LAPORAN PENDAHULUAN ANTE NATAL CARE (ANC)
A. KONSEP DASAR PENYAKIT I. Kehamilan 1. Pengertian
Kehamilan adalah masa yang di mulai dari konsepsi sampai lahirnya janin. Lamanya hamil normal adalah 280 hari (40 minggu atau 9 bulan 10 hari) di hitung dari hari pertama haid terakhir. (Depkes RI, 2005) Kehamilan adalah seorang yang mengandung sel telur yang telah dibuahi oleh
seperma.
Proses
kehamilan
merupakan
satu
mata
rantai
yang
berkesinambungan yang dimulai dari ovulasi (pelepasan ovum), terjadi migrasi spermatozoa dan ovum lalu terjadi konsepsi dan pertumbuhan zigot, setelah itu terjadi
nidasi
pada
uterus,
pembentukan
plasenta,
pertumbuhan
dan
perkembangan hasil konsepsi sampai aterm. (Prawiroharjo, Sarwono, Sarwono, 2005)
2. Fase Kehamilan
a. Menurut Varney, 2007 a. Trimester pertama berlangsung pada minggu pertama sampai minggu ke-
12 (12 minggu) b. Trimester kedua berlangsung pada minggu ke-13 sampai minggu ke-27
(15 minggu) c. Trimester ketiga berlangsung pada minggu ke-28 sampai minggu ke-40
(13 minggu) b. Menurut Sarwono, 2002 a. Trimester pertama (antara 0-12 minggu) b. Trimester kedua dari bulan keempat sampai 6 bulan c. Trimester ketiga dari bulan ketujuh sampai 9 bulan
c. Menurut Hanifa, 2002 a. Triwulan pertama (antara 0-12 minggu) b. Triwulan kedua (antara 12-28 minggu)
2 8-40 minggu) c. Triwulan ketiga (antara 28-40
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3. Tanda-tanda Kehamilan
1)
Presumtif / Tanda-tanda dugaan hamil a. Amenore ( terlambat datang bulan)
Konsepsi dan nidasi menyebabkan tidak terjadi pembentukan folikel degraaf dan ovulasi.
Mengetahiu tanggal haid terakhir dengan perhitungan rumus naegle dapat ditentukan perkiraan persalinan
b. Mual (nausea) dan muntah
Pengaruh estrogen dan progesteron terjadi pengeluaran asam lambung yang berlebihan.
Menimbulkan mual muntah terutama pagi hari yang disebutkan morning sickness.
Dalam batas yang fisiologis keadaan ini dapat diatasi.
Akibat mual dan muntah nafsu makan berkurang
c. Ngidam
Wanita hamil sering menginginkan makanan tertentu, keinginan yang demikian disebut ngidam.
d. Sinkope atau pingsan
Terjadinya
gangguan
sirkulasi
ke
daerah
kepala
(sentral)
menyebabkan iskemia susunan syaraf pusat dan menimbulkan sinkope atau pingsan.
Keadaan ini menghilang setelah umur kehamilan 16 minggu.
e. Payudara tegang
Pengaruh estrogen-progesteron dan somatomamotropin menimbulkan deposit lemak air, dan garam pada payudara.
Payudara membesar dan tegang
Ujung syaraf tertekan menyebabkan rasa sakit terutama pada hamil pertama.
f. Sering miksi
Desakan rahim ke depan menyebabkan kandung kemih cepat terasa penuh dan sering miksi.
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g. Konstipasi atau obstipasi
Pengaruh
progesteron
dapat
menghambat
peristaltik
usus
menyebabkan kesulitan untuk buang air besar. h. Pingmentasi kulit
Sekitar pipi : cloasma gravidarum
Keluarnya melanophore stimulating hormone hipofisis anterior menyebabkan pigmentasi kulit pada muka.
Dinding perut
Strie lividae
Strie nigra
Linea alba makin hitam
i. Perubahan sekitar payudara
Hiperpigmentasi areola mamae
Puting susu makin menonjol
Kelenjar montgomery menonjol
Pembuluh darah menifes sekitar payudara
j. Epulis
Hipertropi gusi disebut epulis bisa terjadi bila hamil
k. Varices atau penampakan pembuluh darah vena
Karena pengaruh dari estrogen dan progesteron terjadi penampakan pembuluh darah vena.
Penampakan pembuluh darah itu terjadi di sekitar genetalia eksterna, kaki dan betis, dan payudara. pa yudara.
2)
Penampakan pembuluh darah ini dapat menghilang setelah persalinan.
Probabilitas / Tanda tidak pasti kehamilan a. Rahim membesar, sesuai dengan tuanya hamil. b. Pada pemeriksaan dapat dijumpai :
Tanda Hegar’s Konsistensi rahim yang menjadi lunak, terutama daerah isthmus uteri sedemikian lunaknya, hingga kalau kita letakkan 2 jari dalam forniks posterior & tangan satunya pada dnding perut atas symphyse, maka
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Tanda chadwicks (kebiruan pada vulva dan vagina) Warna selaput lendir vulva & vagina menjadi ungu.
Tanda piscaseck Uterus membesar ke salah satu jurusan hingga menonjol jelas ke jurusan pembesaran tersebut.
Ballotement Adanya lentingan janin dalam uterus saat palpasi
Braxton hick’s Pada saat palpasi atau waktu toucher, rahim yang lunak sekonyongkonyong menjdi keras karena berkontraksi.
c. Pemeriksaan tes biologis kehamilan positif
3)
Sebagian kemungkinan positif palsu
Absolut / Tanda pasti kehamilan a. Terdengar denyut jantung janin (DJJ) b. Teraba bagian anak oleh pemeriksa c. Terlihat hasil konsepsi dengan USG d. Teraba gerakan janin oleh pemeriksa
4.
Diagnosa Banding Kehamilan
Pembesaran perut wanita tidak selamanya menjadi tanda suatu kehamilan, sehingga perlu dilakukan diagnosis banding diantaranya : 1)
Hamil palsu (pseudocyesis) atau kehamilan spuria Dijumpai tanda dugaan hamil, tetapi dengan pemeriksaan alat canggih dan tes biologis menunjukkan kehamilan.
2) Tumor kandungan atau mioma uteri
3)
Terdapat pembesaran rahim, tetapi tidak disertai tanda hamil
Bentuk pembesaran tidak merata
Perdarahan banyak saat menstruasi
Kista ovarium
Pembesaran perut, tetapi tidak disertai tanda hamil
Datang bulan terus berlangsung
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4)
Hematometa
Terlambat datang bulan yang dapat melampaui umur hamil
Perut terasa sakit setiap bulan
Terjadi penumpukkan darah dalam rahim
Tanda dan pemeriksaan hamil tidak menunjukkan hasil yang positif
Sebab himen in perforata
5) Kandung kemih yang penuh
Dengan
melakukan
kateterisasi,
maka
pembesaran
perut
akan
menghilang.
5. Perubahan Pada Kehamilan
1) Perubahan dan Adaptasi Fisiologis a. Perubahan Pada Kulit Pada kulit terjadi perubahan deposit pigmen dan hiperpigmentasi karena pengaruh melanophore stimulating hormone lobus hipofisis anterior dan pengaruh kelenjar suprarenalis. (Manuaba, 1998) Melasma di wajah yang biasa di sebut cloasma atau topeng kehamilan, adalah bercak pada kulit di derah tonjolan maksila dan dahi khususnya pada wanita hamil berkulit hitam. (Bobak, dkk. 2005) Linea nigra adalah garis pigmentasi dari daerah symfisis pubis sampai bagian atas fundus di garis tengah tubuh dan stria gravidarum atau tanda regangan akan terlihat di bagian bawah abdomen. (Bobak, dkk. 2005) b. Perubahan kelenjar Perubahan kelenjar gondok membesar sehingga leher ibu berbentuk seperti leher pria. Perubahan ini tidak selalu terjadi pada wanita hamil. c. Perubahan payudara Mamae
akan
membesar
dan
tegang
akibat
hormone
Somatomatropin, esterogen, dan progesterone, akan tetapi belum mengeluarkan air susu. (Wiknjosastro, Hanifa. 2007) Rasa penuh, peningkatan sensitivitas, rasa geli dan rasa berat di
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sebasea / lemak yang muncul di areola primer dan tdisebut Tuberkel Montgomery. (Bobak, dkk. 2005) d. Perubahan Uterus Uterus akan membesar pada bulan – bulan pertama di bawah pengaruh esterogen dan progesterone yang kadarnya meningkat. Pembesaran ini pada dasarnya disebabkan oleh hipertropi otot polos uterus. Berat uterus normal < 30 gram, pada akhir kehamilan (40 minggu) berat uterus menjadi 1000 gram dengan panjang < 20 cm dan dinding ± 2,5 cm. (Wiknjosastro, Hanifa. 2007) Selama minggu awal kehamilan, peningkatan aliran darah uterus dan limfe mengakibatkan edema dan kongesti panggul. Akibatnya uterus, servik dan istmus melunak secara progresif dan servik menjadi agak kebiruan, yang disebut “Tanda Chadwick”. (Bobak, dkk. 200 5) Pada sekitar minggu ke 7 dan ke 8, terlihat pola pelunakan uterus sebagai berikut : istmus melunak dan dapat ditekan (Tanda Hegar), servik melunak (Tanda Goodell), dan fundus pada serviks mulai fleksi (Tanda McDonald). (Bobak, dkk. 2005) e. Vagina dan vulva Vagina dan vulva akibat hormone esterogen mengalami perubahan pula. Adanya hipervaskularisasi mengakibatkan vagina dan vulva tampak lebih merah, agak kebiruan (livide). Tanda ini disebut tanda Chadwick. Warna porsio pun tampak livide. (Wiknjosastro, Hanifa. 2007) Selama hamil, pH sekresi vagina menjadi lebih asam. Peningkatan pH ini membuat wanita hamil lebih rentan terhadap infeksi vagina. Dan peningkatan vaskularisasi vagina dan visera panggul menyebabkan peningkatan sensitivitas yang menyolok, yang menyebabkan peningkatan keinginan dan bangkitan seksual, terutama selama trimester kedua. (Bobak, dkk. 2005) f. Perubahan pada tungkai Timbul varises pada sebelah atau kedua belah tungkai. Pada hamil
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tekanan uterus yang membesar pada vena femoralis sebelah kanan atau kiri. g. Perubahan pada sikap tubuh Sikap tubuh ibu menjadi lordosis karena perut yang membesar h. Sistem sirkulasi darah Perubahan sistem sirkulasi darah menurut Mochtar, Rustam (1998) adalah:
Volume darah Volume darah total dan volume plasma darah meningkat pesat sejak akhir trimester pertama. Volume darah akan bertambah banyak, kira – kira 20 %, dengan puncaknya pada kehamilan 32 minggu, diikuti curah jantung yang meningkat sebanyak ± 30 %.
Protein darah Jumlah protein, albumin dan gamaglobulin menurun dalam triwulan pertama dan meningkat secara bertahap pada akhir kehamilan. Beta – Beta – globulin globulin dan fibrinogen terus meningkat.
Hitung jenis dan haemoglobin (Hb) Hematokrit cenderung menurun karena kenaikan relatif volume plasma darah. Konsentrasi Hb menurun, ini disebabkan volume plasma yang meningkat.
Nadi dan Tekanan Darah Tekanan darah arteri cenderung menurun terutama selama trimester kedua, dan akan naik lagi seperti pra hamil. Nadi biasanya naik, rata – rata – rata rata 84 x / menit.
Jantung
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j. Sistem pencernaan Saliva meningkat, dan pada trimester pertama mengeluh mual dan muntah. Tonus otot saluran pencernaan melemah, sehingga motilitas dan makanan lebih lama berada dalam saluran makanan. Gejala muntah / emesis gravidarum sering terjadi biasanya pada pagi hari, disebut sakit pagi / morning sickness.(Mochtar, sickness.(Mochtar, Rustam. 1998) k. Traktus Urinarius Karena pengaruh desakan hamil muda dan turunnya kepala bayi pada hamil tua terjadi gangguan miksi dalam bentuk sering kencing. Desakan tersebut menyebabkan kandung kemih cepat terasa penuh. Filtrasi pada glomerulus bertambah sekitar 69 – 69 – 70%. 70%. (Manuaba, 1998) l. Metabolisme Menurut Manuaba (1998), perubahan metabolisme pada ibu hamil yaitu sebagai berikut :
Metabolisme basal naik sebesar 15 – 15 – 20% 20% dari semula
Keseimbangan asam basa mengalami penurunan 155 mEq/liter menjadi 145 mEq/liter
Kebutuhan protein wanita hamil makin tinggi. Dalam makanan diperlukan protein tinggi sekitar ½ gr/kg BB atau sebutir telur ayam tiap hari
Kebutuhan kalori didapat dari karbohidrat, lemak dan protein
BB ibu hamil bertambah
2) Perubahan dan Adaptasi Psikologis a. Perubahan psikologis ibu Trimester pertama Trimester pertama sering dianggap sebagai
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dirinya telah hamil dan mencari bukti kehamilan pada setiap jengkal tubuhnya. Hasrat seksual pada trimester pertama sangat bervariasi antara wanita satu dengan wanita yang lain. Meski beberapa wanita mengalami peningkatan hasrat seksual akan tetapi secara umum trimester pertama merupakan waktu terjadinya penurunana libido dan hal ini memerlukan komunikasi yang jujur dan terbuka terhadap pasangannya masingmasing. Banyak wanita merasakan kebutuhan kasih saying yang besar dan cinta kasih tanpa seks. b. Trimester II Trimester kedua sering di kenal sebagai periode kesehatan yang baik, yakni periode ketika wanita merasa nyaman dan bebas dari segala rasa ketidaknyamanan yang normal yang dialami oleh ibu hamil. Trimester kedua dibagi menjadi dua fase yakni fase pra-queckning dan pasca
quickening.
Quickening
menunjukkan
kenyataan
adanya
kehidupan yang terpisah , yang menjadi dorongan bagi wanita dalam melaksanakan tugas psikologis utamanya pada trimester ini yakni mengembangkan identitas sebagai ibu bagi dirinya sendiri, yang berbeda dari ibunya. Sebagian besar wanita merasa lebih erotis selama trimester kedua, kurang lebih 80% wanita mengalami kemajuan yang nyata dalam hubungan seksual mereka dibandingkan dengan trimester I dan sebelum hamil. Trimester kedua hamper terbebas dari segala ketidaknyamanan ketidaknyamanan fisik, dan ukuran perut wanita belum menjadi masalah besar, lubrikasi vagina menjadi semakin banyak pada masa ini, kekemasan, kekhawatiran
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trimester ini merupakan waktu persiapan yang aktif menantikan kelahiran bayinya. Hal ini membuat ia berjaga-jaga dan menunggu tanda dan gejala persalinan. Sejumlah ketakutan muncul dalam trimester ini yaitu merasa cemas dengan kehidupan bayinya dan dirinya sendiri, seperti : apakah bayinya nanti akan lahir abnormal, terkait dengan persalinan dan pelahiran (nyeri, kehilangan kendali dan hal – hal hal lain yang tidak diketahui), apakah ia akan menyadari bahwa ia akan bersalin, atau bayinya tidak mampu keluar karena perutnya sudah luar biasa besar, atau apakah organ vitalnya akan mengalami cedera akibat tendangan bayi. Wanita akan kembali merasakan ketidaknyamanan fisik yang semakin kuat menjelang akhir kehamilan. Ia akan merasa canggung, jelek, berantakan dan memerlukan dukungan yang sangat besar dan konsisten dari pasangannya. pasangannya. Hasrat untuk melakukan hubungan seksual akan menghilang seiring dengan membesarnya abdomen yang menjadi penghalang. Alternative Alte rnative possisi dalam berhubungan seksual s eksual dan metode alternative
untuk mencapai mencapai kepuasan dapat dapat membantu atau dapat
menimbulkan perasaan bersalah jika ia merasa tidak nyaman dengan cara- cara tersebut. Berbagi perasaan secara jujur dengan pasangan dan konsultasi mereka dengan tenaga kesehatan menjadi sangat penting.
II. Ante Natal Care (ANC) 1. Pengertian
Ante natal care (ANC) adalah usaha yang dilakukan pada waktu hamil dengan tujuan mempersiapkan ibu dalam masa hamil agar waktu melahirkan
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b. Mengenal dan menangani penyakit yang menyertai hamil, persalinan dan nifas c. Memberikan nasehat dan petunjuk yang berkaitan dengan kehamilan, persalinan, nifas, laktasi dan aspek keluarga berencana. d. Menurunkan angka kesakitan dan kematian ibu dan perinatal
3. Frekuensi Kunjungan ANC
Menurut Saifuddin, AB (2002), sedikitnya empat kali kunjungan selama periode antenatal, yaitu : 1)
1 kali kunjungan selama trimester pertama (sebelum (seb elum 14 minggu)
2)
1 kali kunjungan selama trimester kedua (antara minggu 14 - 28)
3)
2 kali kunjungan selama trimester ketiga (antara minggu 28 – 36 dan sesudah minggu ke 36)
4. Informasi Saat Kunjungan ANC
1) Trimester I (Sebelum minggu ke 14)
Membangun hubungan saling percaya antara petugas kesehatan dan ibu hamil
Mendeteksi masalah dan menanganinya
Melakukan tindakan pencegahan, seperti tetanus neonatorum, anemia kekurangan zat besi, penggunaan praktek tradisional yang merugikan
Memulai persiapan kelahiran bayi dan persiapan menghadapi komplikasi
Mendorong perilaku yang sehat (gizi, latihan, kebersihan dan istirahat)
2) Trimester II (Sebelum minggu ke 28) Sama seperti di atas, ditambah kewaspadaan khusus mengenai pre eklamsia
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5. Nasehat Untuk Ibu Hamil
1) Diet Pada dasarnya dianjurkan makanan empat sehat lima sempurna. Karena kebutuhan akan protein dan bahan makanan tinggi, dianjurkan sebuah telur sehari. Nilai gizi dapat ditentukan dengan bertambahnya BB sekitar 6,5 – 15 15 Kg selama hamil. BB yang bertambah terlalu besar atau kurang perlu mendapat perhatian khusus karena kemungkinan terjadi penyulit kehamilan. Kenaikan BB tidak boleh > ½ kg / minggu. (Manuaba, 1998) 2) Pekerjaan rumah Pekerjaan
rutin
kemampuan, dan
dapat
makin
dilaksanakan.
dikurangi
dengan
Bekerjalah semakin
sesuai tua
dengan
kehamilan.
(Manuaba, 1998) 3) Wanita bekerja di luar rumah Kehamilan bukan merupakan halangan untuk berkarya asalkan dikerjakan dengan pengertian sedang hamil. Wanita karier yang sedang hamil mendapatkan hak cuti hamil selama tiga bulan, yang dapat diambil sebelum
menjelang
(Manuaba,1998) 4) Pakaian hamil
kelahiran
dan
dua
bulan
setelah
persalinan.
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Hentikan hubungan seksual pada mereka yang sering mengalami gugur kandung, persalinan sebelum waktunya, mengalammi kematian dalam kandungan, sekitar dua minggu sebelum persalinan
6) Perawatan payudara Menurut Manuaba (1998), perawatan payudara sebelum lahir bertujuan untuk memelihara hygiene payudara, melenturkan / menguatkan putinng susu, dan mengelurakan putting susu yang datar. Tehnik perawatannya adalah : a. Kompres putting susu dan area sekitarnya dengan menempelkan kapas / lap yang dibasahi minyak. b. Bersihkan putting susu dan area sekitarnya dengan handuk kering yang bersih. c. Pegang kedua putting susu lalu tarik keluar bersama dan diputar ke dalam 20 kali, keluar 20 kali. d. Pangkal payudara dipegang kedua tangan lalu payudara diurut dari panngkal menuju putting putting susu sebanyak 30 kali. e. Kemudian pijat daerah areola sehinga keluar cairan 1 – 2 tetes untuk memastikan saluran susu tidak tersumbat. f. Pakailah BH yang menyokong payudara.
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8) Persiapan persalinan dan laktasi Salah satu tujuan persiapan persalinan adalah untuk meningkatkan kesehatan optimal menjelang persalinan dan segera dapat memberikan laktasi. Untuk dapat mencapai kesehatan optimal menjelang persalinan perlu dilakukan dua langkah penting yaitu melakukan senam hamil dan mempersiapkan keadaan puyudara puyudara untuk laktasi. (Manuaba, 1998) 9) Senam hamil Senam hamil bertujuan untuk mempersiapkan dan melatih otot – otot – otot otot sehingga dapat dimanfaatkan untuk berfungsi secara optimal dalam persalinan normal. Senam hamil ditujukan bagi ibu hamil tanpa kelainan atau tidak terdapat penyakit yang menyertai kehamilan, yaitu penyakit jantung, penyakit ginjal, penyulit kehamilan (hamil dengan perdarahan, hamil dengan gestosis, hamil dengan kelainan letak), dan kehamilan disertai anemia. Senam hamil dimulai pada umur kehamilan sekitar 24 – 24 – 28 28 minggu.
6. Tanda Bahaya Kehamilan
Berkaitan dengan ibu Menurut Saifuddin (2002), tanda bahaya ibu hamil adalah : a. Perdarahan peervaginam
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IV. Pathway Kehamilan (Konsepsi dan nidasi)
Perubahan hormonal (peningkatan hormon estrogen progesteron)
Metabolisme Meningkat
Cardiak out
Aktifitas kelenjar
Pembesaran
Penekakan pada
Tonus otot saluran
Perubahan
meningkat
uterus
vesika urinaria
pencernaan menurun
psikologis
Produksi Hcl
put meningkat
lambung dan saliva meningkat
Frekuensi nadi meningkat
Diafragma tertekan
Rangsangan
Pengembangan diafragma
terhadap medula
tidak optimal
vomiting center
Frekuensi miksi
Motilitas usus
meningkat
menurun
Peran baru dalam keluarga
Keterbatasan Inhibisi refluks
kognitif
spingter menurun
meningkat Intake nutrisi
Sisa pencernaan
berkurang Mual dan muntah
Ekspansi paru
tertahan lama pada
menurun
usus Gangguan pola
Kelemahan fisik
Cemas
Aktifitas
Kekurangan
Pola napas tidak
intoleras
volume cairan
efektif
tidur dan Konstipasi
istirahat
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B. DAMPAK PENYAKIT TERHADAP KEBUTUHAN DASAR MANUSIA
1. Kebutuhan Oksigenasi Untuk memenuhi kebutuhan oksigen dan akibat desakan pembesaran rahim pada diafragma, mengakibatkan pergerakan diafragma pada saat respirasi tidak optimal sehingga terjadi peningkatan respirasi yang fisiologis sekitar 20 -25%. 2. Kebutuhan Cairan dan Elektrolit Akibat pengaruh peningkatan hormon estrogen dan progesteron terjadi peningkatan secresi Hcl lambung, mengakibatkan terjadinya mual dan muntah dalam batas yang fisiologis. Akibat maul dan muntah intake cairan akan ber kurang. 3. Kebutuhan Sirkulasi Tekanan darah agak lebih rendah dari pada normal (8 – 12 12 minggu), kembali pada tingkat pra kehamilan selama setengah kehamilan teakhir. Denyut nadi meningkat 10-15 %. Murmur sistolik pendek dapat terjadi sehubungan dengan peningkatan volume, varises, sedikit edema ekstremitas bawah/tangan mungkin ada (terutama pada trimester terakhir). 4. Kebutuhan Nutrisi Terjadi
peningkatan
metabolisme
basal
15-20%.
Akibat
pengaruh
peningkatan hormon estrogen dan progesteron terjadi peningkatan secresi Hcl lambung, mengakibatkan terjadinya mual dan muntah dalam batas yang fisiologis.
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C. ASUHAN KEPERAWATAN 1) Pengkajian 1) Identitas
Nama suami dan istri Agar dalam melakukan komunikasi dengan pasien keluarga dapat terjalin komunikasi dengan baik.
Usia Penyulit dalam kehamilan remaja lebih tinggi dibanding umur 20 sampai 30 tahun.
Alamat Ditanyakan
untuk
maksud
mempermudah
hubungan /
informasi bila
diperlukan. Bila keadaan mendesak, dengan diketahuinya alamat tersebut bidan dapat mengetahui tempat tinggal pasien/klien dan lingkungannya.
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Riwayat keluhan utama
P : Provokasi / palatif (penyebab)
Q : Quality / bagaimana gejala dirasakan dirasakan
R : Region / dimana gejala dirasakan
S : Skala keadaan / seberapa parah yang dialami pasien
T : Time / sejak kapan keluhan terjadi dan sampai kapan
2. Riwayat kesehatan sekarang Yang perlu dikaji : sejak kapan ibu merasakan pergerakan anak, umur kehamilan, ANC berapa kali, dimana imunisasi TT didapatkan, teraphie yang didapatkan, penyuluhan yang didapatkan, bila mulai didapatkan gerakan anak,kalau kehamilan masih muda adalah mual, muntah, sakit kepala, perdarahan.kalau kehamilan tua adalah bengkak di kaki/muka, sakit kepala,
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3)
Dada : bentuk buah dada, pigmentasi puting susu dan gelanggang susu, keadaan puting susu, adakah kolostrum
4)
Abdomen GIT : bentuk abdomen,warna, adakah luka bekas operasi apendeksitis, terbagi 9 regio hipokondria kanan (pembesaran hepar), epigastrik (gastritis), hipokondria kiri (pembesaran lien), lumbal kanan dan kiri (ginjal), umbilikus, iliaka kanan (apendiksitis), hipokondria, iliaka kiri (scibala).
5)
Abdomen obstetrik : perut membesar ke depan atau ke samping, keadaan pucat, pigmentasi linia alba, nampakkah gerakan anak atau kontraksi uterus, adakah strie gravidarum atau bekas luka.
6)
Vulva : keadaan perineum, carilah varises, tanda chadwick, condyloma akuminata, flour albus..
7)
Anggota bawah : cari varises, oedema, luka, cicatrix pada lipat paha,
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4)
Menurut leopold 1) Leopold I
Kaki penderita di bengkokan pada lutut dan lipatan paha
Pemeriksa berdiri sebelah kakan penderita dan melihat ke arah muka penderita.
Rahim dibawa ke tengah
Tingginya fundus uteri ditentukan dan bagian apa dari anak yang terdapat dalam fundus
Tujuan : untuk mengetahui usia kehamilan dan TFU dan bagian apa yang di fundus.
2) Leopold II
Keadaan tangan pindah ke samping
Tentukan dimama punggung anak , punggung anak terdapat di
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Jika kita rapatkan ke dua tangan pada permukaan dari bagian terbawah dari kepala yang masih teraba diluar :
Convergent → bagian kecil dari k epala epala turun ke rongga panggul
Sejajar → separuh dari kepala masuk ke dalam rongga panggul
Divergent → sebagian besar dari kepala masuk kedalam rongga panggul
Tujuan : menentukan apa yang menjadi bagian bawah dan berapa masuknya bagian bawah kedalam rongga panggul .
c. Auskultasi
Djj terdengar dimana,frekwensi, irama, dengan cara 5 detik berselang, 30 menit dikalikan 2/dihitung selama 1 menit penuh.
Kalau bunyi jantung janin kurang dari 120/menit atau lebih dari 160/menit atau tidak teratur,maka anak dalam keadaan asphyxial (kekurangan O2)
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Urine Reduksi Untuk mengetahui kadar glukosa dalam urine, sehingga dapat mendeteksi penyakit DM pada ibu hamil yang merupakan faktor risiko dalam kehamilan maupun persalinan.
Haemoglobin Untuk mendeteksi adanya anemia, bila Hb kurang dari 10 gr%. (normalnya : 11 gr%)
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2. Diagnosa Keperawat Keperawatan an
1) Ansietas berhubungan dengan adanya factor-faktor resiko khusus, krisis situasi, ancaman pada konsep diri, konflik disadari dan tidak disadari tentang nilai-nilai esensial dan tujuan hidup, kurang informasi. 2) Nutrisi kurang dari kebutuhan tubuh berhubungan dengan perubahan napsu makan, mual/muntah, tidak mengenal peningkatan kebutuhan metabolik. 3) Kekurangan volume cairan berhubungan dengan output berlebihan (muntah),
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b. Berikan informasi tentang penyimpangan genetic khusus, resiko yang dalam reproduksi dan ketersediaan tindakan/pilihan diagnosa. RASIONAL ketidaktahuan
:
dapat dan
menghilangkan
membantu
keluarga
ansietas
berkenaan
mengenai
stress,
dengan membuat
keputusan, dan beradaptasi secara positif terhadap pilihan c. Kembangkan sikap berbagi rasa secara terus menerus. RASIONAL : kesempatan bagi klien/pasangan untuk memuji pemecahan
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d. Timbang BB klien. berikan informasi tentang penambahan prenatal yang optimum. RASIONAL : ketidakadekuatan penambahan berat badan prenatal dan atau dibawah berat badan normal masa kehamilan, meningkatkan resiko retardasi pertumbuhan intrauterine (IUGR) pada janin dengan BBLR. e. Tinjau ulang frekuensi dan beratnya mual/muntah. RASIONAL : mual/muntah trimester pertama dapat berdampak negative
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e. Anjurkan peningkatan masukan minuman berkarbonat, makan enam kali sehari dengan jumlah yang sedikit dan makanan tinggi karbohidrat (popcorn, roti kering sebelum bangun tidur. RASIONAL : membantu dalam meminimalkan mual/muntah dengan menurunkan keasaman lambung. 4)
Resiko
tinggi
pola
napas
tidak
efektif
berhubungan
dengan
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lebih sering, dengan menggunakan posisi semi fowler, untuk duduk atau
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d. Anjurkan klien untuk menghindari posisi tegak atau supine dalam waktu
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7) Nyeri berhubungan dengan perubahan fisik, pengaruh hormonal hormonal
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8)
Kelebihan volume cairan berhubungan dengan perubahan, mekanisme
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9)
Intoleransi aktivitas berhubungan dengan kelemahan.
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