LAPORAN PENDAHULUAN KETOASIDOSIS DIABETIK ( KAD )
Nama mahasiswa
: Devi Fauziyyah
NI
: !"!#"
Tem$a% $&a'%i'
: IU L%" RS Ha*i +a'a&%a Timu&
Ha&i , Ta-..a/
: Kamis , 01 Fe2&ua&i "0!#
Ke/as
: III 3
A DEFI DEFINI NISI SI Ke%4asi54si Ke%4asi54siss Dia2e%i' Dia2e%i' (KAD) a5a/ah 'ea5aa- 5e'4m$e-sasi 5e'4m$e-sasi 'e'a6aua'e'a6aua- me%a24/i6 me%a24/i6 ya-. 5i%a-5ai 4/eh %&ias hi$e&./i'emia7 asi54sis 5a- 'e%4sis %e&u%ama 5ise2a2'a- 4/eh 5e8isie-si i-su/i- a2s4/u% a%au &e/a%ive KAD 5a- hi$4./i'emia me&u$a'a- '4m$/i'asi a'u% 5ia2e%es me//i%us (D) ya-. se&ius 5a- mem2u%uh'a- $e-.e/4/aa- .awa% 5a&u&a% A'i2a% 5iu&esia 4sm4%i'7 KAD 2iasa-ya me-.a/ami 5ehi5&asi 2e&a% 5a- 5a$a% sam$ai me-ye2a2'a- sy4' Ke%4Ke%4- asi54s asi54sis is 5ia2e% 5ia2e%i'u i'um m me%a24 me%a24/i' /i' aa'i2a aa'i2a%%
a5a/ah a5a/ah
$em2e$em2e-%u'a %u'a-
'e%4'e%4-
'ea5aa'ea5aaya-. ya-.
ya-. ya-.
5i%a-5 5i%a-5ai ai
2e&/e2 2e&/e2iha iha-7 -7
5e-.a5e-.a- asi54s asi54sis is
(Ame&i (Ame&i6a6a-
Dia2e% Dia2e%es es
Ass46ia%i4-7 "001) Ke%4asi54sis 5ia2e%i'um a5a/ah me&u$a'a- %&ias 5a&i hi$e&./i'emia7 asi54sis7 5a- 'e%4sis ya-. %e&/iha% %e&u%ama $a5a $asie- 5e-.a- 5ia2e%es %i$e9! (Sami*ea- N4&5ma&'7 "00) B ETI ETIOLO; OLO;II A5a se'i%a& "0< $asie- KAD ya-. 2a&u 5i'e%ahui me-5e&i%a D u-%u' $e&%ama 'a/i Pa5a $asie- ya-. su5ah 5i'e%ahui D se2e/um-ya7 0< 5a$a% 5i'e-a/i a5a-ya 8a'%4& $e-6e%us e-.a%asi 8a'%4& $e-6e%us i-i $e-%i-. 5a/am $e-.42a%a- 5a- $e-6e.aha'e%4asi54sis 2e&u/a-. Ti5a' a5a-ya i-su/i- a%au %i5a' 6u'u$-ya *um/ah i-su/i- ya-. -ya%a7 ya-. 5a$a% 5ise2a2'a- 4/eh : ! I-su/iI-su/i- %i5a' %i5a' 5i2e&i'a 5i2e&i'a- a%au 5i2e&i 5i2e&i'a'a- 5e-.a5e-.a- 54sis 54sis ya-. ya-. 5i'u&a-.i 5i'u&a-.i
" Kea5aa- sa'i% a%au i-8e'si = a-i8es%asi $e&%ama $a5a $e-ya'i% 5ia2e%es ya-. %i5a' %e&5ia.-4sis 5a- %i5a' 5i42a%i Be2e&a$a $e-ye2a2 %e&*a5i-ya KAD a5a/ah: a I-8e'si : $-eum4-ia7 i-8e'si %&a'%us u&i-a&ius7 5a- se$sis 5i'e%ahui 2ahwa *um/ah 2 6 5 e
se/ 5a&ah $u%ih mu-.'i- me-i-.'a% %a-$a i-5i'asi ya-. me-5asa&i i-8e'si Ke%i5a'$a%uha-: 'a&e-a 'e%i5a'$a%uha- 5a/am 54sis Pe-.42a%a-: 4-se% 2a&u 5ia2e%es a%au 54sis i-su/i- %i5a' a5e'ua% Ka&5i4vas'u/e& : i-8a&' mi4'a&5ium Pe-ye2a2 /ai-: hi$e&%i&4i5isme7 $a-'&ea%i%is7 'ehami/a-7 $e-.42a%a'4&%i'4s%e&4i5 a-5 a5&e-e&.i' (Sami*ea- N4&5ma&'7"00)
PATH>A?
;e*a/a 5a- %a-5a ya-. %im2u/ $a5a KAD 5ise2a2'a- %e&*a5i-ya hi$e&./i'emia 5a'e%4.e-esis De8isie-si i-su/i- me&u$a'a- $e-ye2a2 u%ama %e&*a5i-ya hi$e&./i'emia a%au $e-i-.'a%a- 'a5a& ./u'4sa 5a&ah 5a&i $eme6aha- $&4%ei- 5a- ./i'4.e- a%au /i$4/isis a%au $eme6aha- /ema' Hi$e&./i'emia me-ye2a2'a- 5iu&esis 4sm4%i' 5e-.a- hi$4v4/emia 'emu5ia- a'a- 2e&/a-*u% %e&*a5i-ya 5ehi5&asi 5a- &e-*a%a- a%au sy4' ;/u'4-e4.e-esis me-am2ah %e&*a5i-ya hi$e&./i'emi'
Li$4/isis ya-. %e&*a5i a'a- me-i-.'a%'a- $e-.a-.'u%a- 'a5a& asam /ema' 2e2as 'e ha%i sehi-..a %e&*a5i 'e%4asi54sis7 ya-. 'emu5ia- 2e&a'i2a% %im2u/-ya asi54sis me%a24/i'7 se2a.ai '4m$e-sasi %u2uh %e&*a5i $e&-a8asa- 'ussmau/
D ANIFESTASI KLINIK ! P4/iu&ia " P4/i5i$si = Pe-./iha%a- 'a2u& 1 Lemah @ Sa'i% 'e$a/a # Hi$4%e-si 4&%4s%a%i' ($e-u&u-a- %e'a-a- 5a&ah sis%4/i' "0 mmH. a%au $a5a saa% 2e&5i&i) A-4&e'sia7 ua/7 u-%ah Nye&i a254meC Hi$e&ve-%i/asi !0 Pe&u2aha- s%a%us me-%a/ (sa5a&7 /e%a&.i'7 '4ma) !! Ka5a& .u/a 5a&ah %i-..i ( "10 m.,5/) !" Te&5a$a% 'e%4- 5i u&i!= Na8as 2e&2au ase%4!1 Bisa %e&*a5i i/eus se'u-5e& a'i2a% hi/a-.-ya K 'a&e-a 5iu&esis 4sm4%i6 !@ Ku/i% 'e&i-.7 2e&'e&i-.a%
E PEERIKSAAN DIA;NOSTIK ! Ka5a& ./u'4sa 5a&ah: =00 m. ,5/ %e%a$i %i5a' 00 m.,5/ " E/e'%&4/i% 5a&ah (%e-%u'a- 64&&e6%e5 Na) 5a- 4sm4/a/i%as se&um = A-a/isis .as 5a&ah7 BUN 5a- '&ea%i-i- 1 Da&ah /e-.'a$ ($a5a KAD se&i-. 5i*um$ai .am2a&a- /e'4si%4sis)7 H2A!67 u&i-a/isis @ #
(5a- 'u/%u& u&i-e 2i/a a5a i-5i'asi) F4%4 $4/4s 5a5a Ke%4sis (Ke%4-emia 5a- Ke%4-u&ia) Ase%4- $/asma ('e%4-) : $4si%i8 se6a&a me-64/4' Osm4/a/i%as se&um : me-i-.'a% %e%a$i 2iasa-ya 'u&a-. 5a&i ==0 mOsm,/ Peme&i'saa-
Osm4/a/i%as "NaKG ;DR,!G UREU,#G C Hem4./42i- ./i'4si/a% : 'a5a&-ya me-i-.'a% "91 'a/i /i$a% 5a&i -4&ma/ ya-. me-6e&mi-'a- '4-%&4/ D ya-. 'u&a-. se/ama 1 2u/a- %e&a'hi& !0 ;as 5a&ah a&%e&i : 2iasa-ya me-u-*u''a- $H 7= 5a- $e-u&u-a- $a5a HO= "@0 F
PENATALAKSANAAN
P&i-si$
%e&a$i
KAD
a5a/ah
5e-.a-
me-.a%asi
5ehi5&asi7
hi$e&./i'emia7
5a-
'e%i5a'seim2a-.a- e/e'%&4/i%7 se&%a me-.a%asi $e-ya'i% $e-ye&%a ya-. a5a Fase I,;awa% : ! Rehi5&asi a Be&i'a- 6ai&a- is4%4-i' Na/ 07C< a%au RL "L /4a5i-. 5a/am " *am $e&%ama7 /a/u 0 %$m se/ama 1 *am7 /a/u =09@0 %$m se/ama ! *am (19#L,"1*am) 2 A%asi sy4' (6ai&a- "0 m/,'. BB,*am) 6 Bi/a sy4' %e&a%asi 2e&i'a- 6ai&a- sesuai %i-.'a% 5ehi5&asi 5 Rehi5&asi 5i/a'u'a- 2e&%aha$ u-%u' me-.hi-5a&i he&-iasi 2a%a-. 4%a' ("1 3 1 *am) e Bi/a ;u/a 5a&ah "00 m.,5/7 .a-%i i-8us 5e-.a- D@< 8 K4&e'si hi$4'a/emia ('e6e$a%a- ma 07@mEJ,'.BB,*am) . 4-i%4& 'eseim2a-.a- 6ai&a-
" I-su/ia B4/us i-su/i- 'e&*a 6e$a% (RI) 07! iu,'.BB (iv,im,s6) 2 Be&i'a- i-su/i- 'e&*a 6e$a% (RI) 07!,'.BB 5a/am 6ai&a- is4%4-i6 6 4-i%4& ;u/a 5a&ah %ia$ *am $a5a 1 *am $e&%ama7 se/a-*u%-ya %ia$ 1 *am se'a/i 5 Pem2e&ia- i-su/i- $a&e-%e&a/ 5iu2ah 'e S 2i/a : A;D !@ mEJ,L "@0m.<7 Pe&2ai'a- hi5&asi7 Ka5a& HO= = I-8us K (%i5a' 24/eh 24/us) Bi/a K =mEJ,L7 2e&i @mEJ,L Bi/a K =9=@mEJ,L7 2e&i @0 mEJ,L Bi/a K =@ 91mEJ,L7 2e&i "@mEJ,L asu''a- 5a/am Na/ @0066,"1 *am 1 I-8us Bi6a&24-a% Bi/a $H 7!7 %i5a' 5i2e&i'a@ A-%i2i4%i' 54sis %i-..i Ba%as 8ase I 5a- 8ase II se'i%a& ;DR "@0 m.,5/ a%au &e5u'si Fase II,ai-%e-a-6e: a) ai&a- mai-%e-a-6e Na6/ 0C< a%au D@ a%au ma/%4se !0< 2e&.a-%ia- Se2e/um ma/%4se7 2e&i'a- i-su/i&e.u/e& 1IU 2) Ka/ium Pe&e-%e&a/ 2i/a K "10 m.,5L a%au 2a5a- %e&asa %i5a' e-a ' 6) Saa% sa'i%7 ma'a-/ah sesuai $e-.a%u&a- ma'a- se2e/um-ya Bi/a %i5a' -a8su ma'a-7 24/eh ma'a- 2u2u& a%au mi-uma- 2e&'a/4&i /ai- 5) i-um/ah ya-. 6u'u$ u-%u' me-6e.ah 5ehi5&asi ; KOPLIKASI K4m$/i'asi ya-. 5a$a% %e&*a5i a'i2a% KAD yai%u:
! " = 1 @ #
E5ema $a&u Hi$e&%&i./ise&i5a I-8a&' mi4'a&5 a'u% Hi$4./i'emia Hi$4'a/semia Hi$e&'/4&emia E5ema 4%a' Hi$4'a/emia
KONSEP DASAR KEPERA>ATAN A Pe-.'a*iaA-am-esis : ! Riwaya% D " P4/iu&ia7 P4/i5i$si = Be&he-%i me-yu-%i' i-su/i1 Demam 5a- i-8e'si @ Nye&i $e&u%7 mua/7 mu%ah # Pe-./iha%a- 'a2u& Lemah 5a- sa'i% 'e$a/a Peme&i'sa- Fisi' : ! " = 1 @ #
O&%4s%a%i' hi$4%e-si (sis%4/e %u&u- "0 mmH. a%au /e2ih saa% 2e&5i&i) Hi$4%e-si7 Sy4' Na8as 2au ase%4- (2au ma-is se$e&%i 2uah) Hi$e&ve-%i/asi : Kusmua/ (RR 6e$a%7 5a/am) Kesa5a&a- 2isa 7 /e%a&.i a%au '4ma Dehi5&asi
Pe-.'a*ia- .awa% 5a&u&a% : Pe-.'a*ia- $&ime& ! Ai&ways : 'a*i 'e$a%e-a- *a/a- -a8as $asie-7 a5a %i5a'-ya s$u%um a%au 2e-5a asi-. ya-. me-.ha/a-.i *a/a- -a8as " B&ea%hi-. : 'a*i 8&e'ue-si -a8as7 2u-yi -a8as7 a5a %i5a'-ya $e-..u-aa- 4%4% 2a-%u $e&-a8asa= i&6u/a%i4- : 'a*i -a5i7 6a$i//a&y &e8i// Pe-.'a*ia- se'u-5e&
Pe-.'a*ia- hea5 %4 %4e ! Da%a su2ye'%i8 : Riwaya% $e-ya'i% 5ahu/u Riwaya% $e-ya'i% se'a&a-. S%a%us me%a24/i6 I-%a'e ma'a-a- ya-. me/e2ihi 'e2u%uha- 'a/4&i7 i-8e'si a%au $e-ya'i%9$e-ya'i% a'u% /ai-7 s%&ess ya-. 2e&hu2u-.a- 5e-.a- 8a'%4&98a'%4& $si'4/4.is 5a- s46ia/7 42a%942a%aa%au %e&a$i /ai- ya-. mem$e-.a&uhi ./u'4sa 5a&ah7 $e-.he-%ia- i-su/i- a%au 42a% a-%i hi$e&./i'emi' 4&a/ " Da%a O2ye'%i8 : a A'%ivi%as , Is%i&aha% ;e*a/a : Lemah7 /e%ih7 su/i% 2e&.e&a',2e&*a/a-7 '&am 4%4%7 %4-us 4%4% me-u&u-7 .a-..ua- is%&aha%,%i5u& Ta-5a : Ta'i'a&5ia 5a- %a'i$-ea $a5a 'ea5aa- is%&aha% a%au a'%i8i%as7 /e%a&.i ,5is4&ie-%asi7 '4ma 2 Si&'u/asi ;e*a/a : A5a-ya &iwaya% hi$e&%e-si7 I a'u%7 '/au5i'asi7 'e2as 5a- 'esemu%a $a5a e's%&emi%as7 u/'us $a5a 'a'i7 $e-yem2uha- ya-. /ama7 %a'i'a&5ia Ta-5a : Pe&u2aha- %e'a-a- 5a&ah $4s%u&a/7 hi$e&%e-si7 -a5i ya-. me-u&u-,%i5a' a5a7 5is&i%mia7 '&e'e/s7 5is%e-si ve-a *u.u/a&is7 'u/i% $a-as7 'e&i-.7 5a- 'eme&aha-7 24/a ma%a 6e'u-. 6 I-%e.&i%as, E.4 ;e*a/a : S%&ess7 %e&.a-%u-. $a5a 4&a-. /ai-7 masa/ah 8i-a-sia/ ya-. 2e&hu2u-.a5e-.a- '4-5isi Ta-5a : A-sie%as7 $e'a &a-.sa-. 5 E/imi-asi ;e*a/a : Pe&u2aha- $4/a 2e&'emih ($4/iu&ia)7 -4'%u&ia7 &asa -ye&i,%e&2a'a&7 'esu/i%a- 2e&'emih (i-8e'si)7 ISK 2a&u,2e&u/a-.7 -ye&i %e'a- a254me-7 5ia&e Ta-5a : U&i-e e-6e&7 $u6a%7 'u-i-.7 $4/iu&i ( 5a$a% 2e&'em2a-. me-*a5i 4/i.u&ia,a-u&ia7 *i'a %e&*a5i hi$4v4/emia 2e&a%)7 u&i- 2e&'a2u%7 2au 2usu' (i-8e'si)7 a254me- 'e&as7 a5a-ya asi%es7 2isi-. usus /emah 5a- me-u&u-7 hi$e&a'%i8 (5ia&e) e Nu%&isi,ai&a;e*a/a : Hi/a-. -a8su ma'a-7 mua/,mu-%ah7 %i5a' mema%uhi 5ie%7 $e-i-.'a%amasu'a- ./u'4sa,'a&24hi5&a%7 $e-u&u-a- 2e&a% 2a5a- /e2ih 5a&i 2e2e&a$a ha&i,mi-..u7 haus7 $e-..u-aa- 5iu&e%i6 Ta-5a Ku/i% 'e&i-.,2e&sisi'7 %u&.4& *e/e'7 'e'a'ua-,5is%e-si a254me-7 mu-%ah7 $em2esa&a- %i&4i5 ($e-i-.'a%a- 'e2u%uha-
me%a24/i' 5e-.a- $e-i-.'a%a- .u/a 5a&ah)7 2au ha/isi%4sis,ma-is7 2au 2uah (-a$as 8
ase%4-) Neu&4se-s4&i ;e*a/a : Pusi-.,$e-i-.7 sa'i% 'e$a/a7 'esemu%a-7 'e2as7 'e/emaha- $a5a 4%4%7 $a&es%esi7 .a-..ua- $e-./iha%a- Ta-5a : Dis4&ie-%asi7 me-.a-%u'7 a/e&.i7 s%u$4&,'4ma (%aha$ /a-*u%)7 .a-..ua- mem4&i (2a&u7 masa /a/u)7 'a6au me-%a/7
&e8/e's %e-54- 5a/am me-u&u- ('4ma)7 a'%i8i%as 'e*a-. (%aha$ /a-*u% 5a&i DKA) . Nye&i,'e-yama-a;e*a/a : A254me- ya-. %e.a-.,-ye&i (se5a-.,2e&a%) Ta-5a : >a*ah me&i-.is 5e-.a- $a/$i%asi7 %am$a' sa-.a% 2e&ha%i9ha%i h Pe&-a$asa;e*a/a : e&asa 'e'u&a-.a- 4'si.e-7 2a%u' 5e-.a-,%a-$a s$u%um $u&u/e(%e&.a-%u-. a5a-ya i-8e'si,%i5a') Ta-5a : La$a& u5a&a7 2a%u' 5e-.a-,%a-$a i
s$u%um $u&u/e-7 8&e'ue-si $e&-a$asa- me-i-.'a% Keama-a;e*a/a : Ku/i% 'e&i-.7 .a%a/7 u/'us 'u/i% Ta-5a : Demam7 5ia$h4&esis7 'u/i% &usa'7 /esi,u/se&asi7 me-u&u--ya 'e'ua%a- umum,&e-%a-. .e&a'7 $a&es%esia,$a&a/isis 4%4%
%e&masu' 4%4%94%4% $e&-a$asa- (*i'a 'a5a& 'a/ium me-u&u- 5e-.a- 6u'u$ %a*am) * Se'sua/i%as ;e*a/a : Ra2as va.i-a (6e-5e&u-. i-8e'si) asa/ah im$4%e- $a5a $&ia7 'esu/i%a- 4&.asme $a5a wa-i%a ' Pe-yu/uha-,$em2e/a*a&a;e*a/a : Fa'%4& &esi'4 'e/ua&.a D7 *a-%u-.7 s%&4'e7 hi$e&%e-si Pe-yem2uhaya-. /am2a%7 $e-..u-aa- 42a% se$e&%ii s%e&4i57 5iu&e%i' (%hiazi5)7 5i/a-%i- 5a8e-42a&2i%a/ (5a$a% me-i-.'a%'a- 'a5a& ./u'4sa 5a&ah) u-.'i- a%au %i5a' meme&/u'a- 42a% 5ia2e%i' sesuai $esa-a- Re-6a-a $emu/a-.a- : u-.'imeme&/u'a- 2a-%ua- 5a/am $e-.a%u&a- 5ie%7 $e-.42a%a-7 $e&awa%a- 5i&i7 $ema-%aua- %e&ha5a$ ./u'4sa 5a&ah B Dia.-4sa Ke$e&awa%a- ya-. mu-.'i- %im2u/ ! Ke%i5a'e8e'%i8a- $4/a -a$as 2e&hu2u-.a- 5e-.a- $e-u&u-a- 'emam$ua- 2e&-a$as " De8isi% v4/ume 6ai&a- 2e&hu2u-.a- 5e-.a- $e-.e/ua&a- 6ai&a- 2e&/e2iha- (5iu&esis 4sm4%i6) a'i2a% hi$e&./i'emia = Risi'4 %i-..i %e&*a5i-ya .a-.ua- $e&%u'a&a- .as 2,5 $e-i-.'a%a- 'easama- ( $H me-u&u-) a'i2a% hi$e&./i'emia7 ./u'4-e4.e-esis7 /i$4/ysis Re-6a-a Ke$e&awa%a! Ke%i5a'e8e'%i8a- $4/a -a$as 2e&hu2u-.a- 5e-.a- $e-u&u-a- 'emam$ua- 2e&-a$as
K&i%e&ia Hasi/ : a P4/a -a8as $asie- 'em2a/i %e&a%u& 2 Res$i&asi &a%e $asie- 'em2a/i -4&ma/ 6 Pasie- mu5ah u-%u' 2e&-a8as I-%e&ve-si: a 2 6 5 e
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" De8isi% v4/ume 6ai&a- 2e&hu2u-.a- 5e-.a- $e-.e/ua&a- 6ai&a- 2e&/e2iha- (5iu&esis 4sm4%i6) a'i2a% hi$e&./i'emia K&i%e&ia Hasi/ : a TTM 5a/am 2a%as -4&ma/ 2 Pu/se $e&i8e& 5a$a% %e&a2a 6 Tu&.4& 'u/i% 5a- 6a$i//a&y &e8i// 2ai' 5 Keseim2a-.a- u&i- 4u%$u% e Ka5a& e/e'%&4/i% -4&ma/ 8 ;DS -4&ma/ I-%e&ve-si : a O2se&vasi $emasu'a- 5a- $e-.e/ua&a- 6ai&a- se%ia$ *am 2 O2se&vasi 'e$a%e-a- a%au 'e/a-6a&a- i-8 6 4-i%4& TTM 5a- %i-.'a% 'esa5a&a- %ia$ !@ me-i%7 2i/a s%a2i/ /a-*u%'a- u-%u' se%ia$ *am 5 O2se&vasi %u&.4& 'u/i%7 se/a$u% mu'4sa7 a'&a/7 $e-.isia- 'a$i/e& e 4-i%4& hasi/ $eme&i'saa- /a24&a%4&ium : Hema%4'&i%7
BUN,K&ea%i-i-7
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Pemasa-.a- MP *i'a
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DAFTAR PUSTAKA
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