,er7!)( !)! "u'(, umum#&! *eru*u#%!# )e#%!# e#&!"(, P!)! $r%!# '!(# 8 - I#:e",(e )!# !'!+( meru!"!# r$+e)ur u,!m! &!#% )(%u#!"!# )'m memer("+! "u'(, me#%%u#!"!# 8 - Pe#'(%, u#,u" me#&(#!r( 'e+(. - P!"!(!# )!!, )('e!+"!# +e'uru#&! )!# )(+e'(mu,( )e#%!# *e#!r. - Pr$,e"+( )(r( S!ru#% ,!#%!# !ru+ )(!"!( "e,("! me'!"u"!# emer("+!!# "u'(,. T!m('!# umum "u'(, )("!7( )e#%!# me#%!m!,( 8 - W!r#!+uu "e'em*!*!# "e"er(#%!# ,e"+,ur "u'(, "!+!r !,!u !'u+ - Le+(;!+"u'!r(+!+(. - K$#)(+( r!m*u, +er,! "u"u. - Tur%$r "u'(,e)em!. - W!r#! "u'(, )("!7( )e#%!# me#%!m!,( !r#! %!)(#%$"e'!, - Ku'(, &!#% ,er'u"! )("!!+!# &!#% *er("'(m !#!+ )!# *!#&!" !!&! m!,!!r( e#)eru#% 'e*( *er(%me# )!r( ,u*u '!(##&!.
- E:e" ;!+$)('!,!+( &!#% )(,(m*u'"!# $'e )em!m+e#%!,!# m!,!!r( )!# (#:'!m+( !"!# ,er7!)( eru*!!# "emer!-mer!!# !)! "u'(,. - Kur!#%#&! ;!+u'!r(+!+( "u'(, ,er'(!, 7e'!+ !)! )!er! $#&u#,(;!. Ke*(ru-*(ru!# !)! +(!!#$+(+ me#u#7u"!# &$"+(! +e'u'er )!# mu)! ,er'(!, !)! e",erm(,!+)!+!r "u"u *(*(r +er,! mem*r!#) mu$+! - Ku'(, &!#% me#%u#(#% *eru*u#%!# '!#%+u#% )e#%!# "e#!("!# "!)!r *('(ru*(# +erum. Meng*ai pasien 'engan *u&it ge&ap. 1. Gr!)!+( !r#! &!#% ,er7!)( !)! &!#% *er"u'(, %e'! )(,e#,u"!# 8 - $'e ,r!#++m(+( %e#e,(!r#! er!+e)!#% )!# %e'!. P!)! "u'(, &!#% %e'! me'!#(# 'e*( *e+!r )!# 7um'!#&! 'e*( *!#&!" )(*!#)(#%"!# !)! "u'(, &!#% er!. - Ku'(, &!#% %e'! )!# +e!, mem('("( )!+!r "emer!!# u#)er,$#e M(+!'#&! 8 mu$+! *(*(r'()!*(*(r )!# "u"u "e!)!!# #$rm!' *er!!r#! mer! mu)!.
2. Ru!m !)! "!+u+-"!+u+ rur(,u+ %!,!'-%!,!' !ru+ me#u#7u""!# *!%(!# ,u*u &% .%!,!'. 3. Me#)e,e"+( +(!#$+(+"e!)!!# S&$" !)! !+(e# &!#% *er"u'(, %e'! "u'(, !"!# *er!r#! "e'!*u,em!, &!#% !ru+ )(er!,("!# mu'u, *(*(r )!# )!er! ,u'!#% (()!# )!u# ,e'(#%!. - Ku'(, &!#% "er(#% )!# )(#%(# - re+(r!+( &!#% e!, )!# )!#%"!' - De#&u, #!)( e!, - *(#,("-2 )!r! !'u+ !)! 0$#&u#,(;!. 4.Peru*!!# !r#!. - H&$(%me#,!+( /er"ur!#%#&! !r#! "u'(, "!re#! e#%!#ur!# me'!#$+(, - H&er&%me#,!+( e#(#%"!,!# r#! "u'(, *(+! +e,e'! ,er7!)( +e+u!, Pe#&!"(, !,!u e)er! !)! "u'(,. 5.Me#%"!7( 'e+( "u'(,. Le+( "u'(, meru!"!# "!r!",er(+,(" &!#% !'(#% me#$#7$' !)! "e'!(#!# Derm!,$'$%(.mem('("( u"ur!# )!# *e#,u" &!#% *er!%!m. Le+( r(mer meru!"!# (#(+(!' )!# "!re",er(+,(" e#&!"(, (,u +e#)(r(. Le+( +eu#)er $'e "!re#! +e*!*-+e*!* e",er#!' %!ru"!# )!# ,r!um! A,!u eru*!!# !"(*!, "e+em*u!# 'u"! . M!u'! )(!me,er "ur!#% 1m ,e( +(rum+"r(,! . /er!" !, 'e*( )r) 1m,e( (rre%u'!r. . P!u'!)(!me,er "ur!#% 6.5 m.m!+! &% me#$#7$' ,er!*! )!# !)!,. Te( +(rum+"r(,!. . N$)u' 6.5- 2m m!+! &!#% me#$#7$',er!*! )!# !)!,. . Tum$r)(!me,er 'e*( )!r( 1-2 m. ,)" +e'!'u mem('("( ,e( &% ,!7!m. . =e+(e'.)(!me,er "ur!#% 6.5 m.)!# *u''! 'e*( 6.5 m!+! +rum+"r(: ,!me#$#7$' )!# ,er!*! &!#%# me#%!#)u#% !(r!# +er$+!. . /(#,u'm!+! &!#% me#$#7$' )e#%!# *!,!+ &!#% ,()!" 7e'!+,()!" ,r!,ur $'e er(#)!!# !(r!# +er$+! "e)!'!m )erm(+. . Pu+,u''! ;e+('e &!#% *er(+( !(r!# #!#! Pu+. . K(+,! m!+! +em( !)!, !,!u *er(+( !(r!# &!#% *er"+u'. . Er$+( ('!#%#&! '!(+!# e()erm(+ &!#% +uer:(+(!'.
. U'"u+ "e('!#%!# "u'(, me'u!+ me'!m!u( '!(+!# e()erm(+. . >(+ur!re,!"-re,!"!# !)! '(#e!r !)! "u'(. . S"u!m!+(+(" !"(*!, )e+"u!m!+( e(,e' &!#% m!,(. . Kru+,!"er!" re+()u +erum )!r! )!# u+ &!#% m$#%er(#% !)! ermu"!!# "u'(,. . P!ru, +("!,r(" *e"!+ !)! "u'(, &!#% ,er,(#%%!' +e+u)! 'u"!<'e+( me#%!'!m( "e+em*u!#. . Ke'$() 7!r(#%!# +("!,r(" &!#% me#%!'!m( &er,r$(. . L("e#(:("!+( "u'(, &!#% me#e*!' )!# me#7!)( "!+!r. Untu* menentu*an %esarn(a 'iameter/&e%arn(a &esi %isa 'iu*ur 'engn Penggaris 'an per*em%angann(a *ita m,nit,r terus. Se,e'! )(+,r(*u+( 'e+( )(,e#,u"!# (#:$rm!+( *er("u,#&! !ru+ )(er$'e D!# )(7e'!+"!# +e!r! r(#( 8 - /!%!(m!#! !r#! 'e+( ,er+e*u, @ - A!"! ,er)!!, "emer!!# !#!+#&er(!,!u em*e#%"!"!#. - /er!! 'u!+ )!er! "u'(, &!#% ,er"e#!@ - L$"!+(#&! )(m!#! @ - A!"! eru+( ,er+e*u, *e*e#,u" m!u'!!u'! +"u!m$+! @ - /!%!(m!#! )(+,r(*u+( 'e+( ,er+e*u, +(me,r(+ < ,()!" @ Meng*aai 0as*u&arisasi 'an h('rasi Peru*!!# ;!+u'!r !)! "u'(, !ru+ )('!"u"!#e#%!m!,!# me#!"u 8 - L$"!+( - D(+,r(*u+( - !r#! - W!r#! - U"ur!# - !)!#&! u'+!+(. Peru*!!!# ;!+u'!r &!#% '!9(m )(,emu"!# !)!'! 8 - Pe,e(!e - E"(m$+(+ - Te'e#%(e",!+(+ ;e#u+ - !#%($m! +,!r "e*(ru-*(ru!# m(r(: +!r!#% '!*!-'!*! *,!#% )('!,!+( +uer;(+(!' em *u'u )!r! ;e#!
*.R!m*u,. D('!"+!#!"!# +e!r! (#+e"+( )!# !'!+(. - Pe#er!#%!# ru!#%!# !ru+ u"u *!(" . - Mem!"!( +!ru#% ,!#%!#. Y!#% me#!,!, ,e#,!#% 8 - !r#!,e"+,ur )!# )(+,r(*u+(#&!. *.1.W!r#! )!# ,e"+,ur. - W!r#! *(+! (,!m !,!u u,( !,!u "e'!*u "e,("! +e$r!#% me#7!)( ,u! ,e,!( !)! 7u%! &% "e'!*u *eru*!# !)! u+(! mu)! "!re#! :!,$r ere)(,er. - Or!#% !'*(#(+me ,()!" !)!#&! (%me#,!+( +e!r! !r,(!' !,!u ,$,!' ,er7!)( u*!# +e7!" '!(r
"!re#! memu#&!( :!,$r %e#e,(. -Te"+,ur r!m*u, er'u )('(!, ,e#,!#% 8 . r!m*u, &!#% ,um*u )(+e'uru ,u*u mem('("( ,e",ur &% !'u+."u!'( !)! )!er! !B(!' )!# u*(+. . R!m*u, ,e*!' .*er$m*!""er(#% )!# mu)! !,!r!m*u, *erm(#&!" . r!m*u, &!#% mu)! !,! )!# "er(#% !"(*!, e!r#! r!m*u, &!#% *er'e*(!#.!,!u "!re#! em!"!(!# r$)u" r!m*u, "$mer++(!' &!#% *er'e*(!#. *.2.D(+,r(*u+(. L!"(-'!"( e#)eru#% mem('("( r!m*u, !)! !7! )!# *!)!# "e,(m*!#% W!#(,! 8 - "er$#,$"!# r!m*u, !''$e+(! *(+! ,er7!)( !"(*!, "e*(!+!!# me#!*u, r!m*u,em!"!(!# *!!# e!r#!m(#&!" r!m*u,em!"!( re!r!, "em$,er!((#:e",(e 7!mur)!# e#&!"(, "!#"er !)! "u'(, "e !'! *3.Peru*!!# '!(#. H(r,+u,(+me e#(#%"!,!# r!m*u, ,u*u )!!, ,er'(!, !)! !#(,! !)! +!!, !#(,! mu'!( me#:!u+e."e,("! $rm$#e e+,r$%e# ,()!" *er:u#%+( '!%( Teru,!m! +e"!'( )( )!er! !7!. Peng*aian terha'ap masa&ah psi*,s,sia& Ke'!(#!# )erm!,$'$%(+ )!!, mem*u!, !+(e# mer!+! +!!"(, &&!#% *er"e!# 7!#%!# +e(#%%! ,(m*u' 8 - Dere+( ru+,!+( "e+!)!r!# )(r( )!# e#$'!"!#. - A"(*!, %!,!'-%!,!' )!# (r(,!+( "u'(, &!#% *er"e!#7!#%!#mem*u!, !+(e# me#%!'!m( %!#%%u!# ,())ur!#+(e,!+ )!# )ere+( &!#% !)! !"(r#&! !"!# me#(m*u'"!# m!+!'! (,r! )(r( )!# u*u#%!# (#,erer Per+$#!'.
E0a&uasi iagn,sti*. Derm!,$'$%(e meru!"!# "e!'(!# &!#% $r(e#,!+(#&! ;(+u!')(+!m(#% C - me#)!!,"!# r(!&!, !+(e#. - Me'!"u"!# (#+e"+( ,e!)! 'e+( r(mer )!# +e"u#)er. - D(!%#$+,( ,er,e#,u u#,u" mem*!#,u me#%e#!'( "e'!(#!# "u'(, +e*! %!( *er("u, 8 1. /($+( "u'(,.u#,u"me#)!!,"!# 7!r(#%!# *!%( emer("+!!# m(r$+$e )e#%!# e"+(+()e#%!# e#u+u"!# )e#%!# !'!, "u+u+ +"(# Pu# ,er!)! #$)u'. 2. Immu#(:'ur$+(#eme#%"$m*(#!+("!# !#,(%e# !,!u !#,(*$)& )e#%!# 9!, >'u$r$"r$m !#,(*$)& )!!, *ere#!r )e#%!# me#%("!,"!# !)! 9!, !r#! - I )(re, ,e+, u#,u" me#)e,e"+( !u,$!#,(*$)& ,er!)! *!%(!# *!%(!# Ku'(,. - IP (#)(re, ,e+,me#)e,e"+( !#,(*$)& &!#% +e+(:(" )!'!m +erum !+(e#. 3. P!, ,e+,u#,u" me#%e#!'( +u*+,!#+( &!#% me#(m*u'"!# !'er%( !)! ,u*u !+(e#.)e#%!# !r! !'("!+( !''er%e# )(*!! 'e+,er7("! ,er7! )( )erm!,(,(+ !"!# me#(m*u'"!# re!"+( 8 - P$+(,(: Lem! !!*('! !)! "emer!-mer!!#,$#7$'!# !'u+ )!# %!,!'-%!,!'. - P$+(,(: Se)!#%!!*('! !)! !u''!)!# %!,!'-%!,!'. - P$+(,(: "u!,!)!!#&! *u''!#&er( +er,! u'+er!+(
Se*e'um )!# Se+u)! e'!"+!##!!# !, ,e+, ,()!" *$'e me#%%u#!"!# $*!, "$r,(+$#. S!me' m!+(#%-m!+(#% *!!# ,e+, )!'!m 7um'! &!#% +e)("(, )(*u*u"!# P!)! 'e+,er *er*e#,u" !"r!m. Penata&a*sanaan pasien gangguan *u&it Tu7u!# ,er!( !)!'! 8 1. Me#e%! "eru+!""!# !)! "u'(, &!#% +e!,. 2. me#e%! (#:e"+( +e"u#)er. 3. me#%em*!'("!# r$+e+ (#:'!m!+(. 4. Mere)!"!# %e7!'!.
- Ku'(, &!#% ,er"e'u!+ )e#%!# )e+"u!m!+( &% 'u!+<"e(' +!#%!, re#)!!# me#%!'!m( "eru+""!#. . P!)! +!!, m!#)( e#)!"#&! me#%%u#!"!# +!*u# *!&( &!#% 'em*u, )!# *er'em!" +uer:!,,e) m(') +$! !,!u '!ru,!# !#,(+e,( e#%%!#,( +!*u#. . Me#%er(#%"!# *!%(!# "u'(, &!#% *!+! )e#%!# !#)u" 'em*u,. . P!)! +!!, me#%%!#,( "$mre+ )e#%!# "!!+ &!#% )(e'u"!# )'m m(#&!" !"!# mem*!#,u me'e!+"!# "ru+,! "er!"me#%('!#%"!# e"+u)!, !,!u me#%!#%"!, "!+! <"!!+ &!#% me#%er(#%.. . K!+! "$mrre+ )!!, )(*!+!( )e#%!# '!ru,!# +!'(# #!' !,!u !(r!# )(re+e"!# $'e )$",er u#,u" me'e!+"!#
). Me#(#%"!,"!# r$+e+ e#&em*u!# mer!#%+!#% em*e#,u"!# %r!#u'!+( 7! r(#%!# *!ru. K$mre+ *!+! (#( me#%%u#!"!# 8 - A(r 'e)e#% *er+( !(r +!'(# #!' - Pre!r!, '!(# L!rur!# Per!" #(,r!,'!ru,!# *ur$(K!'(um erm!#%!#!,e 5 +e!r! ,er,u,u u#,u" me#%ur!#%( e;!$r!+(.
ASUHAN KEPE!AATAN E!MATITIS 1.e)enisi
Derm!,(,(+ !)!'! er!)!#%!# "u'(, e()erm(+ )!# )erm(+ +e*!%!( re+$# ,er!)! e#%!ru :!",$r e"+$%e# !,!u e#%!ru :!",$r e#)$%e# me#(m*u'"!# "e'!(#!# "'(#(+ *eru! e:'$re+e#+( $'(m$r:(" er(,em! e)em! !u' ;e+("e' +"u!m! )!# "e'u!# %!,!' ( Djuanda, Adhi, 2007 ). Derm!,(,(+ !)!'! er!)!#%!# !)! "u'(, (m:'!m!+( !)! "u'(, &!#% )(+er,!( )e#%!# e#%e'u!+!# "u'(, !r( )!# em*e#,u""!# +(+(" /ru##er )!# Su))!r, 2666 . J!)( )erm!,(,(+ !)!'! er!)!#%!# "u'(, &!#% )(,!#)!( $'e r!+! %!,!'.
2.K&asi)i*asi a$ Derm!,(,(+ "$#,!" Derm!,(,(+ "$#,!" !)!'! re+$# er!)!#%!# "u'(, !"u, !,!u "r$#(" ,er!)! !!r!#
*!!# (r(,!# e"+,er#!' &!#% me#%e#!( "u'(,. Derm!,(,(+ "$#,!"( ,er*!%( 2 &!(,u 8 Derm!,(,(+ "$#,!" (r(,!# me"!#(+me #$# (mu#$'$%(" • Derm!,(,(+ "$#,!" !'er%(" me"!#(+me (mu#$'$%(" +e+(:(" • Per*e)!!# Derm!,(,(+ "$#,!" (r(,!# )!# "$#,!" !'er%(" N$ . 1. 2. 3. 4.
Pe#&e*!* Permu'!!# Pe#)er(,! Le+(
5.
U7( Teme'
Derm!,(,(+ "$#,!" (r(,!#
Derm!,(,(+ "$#,!" !'er%("
Ir(,!# r(mer P!)! "$#,!" er,!m! Semu! $r!#% /!,!+ 'e*( 7e'!+ Er(,em! +!#%!, 7e'!+ Se+u)! )(,eme' 24 7!m
A'er%e# "$#,!" S.sensitizer P!)! "$#,!" u'!#% H!#&! $r!#% &!#% !'er%(" /!,!+ ,()!" *e%(,u 7e'!+ Er(,em! "ur!#% 7e'!+ /('! +e+u)! 24 7!m *!!# !''er%e# )(
*('! (r(,!# )( !#%"!, re!"+(
!#%"!, re!"+( me#e,! !,!u me'u!+
!"!# +e%er!
*ere#,(.
* Derm!,(,(+ !,$(" Derm!,(,(+ !,$(" !)!'! "e!)!!# er!)!#%!# "u'(, "r$#(+ )!# re+()(: )(+er,!( %!,!' )!# umum#&! +er(#% ,er7!)( +e'!m! m!+! *!&( )!# !#!"-!#!" +er(#% *eru*u#%!# )e#%!# e#(#%"!,!# "!)!r I%E )!'!m +erum )!# r(!&!, !,$( !)! "e'u!r%! !,!u e#)er(,!. Ke'!(#!# "u'(, *eru! !u' %!,!' &!#% "emu)(!# me#%!'!m( e"+"$r(!+( )!# '("e#(:("!+( ,em!,#&! )('(!,!# !,!u :'e"+ur!'..
Derm!,(,(+ #umu'!r(+ Meru!"!# )erm!,(,(+ &!#% *er+(:!, "r$#(" re+()(: )e#%!# 'e+( *eru"ur!# +e*e+!r u!#% '$%!m )!# umum#&! *er'$"!+( !)! +(+( e"+,e#+$r e"+,rem(,!+. ) Derm!,(,(+ +e*$r$(" Meru!"!# %$'$#%!# "e'!(#!# "u'(, &!#% )()!+!r( $'e :!,$r "$#+,(,u+( $rm$# "e*(!+!!# *uru" )!# *('! )(7um!( !)! mu"! )!# !"+('! !"!# +u'(, )(*e)!"!#. P!)! mu"! ,er)!!, )( +e"(,!r 'eer !'(+ m!,! )!# )( *e'!"!#% ,e'(#%!.
M!#!7emem "eer!!,!# !)! !+(e# Derm!,(,(+ +e*$r$(" !. S!r!#"!# !)! !+(e# u#,u" me#%(#)!r( (r(,!+!( )!r( 'u!r :!,$r em(u &!#% me#&e*!*"!# mu#u' '!%( )erm!,(,(+ +e*$r$(" u'!#%!# )!# me#&!r!#"!# u#,u" ,()!" +er(#% me#%%!ru" !re! &!#% %!,!'. *. D(+"u+("!# !)! !+(e# u#,u" me#%(#)!r( u)!r! "e "u'(, )!# +e'!'u me#7!%! "e*er+(!# e'(!,!# !)! "u'(, )!# u+!!"!# +u!&! ,e,! "er(#%. . I#+,ru"+("!# u#,u" me#%%u#!"!# +!m$$ )!# me#%(#)!r( "e*(!+!!# &!#% *uru" ). /er(,!u !+(e# *!! )erm!,(,(+ +e*$r$(" !)!'! m!+!'! &!#% +!#%!, "r$#(" )!# ,()!" ,er,u,u "emu#%"(#!# u#,u" mu#u' '!%(. e. A7!r"!# !)! !+(e# me#eme'"!# !r!-!r! u#,u" me#%%(#)!r( )erm!,(,(+.
3.Eti,&,gi
Pe#&e*!* )erm!,(,(+ *e'um )("e,!u( +e!r! !+,(. Se*!%(!# *e+!r meru!"!# re+$# "u'(, ,er!)! !%e#-!%e# m(+!' #&! 9!, "(m(! *!",er( )!# :u#%( +e'!(# (,u !'er%( m!"!#!# 7u%! *(+! me#&e*!*"!# )erm!,(,(+. Re+$# ,er+e*u, )!!, *eru*u#%!# )e#%!# !'er%(. Ar(e: M!#+7$er.1.FK!(,! +e'e",!F Pe#&e*!* Derm!,(,(+ +e!r! umum )!!, )(*e)!"!# me#7!)( 2 &!(,u ! Lu!r e"+$%e# m(+!'#&! *!!# "(m(! )e,er7e# $'( +eme# !+!m *!+! :(+(" +(#!r m!,!!r( +uu m("r$$r%!#(+me m("r$$r%!#(+me 7!mur. * D!'!m e#)$%e# m(+!'#&! )erm!,(,(+ !,$(".
4.Mani)estasi K&inis
P!)! umum#&! m!#(:e+,!+( "'(#(+ )erm!,(,(+ !)!#&! ,!#)!-,!#)! r!)!#% !"u, ,eru,!m! rur(,u+ %!,!' "e#!("!# +uu ,u*u "emer!!# e)em! m(+!'#&! !)! mu"! ,eru,!m! !'e*r! )!# *(*(r %!#%%u!# :u#%+( "u'(, )!# %e#(,!'(! e"+,er#!. ! S,!)(um !"u, 8 "e'!(#!# "u'(, *eru! er(,em! e)em! ;e+("e' !,!u *u'! er$+( )!# e"+u)!+( +e(#%%! ,!m!" *!+!. * S,!)(um +u*!"u, 8 er(,em! )!# e)em! *er"ur!#% e"+u)!, me#%er(#% me#7!)( "u+,!. S,!)(um "r$#(+ 8 'e+( ,!m!" "er(#% +"u!m! (er(%me#,!+( !u' )!# '("e#e:("!+(.
S,!)(um ,er+e*u, ,()!" +e'!'u *eruru,!# *(+! +!7! +e7!" !!' +u!,u )erm!,(,(+ +e7!" !!' mem*er( %!m*!r!# "'(#(+ *eru! "e'!(#!# "u'(, +,!)(um "r$#(+.
5. Pemeri*saan Penunang 'an iagn,sti*
1. Pemer("+!!# e#u#7!#% 8 ! Per$*!!# !+e,("$'(# +u#,("!# )!'!m (#,r!u,!# +$'u+($ !+e,('"$'(# 1<5666. * Per$*!!# (+,!m(# $+,!, )(+u#,(""!# !)! 'e+( 2. L!*$r!,$r(um ! D!r! 8 H* 'eu"$+(, (,u#% 7e#(+ ,r$m*$+(, e'e",r$'(, r$,e(# ,$,!' !'*um(# %'$*u'(# * Ur(# 8 emer("!+!!# (+,$!,$'$%(
6. Penata&a*sanaan Me'is 'an Keperawatan
Pe#!,!'!"+!#!!# me)(+ )!# "eer!!,!# )erm!,(,(+ me'!'u( ,er!( &!(,u 8 ! Ter!( +(,em("
P!)! )erm!,(,(+ r(#%!# )(*er( !#,((+,!m(# !,!u "$m*(#!+(
!#,((+,!m(# !#,(+er$,$#(# !#,(%r!)(,(#(# !r(, C SRS C A )!# !)! "!+u+ *er!, )(er,(m*!#%"!# em*er(!# "$r,("$+,er$(). * Ter!( ,$(!' Derm!,(,(+ !"u, )(*er( "$mre+ *('! +u* !"u, u"u )(*er( *e)!"
"$$" *('! "r$#(" )(*er( +!'e*. D(e, T(#%%( "!'$r( )!# ,(#%%( r$,e(# TKTP 0$#,$ 8 )!%(#% +u+u ("!#
"!!#%-"!!#%!# 7eru" (+!#% )!# '!(#-'!(#.
7. K,mp&i*asi
! I#:e"+( +!'ur!# #!:!+ !,!+ * /r$#"(,(+ I#:e"+( "u'(,
B. Lan'asan Te,ritis Asuhan Keperawatan 1. Peng*aian a.Peng*aian I'entitas K&ien
N!m!
8
MR
8
M!+u" "e RS 8 T!#%%!' L!(r 8 Umur
8
Je#(+ "e'!m(# 8
A%!m!
8
A'!m!,
8
%. Peng*aian !iwa(at Kesehatan
R(!&!, "e+e!,!# )!u'u R(!&!, "e+e!,!# "e'u!r%! R(!&!, "e+e!,!# +e"!r!#%
8. Pemeri*asaan Penunang
Peng*aian 11 -unggsi,na& 9,r',n 1. P$'! Per+e+( Ke+e!,!# A)!#&! r(!&!, (#:e"+( +e*e'um&!. Pe#%$*!,!# +e*e'um#&! ,()!" *er!+('. R(!&!, me#%$#+um+( $*!,-$*!,!# ,er,e#,u m(+. ;(,!m(# 7!mu. A)!"! "$#+u',!+( ru,(# "e D$",er. H&%(e#e er+$#!' &!#% "ur!#%. L(#%"u#%!# &!#% "ur!#% +e!, ,(#%%!' *er)e+!"-)e+!"!#. 2. P$'! Nu,r(+( Me,!*$'(" P$'! m!"!# +e!r(-!r(8 7um'! m!"!#!# !",u m!"!# *er!! "!'( +e!r(
m!"!#. Ke*(!+!!# me#%$#+um+( m!"!#!# ,er,e#,u8 *erm(#&!" e)!+. Je#(+ m!"!#!# &!#% )(+u"!(. N!:+u m!"!# me#uru#. Mu#,!-mu#,!. Pe#uru#!# *er!, *!)!#. Tur%$r "u'(, *uru" "er(#% *er+(+(" e!-e! *e#7$'!#. Peru*!!# !r#! "u'(, ,er)!!, *er!"-*er!" %!,!'-%!,!' r!+! ,er*!"!r !,!u 3.
4.
5.
6.
7.
er(. P$'! E'(m(#!+( Ser(#% *er"er(#%!,. ,!#&!"!# $'! *er"em( )!# *$e'. P$'! A",(;(,!+ )!# L!,(!# Peme#u!# +e!r(-!r( ,er%!#%%u. Ke'em!!# umum m!'!(+e. T$'er!#+( ,er!)! !",(;(,!+ re#)!. Mu)! *er"er(#%!, +!!, me'!"u"!# !",(;(,!+ r(#%!# Peru*!!# $'! #!!+ +!!, me'!"u"!# !",(;(,!+. P$'! T()ur )!# I+,(r!!, Ke+u'(,!# ,()ur !)! m!'!m !r( "!re#! +,re+. M(m( *uru". P$'! Per+e+( K$%#(,(: Peru*!!# )!'!m "$#+e#,r!+( )!# )!&! (#%!,. Pe#%e,!u!# !"!# e#&!"(,#&!. P$'! Per+e+( )!# K$#+e D(r(
Per!+!!# ,()!" er!&! )(r( !,!u m(#)er. Per!+!!# ,er(+$'!+(. :. P$'! Hu*u#%!# )e#%!# Se+!m! H()u +e#)(r( !,!u *er"e'u!r%! >re"ue#+( (#,er!"+( *er"ur!#% Peru*!!# "!!+(,!+ :(+(" u#,u" me'!"+!#!"!# er!# . P$'! Rer$)u"+( Se"+u!'(,!+ G!#%%u!# eme#u!# "e*u,u!# *($'$%(+ )e#%!# !+!#%!#. Pe#%%u#!!# $*!, K/ meme#%!ru( $rm$#. 1<. P$'! Me"!#(+me K$(#% )!# T$'er!#+( Ter!)! S,re++ Em$+( ,()!" +,!*(' A#+(e,!+ ,!"u, !"!# e#&!"(,#&! D(+$r(e#,!+( %e'(+! 11. P$'! S(+,em Keer!&!!# Peru*!!# )!'!m )(r( "'(e# )!'!m me'!"u"!# (*!)! A%!m! &!#% )(!#u,
2. Asuhan Keperawatan N,
NANA
. 1.
K e rusa*an
•
•
NO# Integritas
NI#
Integritas
=aringan+
Ku&it
Ku&it
Mem%ran
D!,! Pe#u#7!#% 8
Mu*,sa
Ku'(, 'u"! %!,!' !r#!
>
Se#+!+( IER •E'e+,(+(,! IER "u'(, (,!m !*u2 "er(#% •H()r!+( IER *er+(+(" •P(%me#,!+( IER Tur%$r "u'(, 7e'e" •Per+(r!+( IER •W!r#! IER •Te"+,ur IER •
Pengawasan Ku&it •
Am!,( !r#! "e!#%!,!# +uu *e#%"!" %e,!r!# ,e"+,ur e)em!
)!# #!#! !)! e",rem(,!+ •Per("+! "emer!!# eru*!!# +uu &!#% e"+,r(m !,!u )r!(#!+e )!r( "u'(, )!# mem*r!# mu"$+! +um*er ,e"!#!# •P!#,!u er%e+er!# (#:e"+( •P!#,!u
"u+u+#&!
)!# !)!
)!er! e)em!,$u+ •P!#,!u !re! &!#% ,()!" *er!r#! )!# mem!r
"u'(,
mu"$+! "e'!(#!# •P!#,!u
)!#
mem*r!#e
"e"er(#%!#
)!#
"e'em*!*!# "u'(, •Per("+! "e"e,!,!# !"!(!# •0!,!, eru*!!# "u'(, !,!u mem*r!#e mu"$+! •Te%!""!# u"ur!# u#,u" e#e%!!#
'!#7u,!# &!#% 'e*( *uru" 2.
N(eri
D!,! e#u#7!#% 8 •
• • • •
• •
Me#%!,u"!# r!!#% <
K,ntr,& !esi*, •
Manaemen N(eri +
K'(e# me'!$r"!# #&er(• K!7( *er"ur!#% )% +!'! 2-
me#%e!'"!# ,!#%!# 3 A%(,!+( • E"+re+( !7! ,e#!#% A#+(e,!+ • "'(e# )!!, (+,(r!!, )!# • Peru*!!# $'! ,()ur ,()ur Me#!r(" )(r( *('! • ;<+ )*# )(+e#,u Mu!' )!# mu#,! G!m*!r!# "uru+ •
#&er( '$"!+(
:re"ue#+(
+e!r!
"$mree#+(:
"!r!",er(+,(" "u!'(,!+
)ur!+(
)!#
:!",$r
re+((,!+( . O*+er;!+( re!"+( N= )r "e,()!" #&!m!#!#. Gu#!"!# ,e"#(" ,er!eu,("
u#,u"
"$mu#("!+( me#%e,!u(
e#%!'!m!# #&er( "'(e# +e*e'um#&! K$#,r$' :!",$r '(#%"u#%!# &!#% meme#%!ru( #&er( +eer,( +uu
•
ru!#%!# e#!!&!!# "e*(+(#%!#. P('( )!# '!"u"!# e#!#%!#!# #&er(
•
:!rm!"$'$%(+<#$# :!rm!"$'$%(+. A7!r"!# ,e"#(" #$# :!rm!"$'$%(+ re'!"+!+(
)(+,r!"+(
)''
u#,u"
•
me#%e,!+( #&er(.. K$'!*$r!+( em*er(!#
•
u#,u" me#%ur!#%( #&er(. E;!'u!+( ,(#)!"!# e#%ur!#%
•
#&er(<"$#,r$' #&er(. M$#(,$r TT=
!#!'%e,("
As*ep Be'ah !e*,nstru*si Ku&it /e)! re"$#+,ru"+( meru!"!# ,(#)!"!# *e)! &!#% me#%"u+u+"!# !)! e#!#%!#!# "e!!,!# +er,! "e'!(#!# !)! "u'(, 7!r(#%!# 'u#!" r!#%"! )!# $,$,. 0!!, ,er+e*u, )!!, )(+e*!*"!# $'e "e'!(#!# *!!!# e#&!"(, (#:e"+( !,!u "ee'!"!!#. S!'! +!,u $#,$ ,(#)!"!# *e)! (#( !)!'! !#%"$" "u'(, transplantasi kulit !)! !+(e# &!#% me#%!'!m( "eru+!"!# "u'(, !"(*!, 'u"! *!"!r !,!u "ee'!"!!#. Tr!#+'!#,!+( "u'(, umum#&! meru!"!# !u,$-,r!#+'!#,!+( &!(,u "u'(, &!#% )(%u#!"!# *er!+!' )!r( (#)(;()u &!#% +!m!. H!' (#( )('!"u"!# +e*!%!( u!&! u#,u" me#(#%"!,"!# "e*er!+('!# ,(#)!"!# *e)! &!#% )('!"u"!# !%!r mem(#(m!'"!# re!"+( e#$'!"!# ,u*u &!#% )!!, ,(m*u'. Me,$)e *!ru &!#% )(%u#!"!# )!'!m ,r!#+'!#,!+( "u'(, &!(,u +'(, !#%"$" "u'(, )!# :'!.
Sp&it 8ang*,* *u&it "s*in gra)ting$ S'(, !#%"$" "u'(, meru!"!# !#%"$" '!(+!# e()erm(+ "u'(, &!#% )!!, )((#)!"!# +e!r! *e*!+. Ku'(, &!#% )(%u#!"!# )!!, *er!+!' )!r( *!%(!# m!#! +!7! )!r( ,u*u #!mu# !)! umum#&! *er!+!' )!r( )!er! !! u#%%u#% !,!u eru,. Permu"!!# "u'(, )!!, )(er'u!+ )e#%!# mem*u!, (r(+!#(r(+!# &!#% *(!'! )(re#%%!#%"!# !"!# mem*e#,u" 7!'! +e(#%%! 'u!+#&! )!!, me#!!( 15 (#%%! ?- "!'( 'u!+ +emu'!. Te"#(" !#%"$" 7!'! (#( )(+e*u, me+ )!# *(!+!#&! )(%u#!"!# !)! 'u"! *!"!r &!#% 'u!+. U#,u" me#)!!,"!# !+(' &!#% m!"+(m!' m!"! )(er'u"!# *e*er!! er+&!r!,!# !#,!r! '!(# +(+,em ere)!r!# )!r! !)! )!er! re+((e# )!er! &!#% me#)!!, "u'(, !#%"$"!# !ru+ *!(" ,()!" !)! (#:e"+( )!# "e!)!!# umum e#)er(,! !ru+ *!(".
-&ap >'! !)!'! !#%"$" 7!r(#%!# "u'(, *e+er,! 7!r(#%!# 'u#!" )( *!!#&! &!#% )(!#%"!, )!r( ,em!, !+!'#&!. >'! &!#% )((#)!"!# !"!# mem*e#,u" e#)r!!# *!ru )( ,em!, re+((e#. T(#)!"!# *e)! re"$#+,ru"+( (#( !#,!r! '!(# +er(#% )(%u#!"!# u#,u" memer*!("( "e!!,!# !,!u "e'!(#!# &!#% ,(m*u' !"(*!, "ee'!"!!#. A'("!+( ,e"#(" *e)! (#( )(%u#!""!# !)! re"$#+,ru"+( ()u#% memer*!("( "e'!(#!# !)! !7! !"+! $er!+( m(+!'#&! "e'!(#!# !)! (( !"+! $er!+( ,um$r )!# '!(#-'!(#. W!'!uu# )!'!m *e)! re"$#+,ru"+( )(u!&!"!# +em!"+(m!' mu#%"(# me#%%u#!"!# *!!# *!!# &!#% *er!+!' )!r( ,u*u e#)er(,! +e#)(r( #!mu# !)!"!'!#&! !' ,er+e*u, ,()!" memu#%"(#"!#. O'e "!re#! (,u u#,u" me#u#7!#% u!&! *e)! re"$#+,ru"+( m!+( )(er'u"!# *!!#-*!!# +(#,e,(+. /!!#-*!!# ,er+e*u, +e*e'um )(%u#!"!# )!# )(,!#!m )!'!m ,u*u !ru+ mem('("( *e*er!! +&!r!, !#,!r! '!(# ,()!" !,!u +e)("(, me#(m*u'"!# re!"+( ,u*u ,()!" *er+(:!, m!%#e,(+ )!# ,()!" me#%!#,!r"!# '(+,r(". /!!# +(#,e,(" &!#% '!9(m )(!"!( !)!'! +('("$# !"r('(" )!# '$%!m !mur!# +eer,( ,(,!#(um.
Kem!7u!# *e)! re"$#+,ru"+( &!#% meru!"!# +!'! +!,u !*!#% )!r( ('mu *e)! ,e'! mem*er("!# m!#:!!, &!#% +!#%!, *e+!r *!%( mere"! &!#% +e*e'um#&! mu#%"(# +u)! u,u+ !+! !)! "e!!,!# !,!u "e'!(#!# "u'(, &!#% )(m('("(#&!. De#%!# ,(#)!"!# *e)! re"$#+,ru"+( (#( )(!r!"!# )!!, me#(#%"!,"!# "u!'(,!+ ()u )!# me#(#%"!,"!# "eer!&!!# )(r( e#)er(,!. W!'!uu# )em("(!# ,e,! )('!"u"!# e#e'(,(!# )!# e#%em*!#%!# ,e"#(" +e(#%%! )!!, )(er$'e !+(' &!#% 'e*( *!(". +e'!(# (,u 7u%! )(er'u"!# !)!#&! +$+(!'(+!+( &!#% *!(" me#%e#!( ,e"#(" *e)! (#( +e(#%%! m!+&!r!"!, )!!, mem!#:!!,"!# ,e"#(" (#( )e#%!# 'e*( 'u!+
