LAPORAN PENDAHULUAN SKIZOFRENIA A. Definisi Skizofrenia
1. Skizofre Skizofrenia nia adalah adalah suatu suatu bentuk bentuk psikosa psikosa fungsio fungsional nal dengan dengan ganggu gangguan an utama utama pada pada proses fikir serta disharmoni (keretakan, perpecahan) antara proses pikir, afek/emosi, kamauan kamauan dan psikomot psikomotor or diserta disertaii distors distorsii kenyataa kenyataan, n, terutama terutama karena karena waham waham dan halusinasi; asoisasi terbagibagi sehingga timbul inkoherensi, afek dan emosi perilaku bizar. !. Skizofr Skizofrenia enia merupak merupakan an bentuk bentuk psikosa psikosa yang yang banyak banyak di"umpa di"umpaii dimanam dimanamana ana namun namun fakto faktorr penye penyeba babny bnya a belum belum dapa dapatt diide diidenti ntifik fikasi asi seca secara ra "elas "elas.. #raep #raepeli elin n menye menyebu butt gangguan gangguan ini sebagai demensia preco$ ( demensia artinya kemunduran intelegensi intelegensi dan artinya muda/sebelum waktunya). precox artinya
B. Etiologi Skizofrenia
%erdapat beberapa teori yang dikemukakan para ahli yang menyebabkan ter"adinya skizofrenia. %eori teori tersebut antara lain& 1. 'ndokrin %eori ini dikemuka dikemukakan kan berhubu berhubung ng dengan dengan sering sering timbulny timbulnya a Skizofre Skizofrenia nia pada pada waktu waktu pubertas, waktu kehamilan atau puerperium dan waktu klimakterium, tetapi teori ini tidak dapat dibuktikan. !. etabolisme %eori ini mengemukakan bahwa skizofrenia disebabkan karena gangguan metabolisme karena penderita tampak pucat, tidak sehat, u"ung e$tremitas agak sianosis, nafsu makan makan berkura berkurang ng dan berat berat badan badan menurun menurun serta serta pada penderita penderita dengan dengan stupor stupor katatonik konsumsi zat asam menurun. ipotesa ini masih dalam pembuktian dengan pemberian obat halusinogenik seperti meskalin dan asam lisergik diethylamide (*S+ !). -batobat tersebut dapat menimbulkan ge"alage"ala yang mirip dengan ge"ala ge"ala skizofrenia, tetapi reersible. . %eori 0dolf eyer Skizofre Skizofrenia nia tidak tidak disebab disebabkan kan oleh penyakit penyakit badania badaniah h sebab sebab hingga hingga sekaran sekarang g tidak tidak dapat ditemukan kelainan patologis anatomis atau fisiologis yang khas pada susunan
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saraf saraf tetap tetapii eyer eyer menga mengaku kuii bahw bahwa a suatu suatu kons konstit titus usii yang yang infer inferior ior atau atau peny penyaki akitt badania badaniah h dapat dapat mempeng mempengaruh aruhii timbulny timbulnya a Skizofre Skizofrenia. nia. enurut enurut eyer eyer Skizofre Skizofrenia nia merupakan suatu reaksi yang salah, suatu maladaptasi, sehingga timbul disorganisasi kepr kepriba ibadi dian an dan dan lama lama kelam kelamaa aan n oran orang g ters tersebu ebutt men"a men"auh uhkan kan diri diri dari dari keny kenyata ataan an (otisme). . %eori %eori Sigmund 2reud %eori ori Sigmu Sigmund nd freud freud "uga "uga termas termasuk uk teor teorii psiko psikoge genik nik.. enuru enurutt freud freud,, skizof skizofren renia ia terdapat& 1) #elemahan ego, yang dapat timbul karena penyebab psikogenik ataupun somatik !) Superego dikesampingkan sehingga tidak bertenaga lagi dan 3d yamg berkuasa serta ter"adi suatu regresi ke fase narsisisme ) #ehilangaan kapasitas untuk pemindahan (transference) sehingga terapi psikoanalitik tidak mungkin. . 'ugen 4leuler 5enggunaan istilah Skizofrenia menon"olkan ge"ala utama penyakit ini yaitu "iwa yang terpecah belah, adanya keretakan atau disharmoni antara proses berfikir, perasaan dan perbuatan. perbuatan. 4leuler membagi ge"ala Skizofrenia men"adi ! kelompok kelompok yaitu ge"ala primer (gangguan proses pikiran, gangguan emosi, gangguan kemauan dan otisme) ge"ala sekunder (waham, halusinasi dan ge"ala katatonik atau gangguan psikomotorik yang lain).
%eori tentang skizofrenia yang saat ini banyak dianut adalah sebagai berikut& 1. 6enetik %eori ori ini telah telah dibuk dibuktik tikan an deng dengan an pene penelit litian ian tentan tentang g keluar keluarga gak kelu eluar arga ga pende penderit rita a skizofre skizofrenia nia terutama terutama anakan anakanak ak kembar kembar satu satu telur telur sehingg sehingga a dapat dapat dipastik dipastikan an factor factor genetik turut menentukan timbulnya skizofrenia. 0ngka kesakitan bagi saudara tiri 7,8 1,9 :, bagi saudara kandung kandung 1 :, bagi anak dengan dengan salah satu orang tua yang menderita Skizofrenia 7<9 :, kembar ! telur !1 : dan kembar satu telur <19< :
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ipotesis dopaminmenyatakan bahwa skizofrenia disebabkan oeraktiitas pada "aras dopa dopamin mine e mesol mesolimb imbik. ik. al al ini diduk didukun ung g denga dengan n temua temuan n bahw bahwa a amfeta amfetamin min yang yang ker"anya meningkatkan pelepasan dopamine, dapat menginduksi psikosis yang mirip skizofre skizofrenia nia dan obat anti anti psikoti psikotik k beker"a beker"a dengan dengan mengeb mengeblok lok resepto reseptorr dopamin dopamine, e, terutama reseptor + !. . ipotesis 5erkembangan Saraf Studi Studi autopsi autopsi dan studi studi pencitr pencitraan aan otak memperli memperlihatk hatkan an abnormal abnormalitas itas struktur struktur dan morfologi otak penderita skizofrenia antara lain berupa berat orak ratarata lebih kecil <: dari dari norma normall dan dan ukura ukuran n anter anterior iora ant nteri erior or yang yang : lebih lebih pend pendek, ek, pembe pembesar saran an entrikel otak yang nonspesifik, gangguan metabolisme di daerah frontal dan temporal serta kelainan susunan seluler pada struktur saraf di beberapa korteks dan subkortek. Studi neuropsikologis mengungkapkan deficit di bidang atensi, pemilihan konseptual, fungsi eksekutif dan memori pada penderita skizofrenia.
. Pe!"agian Skizofrenia
#raepelin membagi Skizofrenia dalam beberapa "enis berdasarkan ge"ala utama antara lain & 1. Skizofrenia Simplek
Sering timbul pertama kali pada usia pubertas, ge"ala utama berupa kedangkalan emosi dan kemunduran kemauan. 6angguan proses berfikir sukar ditemukan, waham dan halusinasi "arang didapat, "enis ini timbulnya perlahanlahan. 2. Skizofrenia ebefrenia
5ermulaannya perlahanlahan atau subakut dan sering timbul pada masa rema"a atau antaraa 1! tahun. 6e"ala yang menyolok ialah gangguan proses berfikir, gangguan kemauaan dan adaanya depersenalisasi atau double personality. 6angguan psikomotor
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%imbulnya pertama kali umur 17 tahun dan biasanya akut serta sering didahului oleh stress emosional. ungkin ter"adi gaduh gelisah katatonik atau stupor katatonik. 4. Skizofrenia 5aranoid
6e"ala yang menyolok ialah waham primer, disertai dengan wahamwaham sekunder dan halusin halusinasi. asi. +engan +engan pemeriks pemeriksaan aan yang yang teliti teliti ternyat ternyata a adanya adanya ganggua gangguan n proses proses berfikir, gangguan afek emosi dan kemauan. 5. 'pisode Skizofrenia akut
6e"ala Skizofrenia timbul mendadak sekali dan pasien seperti dalam keadaan mimpi. #esada #esadarann rannya ya mungkin mungkin berkabu berkabut. t. +alam +alam keadaa keadaan n ini timbul timbul perasaa perasaan n seakan seakanaka akan n dunia luar maupun dirinya sendiri berubah, semuanya seakanakan mempunyai suatu arti yang khusus baginya. 6. Skizofrenia >esidual
#eadaan #eadaan Skizofrenia Skizofrenia dengan ge"ala primernya 4leuler, tetapi tidak "elas adanya ge"ala ge"ala sekunder. #eadaan ini timbul sesudah beberapa kali serangan Skizofrenia. 7. Skizofrenia Skizo 0fektif
+isamping ge"ala Skizofrenia terdapat menon"ol secara bersamaaan "uga ge"alage"al depresi (skizo depresif) atau ge"ala mania (psikomanik). ?enis ini cenderung untuk men"adi sembuh tanpa defek, tetapi mungkin "uga timbul serangan lagi.
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SKIZOFRENIA
D. #anifestasi Klinik Skizofrenia
1. 6e"ala 5rimer 6angguan proses pikir (bentuk, langkah dan isi pikiran). @ang paling menon"ol adalah gangguan asosiasi dan ter"adi inkoherensi 6angguan afek emosi 1) %er"adi kedangkalan afekemosi afe kemosi !) 5aramimi dan paratimi (incongruity of affect / inadekuat) ) 'mosi dan afek serta ekspresinya tidak mempunyai satu kesatuan ) 'mosi berlebihan ) ilangnya kemampuan untuk mengadakan hubungan emosi yang baik 6angguan kemauan 1) %er"adi kelemahan kemauan kem auan !) 5erilaku negatiisme atas permintaan ) -tomatisme & merasa pikiran/perbuatannya dipengaruhi oleh orang lain 6e"ala psikomotor 1) Stupor atau hiperkinesia, logorea dan neologisme !) Stereotipi ) #atelepsi & mempertahankan posisi tubuh dalam waktu yang lama ) 'cholalia dan echopra$ia 0utisme. !. 6e"ala Sekunder Aaham alusinasi 3stilah ini menggambarkan persepsi sensori yang salah yang mungkin meliputi salah satu dari kelima kelima pancain pancaindra. dra. halusin halusinasi asi pendeng pendengara aran n dan penglih penglihatan atan yang paling paling umum ter"adi, halusinasi penciuman, perabaan, dan pengecapan "uga dapat ter"adi •
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RENTANG RESPON SKIZOFRENIA
F. Penatalaksanaan Skizofrenia 1. %era$i %era$i So!atik e'ika!entosa(
-bat -batob obata atan n yang yang digun digunaka akan n untu untuk k mengo mengoba bati ti Skizo Skizofre frenia nia dise disebut but antip antipsik sikoti otik. k. 0ntipsikotik 0ntipsikotik beker"a mengontrol halusinasi, delusi dan perubahan perubahan pola fikir yang ter"adi pada Skizofrenia. 5asien mungkin dapat mencoba beberapa "enis antipsikotik antipsikotik sebelum mendapa mendapatkan tkan obat obat atau kombinas kombinasii obat obat antipsi antipsikoti kotik k yang yang benarb benarbena enarr cocok cocok bagi bagi pasien. 0ntipsikotik pertama diperkenalkan 7 tahun yang lalu dan merupakan terapi obatobatan pertama yang efekitif untuk mengobati Skizofrenia. %erdapat kategori obat antipsikotik yang dikenal saat ini, yaitu antipsikotik antipsikotik konensional, konensional, newer atypical atypical antipsycotics, dan Blozaril (Blozapine)
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-bat antipsikotik yang paling lama penggunannya disebut antipsikotik konensional. Aalaupun sangat efektif, antipsikotik konensional sering menimbulkan efek samping yang serius. Bontoh obat antipsikotik konensional antara lain & •
aldol (haloperidol) . Stelazine ( trifluoperazine)
•
ellaril (thioridazine) <. %horazine ( chlorpromazine)
•
=aane (thiothi$ene) . %rilafon (perphenazine)
•
5roli$in (fluphenazine) 0kibat berbagai berbagai efek samping yang dapat ditimbulkan ditimbulkan oleh antipsikotik antipsikotik konensional, konensional, banyak ahli lebih merekomendasikan penggunaan newer atypical antipsycotic . 0da ! pengecualian pengecualian (harus dengan antipsikotok antipsikotok konensional). Perta!a, pada pasien yang sudah mengalami perbaikan (kema"uan) yang pesat menggunakan antipsikotik konensional tanpa efek samping yang berarti. 4iasanya para ahli merekomendasikan untuk meneruskan pemakaian antipskotik antipskotik konensional. konensional. Ke'*a, bila pasien mengalami kesulitan minum pil secara reguler. 5roli$in dan aldol dapat diberikan dalam "angka wakt waktu u yang ang lama lama ( long dengan an inte inter ral al ! ! ming minggu gu ( disebu long acting acting ) deng disebutt juga juga depot depot formulations). +engan depot formulation , obat dapat disimpan terlebih dahulu di dalam
tubuh lalu dilepaskan secara perlahanlahan. perlahanlahan. Sistem depot formulation formulation ini tidak dapat digunakan pada newer atypic antipsychotic. ". Ne+er At,$-al Anti$s,-oti-
-batobat -batobat yang tergolong tergolong kelompok ini disebut atipikal karena prinsip ker"anya berbda, serta serta sedik sedikit it menimb menimbulk ulkan an efek efek sampi samping ng bila bila diba dibandi nding ngkan kan deng dengan an antip antipsik sikoti otik k
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menurunkan "umlah sel darah putih yang berguna untuk melawan infeksi. 3ni artinya, pasien yang mendapat Blozaril harus memeriksakan kadar sel darah putihnya secara reguler. 5ara ahli merekomendaskan penggunaan. Blozaril bila paling sedikit ! dari obat antipsikotik yang lebih aman tidak berhasil. Sediaan -bat 0nti 5sikosis dan +osis 0n"uran
No
Nama Generik
1.
Klorpromazin
Sediaan
Tablet, Tablet, 25 dan 100 mg,
Dosis
150 - 600 mg/hari
Ine!"i 25 mg/ml 2
#aloperidol
Tablet, Tablet, 0,5 mg, 1,5 mg, 5 mg,
5 - 15 mg/hari
Ine!"i 5 mg/ml 3
$er%enazin
Tablet Tablet 2, 4, & mg
4
'l(%enazin
Tablet Tablet 2,5 mg, 5 mg
5
'l(%enazin de!anoat
6
)e*omeprazin
Tablet Tablet 25 mg, Ine!"i 25 mg/ml
7
Tri%l(perazin Tri%l(perazin
Tablet Tablet 1 mg dan 5 mg
10 - 15 mg/hari
&
Tioridazin Tioridazin
Tablet Tablet 50 dan 100 mg
150 - 600 mg/hari
+
(lpirid
Tablet Tablet 200 mg
In 25 mg/ml
Ine!"i 50 mg/ml
12 - 24 mg/hari 10 - 15 mg/hari 25 mg/2-4 mingg( 25 - 50 mg/hari
300 - 600 mg/hari 1 - 4 mg/hari
10
$imozid
Tablet Tablet 1 dan 4 mg
1 - 4 mg/hari
11
i"peridon
Tablet Tablet 1, 2, 3 mg
2 - 6 mg/hari
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SKIZOFRENIA
Pe!ilian O"at *nt*k E$iso'e &Serangan( Perta!a
=ewer atypical antipsycoic merupakn terapi pilihan untuk penderita Skizofrenia episode episode pertama pertama karena karena efek samping samping yang yang ditimbul ditimbulkan kan minimal dan resiko resiko untuk untuk terkena tardive dyskinesia lebih rendah. 4iasanya obat antipsikotik membutuhkan waktu beberapa saat untuk mulai beker"a. Sebelum diputuskan pemberian salah satu obat gagal dan diganti dengan obat lain, para ahli biasanya akan mencoba memberikan obat selama < minggu (! kali lebih lama pada Blozaril) Pe!ilian O"at *nt*k kea'aan rela$s &ka!"*(
4iasanya timbul bila pendrita berhenti minum obat, untuk itu, sangat penting untuk untuk menge mengetah tahui ui alasa alasan n menga mengapa pa pende penderit rita a berhe berhenti nti minum minum obat obat.. %erkada rkadang ng pend penderi erita ta berhen berhenti ti minum minum obat obat kare karena na efek efek sampin samping g yang yang ditim ditimbu bulka lkan n oleh oleh obat obat tersebut. 0pabila hal ini ter"adi, dokter dapat menurunkan dosis menambah obat untuk
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Pengo"atan Sela!a fase Pen,e!"*an
Sangat penting bagi pasien untuk tetap mendapat pengobatan walaupun setelah sembuh. 5enelitian terbaru menun"ukkan dari pasien yang behenti minum obat setelah setelah episode episode petama petama Skizofre Skizofrenia nia dapat dapat kambuh. kambuh. 5ara 5ara ahli ahli merekome merekomendas ndasikan ikan pasienpasien Skizofrenia episode pertama tetap mendapat obat antipskotik selama 1! ! bulan sebelum mencoba menurunkan dosisnya. 5asien yang mendertia mendertia Skizofrenia Skizofrenia lebih dari satu episode, atau balum sembuh total pada episode pertama membutuhkan membutuhkan pengobatan yang lebih lama. 5erlu diingat, bahwa penghentian pengobatan merupakan penyebab tersering kekambuhan dan makin beratnya penyakit. Efek Sa!$ing O"at/o"at Anti$sikotik
#arena penderita Skizofrenia memakan obat dalam "angka waktu yang lama, sangat penting untuk menghindari dan mengatur efek samping yang timbul. ungkin masal masalah ah terbe terbesar sar dan dan terser tersering ing bagi bagi pend penderi erita ta yang yang menggu mengguna naka kan n antip antipsik sikoti otik k konensi konensiona onall ganggu gangguan an (kekaku (kekakuan) an) pergera pergerakan kan ototot otototot ot yang yang disebut disebut "uga 'fek samping 'kstra 5iramidal (''5). +alam hal ini pergerakan men"adi lebih lambat dan kaku, sehingga agar tidak kaku penderita harus bergerak (ber"alan) setiap waktu, dan akhirnya mereka tidak dapat beristirahat. 'fek samping lain yang dapat timbul adalah trem tremor or pada pada tang tangan an dan dan kaki kaki.. #ada #adang ngk kad adan ang g dokt dokter er dapa dapatt memb member erik ikan an obat obat antik antikol oline inergi rgik k (biasa (biasany nya a benz benztro tropi pine) ne) bersa bersamaa maan n deng dengan an obat obat antips antipsiko ikotik tik untuk untuk mencega mencegah h atau mengobati mengobati efek samping samping ini. 'fek samping samping lain yang dapat dapat timbul timbul adalah tardive dyskinesia dimana ter"adi pergerakan mulut yang tidak dapat dikontrol, protruding tongue, dan facial facial grimace. grimace. #emungkinan ter"adinya efek samping ini dapat
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antipsikotik atipikal. +iet dan olah raga dapat membantu mengatasi masalah ini. 'fek samping lain yang "arang ter"adi adalah neuroleptic malignant syndrome , dimana timbul dera"at kaku dan termor yang sangat berat yang "uga dapat menimbulkan komplikasi berupa berupa demam demam penyakit penyakitpe penyak nyakit it lain. lain. 6e"ala 6e"alage"a ge"ala la ini membutu membutuhkan hkan penang penangana anan n yang segera. 2. %era$i %era$i Psikososial
a. %era$i %era$i $erilak*
%eknik perilaku menggunakan menggunakan hadiah ekonomi dan latihan ketrampilan sosial untuk meningka meningkatkan tkan kemampua kemampuan n sosial, sosial, kemampua kemampuan n memenuh memenuhii diri diri sendiri sendiri,, latihan latihan praktis, dan komunikasi interpersonal. 5erilaku adaptif adalah didorong dengan pu"ian atau hadiah yang dapat ditebus untuk halhal yang diharapkan, seperti hak istimewa dan pas "alan di rumah sakit. +engan +engan demikian, demikian, frekuensi frekuensi perilaku perilaku maladaptif maladaptif atau menyimpang seperti berbicara lantang, berbicara sendirian di masyarakat, dan postur tubuh aneh dapat diturunkan. ". %era$i %era$i "erorintasi/kel*arga
%erapi ini sangat sangat berguna berguna karena karena pasien pasien skizofre skizofrenia nia seringk seringkali ali dipulang dipulangkan kan dalam keadaan remisi parsial, keluraga dimana pasien skizofrenia kembali seringkali mendapatkan manfaat dari terapi keluarga yang singkat namun intensif (setiap hari). Setelah Setelah periode periode pemulang pemulangan an segera, segera, topik topik pent penting ing yang yang dibah dibahas as dida didalam lam terap terapii keluarg keluarga a adalah adalah proses proses pemulih pemulihan, an, khususn khususnya ya lama dan kecepatannya. kecepatannya. Seringkali, anggota keluarga, didalam cara yang "elas mendorong sanak saudaranya yang terkena
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%erapi kelompok bagi skizofrenia biasanya memusatkan pada rencana, masalah, dan hubungan dalam kehidupan nyata. #elompok mungkin terorientasi secara perilaku, terorientasi secara secara psikodin psikodinamik amika a atau tilikan, tilikan, atau atau suporti suportif. f. %erapi kelompok kelompok efektif efektif dalam menurunkan isolasi sosial, meningkatkan rasa persatuan, persatuan, dan meningkatkan meningkatkan tes realita realitas s bagi bagi pasien pasien skizofre skizofrenia. nia. #elompok #elompok yang yang memimpin memimpin dengan dengan cara cara suporti suportif, f, bukannya dalam cara interpretatif, tampaknya paling membantu bagi pasien skizofrenia. '. Psikotera$i in'i)i'*al
5enelitian yang paling baik tentang efek psikoterapi indiidual dalam pengobatan skizofrenia telah memberikan data bahwa terapi alah membantu dan menambah efek terapi farmakologis. farmakologis. Suatu konsep penting di dalam psikoterapi bagi pasien skizofrenia adalah perkembangan suatu hubungan terapetik yang dialami pasien sebagai aman. 5engalaman 5engalaman tersebut tersebut dipengaruhi dipengaruhi oleh dapat dipercayanya dipercayanya ahli terapi, "arak emosional antara ahli terapi dan pasien, dan keikhlasan ahli terapi seperti yang diinterpretasikan oleh pasien. ubungan antara dokter dan pasien adalah berbeda dari yang ditemukan di dalam dalam peng pengob obata atan n pasien pasien nonpsi nonpsikot kotik. ik. enegak enegakkan kan hubung hubungan an seringk seringkali ali sulit sulit dilakukan; pasien skizofrenia seringkali kesepian dan menolak terhadap keakraban dan
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+okter +okter harus harus "uga menga"arka menga"arkan n pasien pasien dan pengas pengasuh uh serta serta keluar keluarga ga pasien pasien tentang tentang skizofre skizofrenia. nia. 5erawatan 5erawatan di rumah rumah sakit sakit menurun menurunkan kan stres stres pada pasien dan membantu mereka menyusun aktiitas harian mereka. *amanya perawatan rumah sakit tergantung dari keparahan penyakit pasien dan tersedianya fasilitas pengobatan rawat "alan. >encana >encana pengobatan pengobatan di rumah sakit harus memiliki orientasi orientasi praktis ke arah masalah kehidupan, perawatan diri, kualitas hidup, peker"aan, dan hubungan sosial. 5erawa 5erawatan tan di rumah rumah sakit sakit harus harus diarahka diarahkan n untuk untuk mengika mengikatt pasien pasien dengan dengan fasilita fasilitas s perawatan termasuk keluarga pasien. 5usat perawatan dan kun"ungan keluarga pasien kadang membantu pasien dalam memperbaiki kualitas hidup.
0. Poon #asala Skizofrenia
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a. 3dentitas Sering ditemukan pada usia dini atau muncul pertama kali pada masa pubertas. b. #eluhan Ftama #eluhan #eluhan utama yang yang menyebab menyebabkan kan pasien pasien dibawa dibawa ke rumah rumah sakit sakit biasany biasanya a akibat akibat adanya kumunduran kemauan dan kedangkalan emosi. c. 2aktor 5redisposisi 2aktor predisposisi sangat erat terkait dengan faktor etiologi yakni keturunan, endokrin, metabolisme, susunan syaraf pusat, kelemahan ego. d. 5sikososial 1) 6enogram -rang tua penderita skizofrenia, salah satu kemungkinan anaknya 1< : skizofrenia, bila keduanya menderita 7<9 :, saudara tiri kemungkinan 7,81,9 :, saudara kembar !1 :, saudara kandung 1 :. !) #onsep +iri #emu #emund ndur uran an
kema kemaua uan n dan dan keda kedang ngka kala lan n emos emosii yang yang meng mengen enai ai pasi pasien en akan akan
mempengaruhi konsep diri pasien.
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'mosi dangkal 8) 0fek +angkal, tak ada ekspresi roman muka. 17) 3nteraksi Selama Aawancara Benderung tidak kooperatif, kontak mata kurang, tidak mau menatap lawan bicara, diam. 11) 11) 5ersepsi %idak terdapat halusinasi atau waham. 1!) 5roses 4erfikir 6angguan proses berfikir "arang ditemukan. 1) #esadaran #esada #esadaran ran berubah berubah,, kemampua kemampuan n mengada mengadakan kan hubung hubungan an dengan dengan dan pembatas pembatasan an dengan dunia luar dan dirinya sendiri sudah terganggu pada taraf tidak sesuai dengan kenyataan (secara kualitatif). 1) emori %idak ditemukan gangguan spesifik, orientasi tempat, waktu, orang baik.
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SKIZOFRENIA
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. >encana
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. %indak ndaka an
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. #epe #epera rawa wata tan n
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6.
a. Diagnosa keperawatan: Isolasi sosial b.d harga diri rendah
+iagnosa
5erencanaan %u"uan
#eperawatan 3solasi sosial
%*1*an *!*!
b.d harga diri
#lien dapat
rendah
melakukan
#riteria asil
3nterensi
>asional
hubungan sosia secara bertahap %*1*an k*s*s 2 a. #lien dapat
a. 4ina hubungan saling percaya
#lien dapat
mengungkapkan
•
membuna
perawaannya
hubungan saling b. 'kspresi wa"ah
ubungan saling
Sapa klien secara ramah baik
percaya akan
secara erbal maupun nonerbal
menimbulkan kepercayaan klien
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berdampingan h. #lien mau mengutarakan masalah yang dihadapi
mengungkapkan perawaannya tentang penyakit yang diderita c. Sediakan waktu untuk mendengarkan klien d. #atakana pada klien bahwa dia adalah seorang yang berharga dan bertanggung "awab serta mampu menolong dirinya sendiri a. +iskusikan kemampuan dan aspek
%*1*an k*s*s 3
#lien mampu
#lien dapat
mempertahankan
positif yang dimilikiklien dan beri
akan meningkatkan
mengidentifikasi
aspek yang positif
reinforcement atas kemampuan
harga diri klien
kemampuan dan aspek positif yang dimiliki
mengungkapkan perasaannya b. Saat bertemu klien hindarkan memberi penilaian negatif
>einforcement positif
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#lien dapat
beraktiitas sesuai
yang dapat dilakukan setiap hari
kegiatan secara
menetapkan dan
kemampuan
sesuai kemampuan, kegiatan
mandiri men"adi
mandiri, kegiatan dengan bantuan
modal awal untuk
kegiatan sesuai
minimal, kegiatan dengan bantuan
meningkatkan harga
kemampuan
total
diri
merencanakan
b. #lien mengikuti %0# %0#
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dukungan
selama klien dirawat
diri klien
c. 4antu keluarga menyiapkan lingkungan dirumah b. Diagnosa keperawatan: resiko perubahan persepsi sensori: halusinasi pendenganran b.d menarik diri
+iagnosa
5erencanaan
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d. 0da kontak mata e. #lien mau duduk
•
4eri perhatian kepada klien
b. 4eri kesempatan untuk
berdampingan
mengungkapkan perawaannya
dengan perawat
tentang penyakit yang diderita c. Sediakan waktu untuk
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#lien dapat
menyebutkan
keuntungan dan manfaat bergaul
dapat meningkatkan
menyebutkan
keuntungan
dengan orang lain
harga diri
keuntungan
berhubungan
bersosialisasi
dengan orang lain,
mengungkapkan perasaannya
dengan orang lain
misalnya banyak
tentang keuntungan berhubungan
b. 4eri kesempatan kepada klien untuk
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berhubungan dengan orang lain c. Diagnosa keperawatan: Kurang perawatan diri b.d menarik diri
+iagnosa #eperawatan #urang
5erencanaan %u"uan %*1*an *!*!
#riteria asil
3nterensi
>asional
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Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.
Trusted by over 1 million members
Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.