LAPORAN PENDAHULUAN SECTIO CAESAREA ATAS INDIKSI CPD
A. KONSEP DASAR PENYAKIT I. SECTIO CAESARIA 1. Pengertian Pengertian Sectio Caesaria
Seksio sesarea ialah pembedahan untuk melahirkan janin dengan membuka dinding perut dan dinding uterus. ( Prawirohardjo, 1999) Seksio sesarea adalah melahirkan janin melalui insisi pada dinding abdomen dan dinding uterus. (Cunningham dkk, 1990) Seksio sesarea adalah sebuah bentuk melahirkan anak dengan melakukan sebuah irisan pembedahan yang menembus abdomen seorang ibu dan uterus untuk mengeluarkan satu bayi atau lebih. Cara ini biasanya dilakukan ketika kelahiran melalui vagina akan mengarah pada komplikasi-komplikasi, kendati cara ini semakin umum sebagai pengganti kelahiran normal . (Yusmiati, 2007) Dari pengertian diatas dapat disimpulkan bahwa seksio sesarea adalah pembedahan untuk melahirkan janin dengan membuka dinding perut dan dinding uterus.
2. Jenis Sectio Caesarea Berdasarkan Teknik Penyayatan
a. Seksio sesarea klasik atau corporal Dilakukan dengan membuat sayatan memanjang pada korpus uteri kirakira 10 cm. Kelebihannya antara lain : mengeluarkan janin dengan cepat, tidak mengakibatkan komplikasi kandung kemih tertarik, dan sayatan bisa diperpanjang proksimal dan distal. Sedangkan kekurangannya adalah infeksi mudah menyebar secara s ecara intraabdominal karena kare na tidak ti dak ada peritonealis yang baik, untuk persalinan yang berikutnya lebih sering terjadi ruptur uteri spontan. b. Seksio sesarea ismika sesarea ismika atau atau profundal profundal . Dilakukan dengan melakukan sayatan melintang konkat pada segmen bawah rahim (low servikal transversal ) kira-kira 10 cm. Kelebihan dari sectio caesarea ismika, ismika, antara lain : penjahitan luka lebih mudah, mudah, penutupan luka dengan reperitonealisasi yang baik, tumpang tindih dari peritoneal
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flop baik untuk menahan penyebaran isi uterus ke rongga peritoneum, dan kemungkinan ruptur uteri spontan berkurang atau lebih le bih kecil. Sedangkan kekurangannya adalah luka melebar sehingga menyebabkan uteri pecah dan menyebabkan perdarahan banyak, keluhan pada kandung kemih post operasi tinggi. c. Seksio sesarea ekstra sesarea ekstra peritonealis Yaitu tanpa membuka peritoneum parietalis dan tidak membuka cavum abdominal.
3. Klasifikasi Sectio Caesarea a. Seksio Sesarea Primer
Dari semula telah direncanakan bahwa janin akan dilahirkan secara seksio sesarea, tidak diharapkan lagi kelahiran biasa, misalnya pada panggul sempit. b. Seksio Sesarea Sekunder
Dalam hal ini kita bersikap mencoba menunggu kelahiran biasa, bila tidak ada kemajuan persalinan, baru dilakukan seksio sesarea. c. Seksio Sesarea Ulang
Ibu pada kehamilan lalu mengalami seksio sesarea dan pada kehamilan selanjutnya dilakukan seksio sesarea ulang. d. Seksio Sesarea Postmortem
Seksio sesarea yang dilakukan segera pada ibu hamil cukup bulan yang meninggal tiba-tiba sedangkan janin masih hidup.
4. Indikasi Sectio Caesarea
a.
Disproporsi chepalopelvik atau kelainan panggul.
b.
Plasenta previa
c.
Gawat janin
d.
Pernah seksio sesarea sebelumnya
e.
Kelainan letak janin
f.
Hipertensi
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j.
Distosia serviks
k.
Ketidakmampuan ibu mengejan
l.
Malpresentasi janin
Letak lintang - Bila ada kesempitan panggul maka secsio sesarea adalah cara yang terbaik dalam segala letak lintang dengan janin hidup dan besar biasa. - Semua primigravida dengan letak lintang harus ditolong dengan secsio sesarea walau tidak ada perkiraan panggul sempit. - Multipara dengan letak lintang dapat lebih dulu ditolong dengan dengan caracara lain.
Letak bokong Secsio sesarea dianjurkan pada letak bokong bila ada :
-
Panggul sempit
-
Primigravida
-
Janin besar dan berharga
Presentasi dahi dan muka (letak defleksi) bila reposisi dan cara-cara lain tidak berhasil.
Presentasi rangkap, bila reposisi tidak berhasil.
Gemelli, dianjurkan dianjurkan secsio sesarea bila - Janin pertama letak lintang atau presentasi bahu - Bila terjadi interlock - Distosia oleh karena tumor - Gawat janin
5. Komplikasi Sectio Caesarea
a. Infeksi puerpuralis (nifas)
Ringan : Dengan kenaikan suhu beberapa hari saja
Sedang : Dengan kenaikan suhu yang lebih tinggi, disertai dehidrasi atau perut sedikit kembung
Berat : Dengan peritonitis, sepsis dan ileus paralitik. Hal ini sering kita jumpai pada partus terlantar dimana sebelumnya telah terjadi infeksi
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Atonia uteri
Perdarahan pada placenta bed
c. Luka kandung kemih, emboli paru dan keluhan kandung kemih bila reperitonialisasi terlalu tinggi. d. Kemungkinan rupture uteri spontan pada kehamilan mendatang.
6. Penatalaksanaan Pasca Operasi Sectio Caesarea
Penatalaksanaan post operasi sectio operasi sectio caesarea, caesarea, antara lain : 1)
Periksa dan catat tanda - tanda vital setiap 15 menit pada 1 jam pertama dan 30 menit pada 4 ja jamkemudian. mkemudian.
2)
Perdarahan dan urin harus dipantau secara ketat.
3)
Pemberian tranfusi darah, bila terjadi perdarahan post partum.
4)
Pemberian antibiotika. Walaupun
pemberian
antibiotika
sesudah
sesar
efektif
dapat
dipersoalkan, namun pada umumnya pemberiannya dianjurkan. 5)
Mobilisasi. Pada hari pertama setelah operasi penderita harus turun dari tempat tidur dengan dibantu, paling sedikit 2 kali. Pada hari kedua penderita sudah dapat berjalan ke kamar mandi dengan bantuan.
6)
Pemulangan Jika tidak terdapat komplikasi penderita dapat dipulangkan pada hari kelima setelah operasi. (Mochtar Rustam, 2002)
II. LETAK SUNGSANG 1. Pengertian Letak sungsang
Letak sungsang adalah keadaan di mana janin terletak memanjang dengan kepala di fundus uteri dan bokong berada di bagian bawah kavum uteri. (Sarwono, 2006) Letak sungsang adalah janin yang letaknya memanjang (membujur) dalam rahim, kepala berada di fundus dan bokong di bawah. (Mochtar, 1998)
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dengan diameter
transversal
yang lebih
panjang sedikit
daripada
diameter anteroposterior dan dengan panggul tengah t engah serta pintu bawah panggul yang cukup cukup luas. 2)
Panggul anthropoid, dengan diameter anteroposterior yang lebih panjang daripada diameter transversa dan dengan arkus pubis menyempit menyempit sedikit.
3)
Panggul android, dengan pintu atas panggul yang berbentuk sebagai segitiga berhubungan dengan penyempitan ke depan, dengan spina iskiadika menonjol ke dalam dan dengan arkus pubis yang menyempit.
4)
Panggul platipelloid, dengan diameter anteroposterior yang jelas lebih pendek daripada diameter transversa pada pintu atas panggul dan dengan arkus pubis yang luas. Tulang – tulang tulang panggul terdiri dari os koksa, os sakrum, dan os koksigis.
Os koksa dapat dibagi menjadi os ilium, os iskium, dan os pubis. Tulang-tulang ini satu dengan lainnya berhubungan. Di depan terdapat hubungan antara kedua os pubis kanan dan kiri, disebut simfisis. Dibelakang terdapat artikulasio sakro- iliaka yang menghubungkan os sakrum dengan os ilium. Dibawah terdapat artikulasio sakro-koksigea yang menghubungkan os sakrum (tulang panggul) dan os koksigis (tulang (t ulang tungging). Pada wanita, di luar kehamilan artikulasio ini hanya memungkinkan pergeseran sedikit, s edikit, tetapi pada kehamilan dan waktu wa ktu persalinan dapat bergeser ber geser lebih jauh dan lebih longgar, misalnya ujung koksigis dapat bergerak kebelakang sampai sejauh lebih kurang 2,5 cm. Hal ini dapat dilakukan bila ujung os koksigis menonjol ke depan pada saat partus, dan pada pengeluaran kepala janin dengan cunam ujung os koksigis itu dapat ditekan ke belakang. Secara fungsional, panggul terdiri dari dua bagian yaitu pelvis mayor dan pelvis minor. Pelvis mayor adalah bagian pelvis yang terletak diatas linea terminalis, disebut juga dengan false pelvis. Bagian yang terletak dibawah linea terminalis disebut pelvis minor atau true pelvis. Pada ruang yang dibentuk oleh pelvis mayor terdapat organ-organ abdominal selain itu pelvis mayor merupakan tempat perlekatan otot-otot dan ligamen ke dinding tubuh. Sedangkan pada ruang yang dibentuk oleh pelvis minor terdapat bagian dari
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Adapun ukuran panggul adalah sebagai berikut : 1)
Pintu Atas Panggul Pintu atas panggul dibentuk oleh promontorium corpus vertebra sacrum, linea innominata, serta pinggir atas simfisis. Konjugata diagonalis adalah jarak dari pinggir bawah simfisis ke promontorium, Secara klinis, konjugata diagonalis dapat diukur dengan memasukkan jari telunjuk dan jari tengah yang dirapatkan menyusur naik ke seluruh s eluruh permukaan anterior sacrum, promontorium teraba sebagai penonjolan tulang. Dengan jari tetap menempel pada promontorium, tangan di vagina diangkat sampai menyentuh arcus pubis dan ditandai dengan jari telunjuk tangan kiri. Jarak antara ujung jari pada promontorium sampai titik yang ditandai oleh jari telunjuk merupakan panjang konjugata diagonalis. Konjugata vera yaitu jarak dari pinggir atas simfisis ke promontorium yang dihitung dengan mengurangi konjugata diagonalis
1,5 cm,
panjangnya lebih kurang 11 cm. Konjugata obstetrika merupakan konjugata yang paling penting yaitu jarak antara bagian tengah dalam simfisis dengan promontorium, selisih antara konjugata vera dengan konjugata obstetrika sedikit sekali. 2)
Panggul Tengah (Pelvic Cavity) Ruang panggul ini memiliki ukuran yang paling luas. Pengukuran klinis panggul tengah tidak dapat diperoleh secara langsung. Terdapat penyempitan setinggi spina isciadika, sehingga bermakna penting pada distosia setelah kepala engagement. Jarak antara kedua spina ini yang biasa disebut distansia interspinarum merupakan jarak panggul terkecil yaitu sebesar 10,5 cm. Diameter anteroposterior setinggi spina isciadica berukuran 11,5 cm. Diameter sagital posterior, jarak antara sacrum dengan garis diameter interspinarum berukuran 4,5 cm.
3.
Pintu Bawah Panggul Pintu bawah panggul bukanlah suatu bidang datar namun terdiri dari dua segitiga dengan dasar yang sama yaitu garis yang menghubungkan tuber isciadikum kiri dan kanan. Pintu bawah panggul yang dapat
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tengah distensia tuberum atau diameter sagitalis posterior (7,5 cm), dan jarak antara pinggir bawah simpisis ke ujung sacrum (11,5 cm). Gambar 2.1. Anatomi Panggul Wanita
3. Klasifikasi Letak Sungsang
Klasifikasi letak sungsang menurut Mochtar (1998) : a. Letak bokong (Frank Breech) Letak bokong dengan kedua tungkai terangkat keatas. b. Letak sungsang sempurna (Complete Breech) Letak bokong dimana kedua kaki ada di samping bokong c. Letak sungsang tidak sempurna (Incomplete Breech) Adalah letak sungsang di mana selain bokong bagian yang terendah juga kaki atau lutut terdiri dari :
Kedua kaki = Letak kaki sempurna
Satu Kaki = Letak kaki tidak smpurna
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4. Etiologi Letak Sungsang
Pada kehamilan sampai kurang 32 minggu, jumlah air ketuhan relatif lebih banyak, sehingga memungkinkan janin bergerak dengan leluasa, dengan demikian janin dapat menempatkan diri dalam presentasi kepala, letak sungsang atau letak lintang pada kehamilan triwulan terakhir janin tumbuh dengan cepat dan jumlah air ketuban relatif berkurang. Karena bokong dengan kedua tungkai yang berlipat lebih besar dari pada kepala, maka bokong dipaksa untuk menempati ruang yang lebih luas di fundus uteri. Faktor-faktor lain yang memegang peranan dalam terjadinya letak sungsang diantaranya ialah multiparitas, hamil kembar, hidramnion, hidrosepalus, plasenta previa dan panggul sempit, kelainan uterus, plasenta plas enta yang terletak di daerah kornu fundus uteri. (Sarwono, 2006)
5. Diagnosis Letak Sungsang
Diagnosis letak sungsang yaitu pada pemeriksaan luar : di bagian bawah uterus tidak dapat diraba bagian yang keras dan bulat (kepala), kepala teraba di fundus uteri. Selain itu ibu juga merasakan penuh dibagian atas dan gerakannya terasa lebih banyak dibagian bawah. Denyut jantung janin pada umumnya ditemukan setinggi atau sedikit lebih tinggi dari pada umbilicus. Apabila diagnosis letak sungsang dengan pemeriksaan luar tidak dapat dibuat, karena misalnya dinding perut tebal, uterus mudah berkontraksi atau banyaknya air ketuban, maka diagnosis ditegakkan berdasarkan pemeriksaan dalam. Apabila ada keraguan, harus dipertimbangkan untuk melakukan pemeriksaan ultrasonografi, setelah ketuban pecah, dapat diraba lebih jelas adanya bokong yang ditandai dengan adanya sakrum, kedua tuberosisiskii, dan anus. Bisa dapat diraba kaki, maka harus
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badan janin, sehingga trokunter belakang melewati perineum dan lahirlah seluruh bokong diikuti oleh kedua kaki, setelah bokong lahir terjadi putaran paksi luar dengan perut janin berada di posterior yang memungkinkan bahu melewati pintu atas panggul dengan garis terbesar bahu melintang atau miring. Terjadi putaran paksi dalam pada bahu, sehingga bahu depan berada di bawah simfisis dan bahu belakang melewati perineum. Pada saat tersebut kepala masuk ke dalam rongga panggul dengan sutura sagitalis melintang atau miring. Dalam rongga panggul terjadi putaran paksi dalam kepala sehingga muka memutar ke posterior dan oksiput ke arah simpisis. Dengan suboksiput sebagai hipomoklion, maka dagu, mulut, hidung, dahi dan seluruh kepala lahir berturutturut melewati perineum. Ada perbedaan nyata antara kelahiran janin dalam prosentasi kepala dan kelahiran janin dalam letak sungsang. Pada prosentase kepala yang lahir lebih dahulu ialah bagian janin yang terbesar, sehingga bila kepala telah lahir, kelahiran badan tidak memberi kesulitan. Sebaliknya pada letak sungsang, berturut-turut lahir bagian-bagian yang makin lama makin besar dimulai dari lahirnya bokong, bahu dan kemudian kepala. Dengan demikian meskipun bokong dan bahu telah lahir, hal tersebut belum menjamin bahwa kelahiran kepala juga berangsur-angsur berlangsung dengan lancar.
7. Prognosis
a.
Bagi Ibu Kemungkinan robekan pada perineum lebih besar karena dilakukan tindakan, selain itu ketuban lebih cepat pecah dan paritas lebih lama, jadi mudah terkena infeksi.
b.
Bagi anak
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8. Komplikasi
a. Komplikasi pada janin
Prolaps tali pusat.
Trauma pada bayi akibat tangan mengalami extensi, kepala mengalami extensi, pembukaan serviks belum lengkap disporposi chepalopelvic.
Asfiksia karena prolaps tali pusat, kompresi tali pusat pelepasan placenta, kepala macet.
Perlukaan atau trauma pada organ abdomen atau leher.
Patah tulang leher.
b. Komplikasi pada ibu
Pelepasan placenta.
Perlukaan vagina atau serviks.
Endometriosis.
III. POST PARTUM (NIPAS) 1. Pengertian Post Partum
Nifas atau purperium adalah periode waktu atau masa dimana organ-organ reproduksi kembali ke keadaan tidak hamil. (Forner, 1999 ) Masa nifas/masa purperium adalah masa setelah partus selesai dan berakhir setelah kira-kira 6 minggu. (Arif, 1999) Dari dua pengertian di atas dapat disimpulkan bahwa masa nifas adalah masa sejak selesainya persalinan hingga pulihnya alat-alat kandungan dan anggota badan serta psikososial yang berhubungan dengan kehamilan/persalinan selama 6 minggu.
2. Fase Nifas
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karena sitoplasmanya yang berlebihan dibuang. a.
Involusio uterus Terjadi setelah plasenta lahir, uterus akan mengeras karena kontraksi dan reaksi
pada otot-ototnya, otot-ototnya, dapat diamati dengan pemeriksaan TFU
yaitu setelah plasenta lahir hingga 12 jam pertama TFU 1-2 jari dibawah pusat. Pada hari ke-6 TFU normalnya berada di pertengahan simfisis pubis dan pusat. Pada hari ke- 9 atau 12 TFU sudah tidak teraba. b.
Involusio tempat melekatnya plasenta Setelah plasenta dilahirkan, tempat melekatnya plasenta menjadi tidak beraturan dan ditutupi oleh vaskuler yang kontraksi serta trombosis pada endometrium terjadi pembentukan scar sebagai proses penyembuhan luka. Proses penyembuhan luka pada endometrium ini memungkinkan untuk implantasi dan pembentukan plasenta pada kehamilan yang akan datang.
2) Lochea Yaitu kotoran yang keluar dari liang senggama dan terdiri dari jaringan-jaringan mati dan lendir berasal dari rahim dan liang senggama. Lochea terbagi Lochea terbagi menjadi 4 jenis, yaitu : a. Lochea rubra, rubra, berwarna merah yang terdiri dari lendir dan darah, terdapat pada hari kesatu dan kedua. b. Lochea sanguinolenta, sanguinolenta, berwarna coklat yang terdiri dari cairan bercampur darah dan pada hari ke 3 - 6 post partum. c. Lochea serosa, serosa, berwarna merah muda agak kekuningan yang mengandung serum, selaput lendir, leukosit dan jaringan yang telah mati, pada hari ke 7 - 10. d. Lochea alba, alba, berwarna putih/jernih yang berisi leukosit, sel epitel,
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b. Adaptasi sistem cardiovaskuler
Tekanan darah stabil, penurunan tekanan darah sistolik 20 mmHg dapat terjadi pada saat ibu berubah posisi berbaring - duduk. Keadaan Keadaan sementara ini sebagai kompensasi cardiovaskuler terhadap penurunan dalam rongga panggul dan perdarahan.
Denyut nadi berkisar antara 60 - 70 x/menit, berkeringat dan menggigil mengeluarkan cairan yang berlebihan sering terjadi terutama pada malam hari.
c. Adaptasi sistem gastro intestinal Diperlukan waktu 3 - 4 hari sebelum faal usus kembali normal meskipun kadar progesteron menurun setelah melahirkan namun asupan makanan juga mengalami penurunan selama 1 - 2 hari. d. Adaptasi traktus urinarius Selama proses persalinan kandung kemih mengalami trauma yang dapat mengakibatkan oedem dan menghilangkan sensifitas terhadap tekanan cairan. perubahan ini dapat menyebabkan tekanan yang berlebihan dan pengosongan yang tidak sempurna, biasanya ibu mengalami ketidakmampuan untuk buang air kecil selama 2 hari pertama setelah melahirkan.
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h. Laktasi Setelah partus, pengaruh
penekanan dari estrogen dan progesteron
terhadap hipofisis hilang timbul. Pengaruh hormon-hormon hormon-hormon hipofisis kembali antara lain lactogenic lain lactogenic hormon hormon (prolaktin) yang akan menghasilkan mammae yang telah dipersiapkan pada masa hamil, terpengaruhi akibat kelenjarkelenjar
susu berkontraksi sehingga mengeluarkan air susu. Umumnya
produksi air susu baru berlangsung betul pada hari ke-2 - 3 post post partum. 4) Proses menjadi orang tua Steele dan Pollack (1968),
menyatakan bahwa menjadi orang tua
merupakan suatu proses yang terdiri dari dua komponen. Komponen pertama bersifat praktis atau mekanis yang melibatkan ketrampilan kognitif dan motorik, dan komponen kedua bersifat emosional emosional yang yang melibatkan ketrampilan afektif dan
kognitif.
Kedua komponen tersebut penting untuk perkembangan dan
keberadaan bayi. a. Ketrampilan Kognitif-Motorik Komponen ini melibatkan orang tua dalam aktivitas perawatan anak, seperti memberikan makan, menggendong, menenakan pakaiaan, dan membersihkan bayi, ba yi, menjaganya dari bahaya, dan memungkinkan untuk bergerak. (Steele, Pollack,1968)
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tua ini memiliki efek yang mendasar pada cara perawatan perawat an anak yang dilakukan dengan praktis dan pada respon emosionl anak terhadap asuhan yang diterimanya. Suatu hubungan orangtua-anak yang yang positif adalah saling memberi satu sama lain yang dapat mendasari dalam memberikan bantuan mempunyai arti bahwa orang tersebut berharga untuk menerima menerima bantuan. Konsep Erikson (1959-1964), mengatakan tentang dasar kepercayaan perkembangan rasa percaya ini akan menentukan respon bayi seumur hidupnya. Orang-orang yang mengalami hubungan orang tua-anak yang positif cenderung lebih mudah bersosialisasi dan terbuka serta meminta
mampu
bantuan dan menerima bantuan dari orang lain. Sebaliknya,
mereka yang kurang rasa percaya cenderung mengasingkan diri dan menyendiri. Mereka memiliki kemungkinan yang lebih besar untuk mengalami krisis karena ketidakmampuanya menggunakan dukungan orang lain ketika menghadapi masalah. (Bobak, Lowdermilk, Jensen, 2004) 5) Adaptasi psikososial Menjadi orang tua merupakan suatu krisis tersendiri dan harus melewati masa transisi. Masa transisi pada post partum yang harus diperhatikan perawat adalah :
Honeymoon
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Menurut klasifikasi Rubin terdapat tiga tingkat psikologis klien setelah melahirkan adalah :
Fase "taking "taking in" in" (Fase Dependen) Selama 1-2 hari pertama, dependensi sangat dominan pada ibu dan ibu lebih memfokuskan pada dirinya sendiri. Beberapa hari setelah melahirkan akan menangguhkan keterlibatannya dalam tanggung jawab sebagai seorang ibu dan ia lebih mempercayakan kepada orang lain
dan ibu akan lebih meningkatkan kebutuhan akan nutrisi dan
istirahat. Menunjukkan kegembiraan yang yang sangat, misalnya menceritakan tentang pengalaman kehamilan, melahirkan dan rasa ketidaknyamanan.
Fase "taking "taking hold " (Fase Independen)
Ibu sudah malu menunjukkan perluasan fokus perhatiannya yaitu dengan memperlihatkan bayinya.
Ibu mulai tertarik melakukan pemeliharaan pada bayinya.
Ibu mulai terbuka untuk menerima pendidikan kesehatan bagi dirinya dan bayinya.
Fase "letting "letting go" go" (Fase Interdependen) Merupakan suatu kemajuan menuju peran baru, ketidaktergantungan dalam merawat diri diri dan bayinya bayinya lebih meningkat, dan mampu mengenal
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IV. MOBILISASI DINI POST PARTUM (POST SECTIO CAESAREA) 1. Pengertian Mobilisasi
Mobilisasi dini adalah suatu upaya mempertahankan kemandirian sedini mungkin dengan cara membimbing penderita untuk mempertahankan fungsi fisiologis. (Carpenito, 2000) Mobilisasi adalah kemampuan seseorang untuk berjalan bangkit berdiri dan kembali ke tempat tidur, kursi, kloset duduk, dan sebagianya disamping kemampuan mengerakkan ekstermitas atas. (Hincliff, 1999) Mobilisasi ibu post partum adalah suatu pergerakan, posisi atau adanya kegiatan yang dilakukan ibu setelah beberapa jam melahirkan dengan persalinan Caesar. (Soelaiman, 1993) 2. Manfaat Mobilisasi
Menurut Manuaba (1998), tujuan mobilisasi post partum adalah : 1)
Melancarkan pengeluaran lochea, mengurangi infeksi peurperium
2)
Mempercepat involusi alat kandungan
3)
Melancarkan fungsi alat gastrointestinal dan alat perkemihan
4)
Meningkatkan kelancaran peredaran darah, sehingga mempercepat fungsi ASI dan pengeluaran sisa metabolisme.
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2)
Perdarahan yang abnormal Dengan mobilisasi dini kontraksi uterus akan baik sehingga fundus uteri keras, maka resiko perdarahan yang abnormal dapat dihindarkan, karena kontraksi membentuk penyempitan pembuluh darah yang terbuka.
3)
Involusi uterus yang tidak baik Tidak dilakukan mobilisasi secara dini akan menghambat pengeluaran darah dan sisa plasenta sehingga menyebabkan terganggunya kontraksi uterus.
4. Rentang Gerak Dalam Mobilisasi
Menurut Carpenito (2000), dalam mobilisasi terdapat tiga rentang gerak yaitu : 1)
Rentang gerak pasif Rentang gerak pasif ini berguna untuk menjaga kelenturan otot-otot dan persendian dengan menggerakkan otot orang lain secara pasif misalnya
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6. Pelaksanaan Mobilisasi Dini
1) Hari ke 1 :
Berbaring miring ke kanan dan ke kiri yang dapat dimulai sejak 6-10 jam setelah penderita / ibu sadar.
Latihan pernafasan dapat dilakukan ibu sambil tidur terlentang sedini mungkin setelah sadar.
2) Hari ke 2 :
Ibu dapat duduk 5 menit dan minta untuk bernafas dalam-dalam lalu menghembuskannya
disertai
batuk-batuk
kecil
yang
gunanya
untuk
melonggarkan pernafasan dan sekaligus menumbuhkan kepercayaan pada diri ibu/penderita bahwa ia mulai pulih.
Kemudian posisi tidur terlentang dirubah menjadi setengah duduk
Selanjutnya secara berturut-turut, hari demi hari penderita/ibu yang sudah
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IV. Pathway Sectio Caesarea INDIKASI
Kelainan letak janin, Hipertensi, Rupture uteri mengancam, Partus lama, Partus tak maju, Distorsio servik Disproporsi sefalopelvik, Palsenta previa, Gawat janin, Pernah SC sebelumnya, Ketidakmampuan ibu mengejan
Sectio Caesarea
Pasca operatif
Trauma
Luka bekas
jaringan
insisi
psikologis
Mempengaruhi tonus uteri
Isapan bayi
Stimulasi Hip.
peran baru
Posterior Respon mual
Atonia uteri
muntah
Hip.anterior Pola napas tak
Perubahan peran
Stimulasi
infeksI
efektif
Taking hold
Penerimaan
Gangguan Resti
Taking in
Medulla oblongata
pada pons
Nyeri
Adaptasi
fisiologis
Proses laktasi
Invasi
itas jaringan
Adaptasi
Efek anestesi
Supresi SSP Diskontinu
Post partum
Cemas
Sekresi oksitosin
Resti perdarahan Resti kekurangan volume cairan dan
Cemas Sekresi
Stimulasi duktus
Letting go
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B. DAMPAK PENYAKIT TERHADAP KEBUTUHAN DASAR MANUSIA
1. Kebutuhan Oksigenasi Dampak general anastesi mengakibatkan depresi otot yang mengakibatkan reflek batuk menurun, terjadi akumulasi scret pada jalan napas mengakibatkan bersihan jalan napas dan pola napas tidak efektif. 2. Kebutuhan Cairan dan Elektrolit Perdarahan intra/pasca operatif dapat menyebabkan volume intravaskuler menurun, terjadi syok hipovolemik, terjadi gangguan keseimbangan cairan dan elektrolit. 3. Kebutuhan Sirkulasi Perdarahan intra/pasca operatif dapat menyebabkan volume intravaskuler menurun, tidak adequatnya volume cairan intravaskuler menyebabkan penurunan tekanan darah, penurunan aliran darah (blood flow) dan penurunan perfusi jaringan.
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C. ASUHAN KEPERAWATAN 1. Pengkajian
a. Identitas Pada tahap ini perawat perlu mengetahui tentang nama, umur, alamat rumah, agama atau kepercayaan, suku bangsa, bahasa yang dipakai, status pendidikan dan pekerjaan pasien dan suaminya. b. Riwayat Kesehatan 1. Keluhan utama Keluhan utama merupakan faktor utama yang mendorong pasien mencari pertolongan atau berobat ke rumah sakit. Biasanya pada pasien dengan post operasi sectio caesarea hari 1-3 adalah adanya rasa nyeri. 2. Riwayat kesehatan sekarang Mulai kapan klien merasakan adanya keluhan, dan usaha apa saja yang
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kesadaran dimulai dari siuman sampai ngantuk, harus di observasi dan penurunan tingkat kesadaran merupakan gejala gejala syok. 2.
Sistem pernafasan Respirasi bias meningkat atau menurun . Pernafasan yang ribut dapat terdengar tanpa stetoskop. Bunyi pernafasan akibat lidah jatuh kebelakang atau akibat akibat terdapat secret. Suara paru yang yang kasar kasar
merupakan gejala
terdapat secret pada saluran nafas . Usaha batuk dan bernafas dalam
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9.
Keamanan
Balutan abdomen dapat tampak sedikit noda kering dan utuh.
Jalur parental bila digunakan paten can sisi sis i bebas eritema, bengkok, nyeri tekan.
10. Seksualitas
Fundus kontraksi kuat dan terletak di umbilicus.
Aliran lokhia sedang dan bebas bekuan berlebihan/banyak.
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Kriteria hasil :
Tidak mengalami penumpukan sekret, bunyi nafas bersih, dan dapat melakukan batuk efektif.
Intervensi : a. Kaji faktor-faktor penyebab (sekret, penurunan kesadaran, reflek batuk). Rasional : Penumpukan sekret, penurunan kesadaran dan reflek menurun dapat menghalangi jalan nafas.
batuk
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c. Ajarkan teknik relaksasi – distraksi distraksi Rasional : meningkatkan kenyamanan klien. d. Pertahankan tirah baring bila diindikasikan. Rasional : tirah baring diperlukan pada awal selama fase reteksi akut. e. Anjurkan menggunakan kompres hangat. Rasional : membantu mengurangi nyeri dan meningkatkan kenyamanan klien.
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e. Periksa
pembalut
atau
drain
pada
interval
reguler.
Kaji
luka
untuk terjadinya pembengkakan. Rasional
:
pendarahan
yang
berlebihan
dapat
mengacu
kepada
hipovolemia/hemoragi. Pembengkakan lokal mengindikasikan formasi hematoma/pendarahan. f. Pantau suhu kulit, palpasi denyut perifer. Rasional : kulit dingin/lembab, denyut lemah mengindikasikan penurunan
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Intervensi :
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b. Tentukan tipe-tipe anastesi.
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e. Catat hemoglobin dan hematokrit. Catat perkiraan kehilangan darah selama
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8)
Tidak efektifnya laktasi berhubungan dengan terhambatnya pengeluaran ASI,
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pengetahuan ibu, maturasi dan kompetensi.
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