LAPORAN PENDAHULUAN ASUHAN KEPERAWA KEPERAWATAN FRAKTUR INTERTROCHANTER FEMUR
OLEH : GUSTI AYU KOMANG SRI SUNDARI (P07120213034)
JURUSAN KEPERAWA KEPERAWATAN POLT PO LTEKKES EKKES KEMENKES DENPASAR PROGRAM STUDI D-IV KEPERAWATAN 2016
LAPORAN PENDAHULUAN ASUHAN KEPERAWA KEPERAWATAN FRAKTUR FRAKT UR INTERTROCHANTER A. PENG PENGER ERTI TIAN AN Frak!r a"a#a$ %r&!!'a k*+!+a' ,ar+-a !#a- "a.aa! !#ara/a a- !!a "+'%aka *#%$ %kaa a- %r#%+$a (#ak 2005)6 Frak!r a"a#a$ &aa$ !#a- a- +a'aa "+'%aka *#%$ ra!a aa! %a-a +'+k "a '!"! "ar+ %a-a %r'%! k%a"aa !#a- "a ,ar+-a #!ak "+ '%k+ar !#a- aka %%!ka a&aka$ rak!r a- %r,a"+ +! #%-ka& aa! +"ak #%-ka& ( Pr+% 8 9+#'* 200)6 Frak!r %!r aa! &aa$ !#a- &a$a a"a#a$ r!'aka k*+!+a' !#a- &a-ka# &a$a a- "a&a "+'%aka *#%$ ra!a #a-'!- k%#%#a$a ** "a k*"+'+ %r%! '%&%r+ "%-%%ra'+ !#a- aa! *'%*&*r*'+' (Ar+6 M A'!$a k%&%ra/aa k#+% -a--!a '+'% !'!#*'k%#%a# $a# 203)6 Frak!r %r!!& a"a#a$ +#a +"ak a"a $!!-a &aa$ !#a- "%-a "!+a #!ar6Frak!r %r!ka a"a#a$ ra-% !#a- %#!a' %#%/a+ ** "a k!#+ "+aa &*%'+a# !!k %r,a"+ +%k'+ (S,a'!$+"a,a 1;;;)6 D%++'+ rak!r +% +%r rr* r*$ $aa%r %r % %!r a"a#a$ %r&!!'a k*+!+a' !#a- &a"a ar%a "+ aara r* r*$a $a%r %r a*r a*r "a r* r*$a $a %r %r +* +*rr a a-- %r'+a %r'+a %k'raka&'!#ar (A&#% 1;;5)6 B. ETIO ETIOLO LOGI GI FRA FRAKT KTUR UR 16 Tra!a S%a-+a %'ar rak!r "+'%aka *#%$ k%k!aa ** a- +a< +a "a %r#%+$a6 a6 Tra!a Tra!a #a-'!#a-'!-:: "a&a %r!&a %r!&a &%!k! &%!k!#a #a &%-$a &%-$a!ra !ra &%%k! &%%k!ka ka &%!+ra aa! &%ar+ka %!ra &a"a !#a- "a %-ak+aka rak!r &a"a %&a %r'%!6 +#a %rk%a k%k!aa #a-'!- !#a"a&a &aa$ &a"a %&a a- %rk%a= ,ar+-a #!ak ,!-a &a'+ r!'ak 6 Tra!a +"ak #a-'!- : +#a %rk%a k%k!aa ak #a-'!- !#a"a&a %-a#a+ rak!r &a"a %&a a- ,a!$ "ar+ %&a a-
%rk%a %rk%a k%k!a k%k!aa a +! +! k%r!'a k%r!'aka ka ,ar+-a ,ar+-a #!ak #!ak "+ %&a %&a rak!r rak!r !-k+ +"ak a"a 26 K*&r%'+ R%ak "a&a %r,a"+ &a"a !#a- 'aa $a#a '%&%r+ &a"a #*-a "a %"a #a+ ak+a %kaa %r!#a-*&r% >*&r%'+* '+* *r%: k#+% k#+% a- %#*& %#*&a a "ar+ %&a %&a k%+--+ k%+--+a a "a&a "a&a %-ak+aka rak!r k*&r%'+ !#a- %#aka-6 6 M!'#% (**): ak+a +,!r+.'ak+ %r,a"+ r%-a-a ** a- k!a '%$+--a "a&a %%aka rak!r (+'a#= %#%kr+k '$*k "a %a+)6 36 Pa*#*-+k Frak!r "a&a %r,a"+ kar%a %kaa a- *ra# a&a+#a !#a- +! #%a$ #%a$ (+' (+'a# a#a a *#%$ *#%$ !* !*r) r) aa! aa! a&a a&a+# +#aa !#a !#a- +! +! 'a'a-a a ra&! ra&!$$ (+'a#a &a"a &%ak+ paget )6 )6 Pr*'%' &%ak+: kak%r "a r+k%'+a6 C. TANDA DAN GEJALA GEJALA 1. N%r+ $%a "+ %&a rak!r 2. Tak Tak a&! %--%rakka %k'r%+a' a/a$ 3. R*a'+ #!ar "ar+ kak+ #%+$ &%"%k 4. D++k! D++k!++ a"a a"a -%,a#a -%,a#a rak!r rak!r '%ara '%ara !! !! '%&%r '%&%r++ : !-'+ !-'+ %r!a %r!a$ $ %-kak kr+&+a'+ '%&'+' &a"a rak!r %r!ka "%*r+a'6
D. PATO PATOFIS FISIOL IOLOGI OGI Frak!r H%+ar*&#a' +&*#ar
Pr%*&%ra+
Ira*&%ra+
P*'*&%ra+
%"a$ P!a'a
Aa'%'+
A!"#$%!
%"a$
A'+%a'
%"a$
T%r&!!'a k*+!+a' ,ar+-a
R. &#$"'%&!#"()% "ra+ *% +,.%"/%
+*+#+'a'+
GA Oak
k%#%a$a
!!$
?a!-
K%'a"ara P#/% /% %$* R. "'#/%
E%k aa'%'+ Par!<&ar!
N#/" %&$
K#$"'%#&$"5 % )#/!"% %% %5%!
R. "'#/% I'+'+
P%a'a-a R. #/'%/%%
T%r&a&ar '!$! #+-k!-a
R. #/'%/%%
T%r!ka
H",$#/("
P*r "% %r+
R. "5#&!"
E. KLASIFIKASI A"a 2 +&% rak!r %!r a+! : 16
Frak!r +raka&'!#%r •
T%r,a"+ "+"a#a !#a- '%"+ &a--!# "a ka&'!#a
•
M%#a#!+ k%&a#a %!r
•
Haa "+a/a$ k%&a#a %!r
•
M%#a#!+ #%$%r "ar+ %!r
26
Frak!r %k'raka&'!#%r •
T%r,a"+ "+#!ar '%"+ "a ka&'!# %#a#!+ trochanter femur a- #%+$ %'ar aa! a- #%+$ k%+# aa! &a"a "a%ra$ intertrochanter.
•
T%r,a"+ "+a-+a "+'a# %!,! #%$%r %!r %a&+ +"ak #%+$ "ar+ 2 ++ "+a/a$ trochanter k%+#6 S%"a-ka k#a'++ka'+ !!k intertrochanter a"a#a$ %r"a'arka
'a+#+a' "ar+ &*#a rak!r a+! rak!r 'a+# (&*#a rak!r *#+k 'a"ar) "a rak!r +"ak 'a+# (&*#a rak!r *#+k reverse)6
G%()%/ 3. K%!"5"&%!" 5/%&$/ 5#(/ •
Frak!r +%rr*$a%r Pa"a ra!r% ++ -ar+' ra!r% %#+a- "ar+ r*$a%r a*r k% r*$a%r +*r6 T+"ak '%&%r+ ra!r% +raa&'!#ar 'a#a$ 'a! +&% ra!r% %@raa&'!#ar ++ "a&a %a! "%-a #%+$ a+k6 R%'+k* !!k
%r,a"+a k*&#+ka'+ *
H!!-a aarra-% !#a- k!ra- a+k6
<
T%r,a"+ force a- %r#a-'!- %r!' %%r!' a- %%aka displaced !#a- %,a"+ '%ak+ &ara$6
<
Fra!r% "+'%ra+ aa! "+'%aka *#%$ a"aa *'%*&*r*'+'6
Gaar K#a'++ka'+ K#% U!k Fra!r% I%rr*$a%r+6
Gaar K#a'++ka'+ Ea U!k Fra!r% I%rr*$a%r+6
•
M%!r! #*ka'+ rak!r <
>*##%'B rak!r : ,arak a-+a "+'a# rak!r C1 "ar+ &%r!kaa '%"+6
<
Ar+!#ar rak!r : %#+&!+ &%r!kaa '%"+6
<
E@raa&'!#ar : rak!r "%ka '%"+ %a&+ +"ak %ra'!k k% "a#a ka&'!# '%"+6
<
Iraa&'!#ar : rak!r "+"a#a ka&'!# '%"+6
<
A&+&$'%a# : rak!r %r,a"+ k%r!'aka &a"a &!'a *''++ka'+6
F. KOMPLIKASI 16 K*&#+ka'+ a/a# a6 S$*k H+&**#%+k.ra!a+ Frak!r (%k'r++a' %r%ra &%#+' %!r) &%r"ara$a 8 k%$+#a-a a+ra %k'ra'%# k% ,ar+-a a- r!'ak '$*k $+&**#%+ L%&!$ "a #!ka ak+a -+&' 6 E*#+ #%ak >%"%ra 'ara >%"%ra +'%ra# 6 Tr**%*#+ %a %r$!!-a "%-a &%!r!a ak++a'.k*rak'+ **.%"r%' O* "a %"* r*%k "6 I%k'+ Frak!r %r!ka: !#a- k*a+a'+ +%k'+ '%$+--a &%r#! *+*r a"a +%k'+ "a %ra&+ a++*+k6 S%"+ : H%arr*'+' "a +%k'+ >%"%ra #+-a% A#-*"+'r*+ %6 >%"%ra a'k!#ar (%ra'!k '+"r*a k*&ar%%) 26 K*&#+ka'+ #aa a6 T!#a•
N%kr*'+' aa'k!#ar : Kar%a '!&#a+ "ara$ %!r! '%$+--a %!r!ka !-'+ !#a-
•
D%#a%" !+* : Pr*'%' &%%!$a rak!r 'a-a #aa "ar+ a- "+$ara&ka +a'aa #%+$ "ar+ 4 !#a6 Pr*'%' ++
%r$!!-a "%-a &r*'%' +%k'+6 D+'rak'+.ar+ka a-+a ra-% !#a-6 •
N* !+* : Pr*'%' &%%!$a -a-a# %'k+&! '!"a$ "+%r+ &%-*aa6 Ha# ++ "+'%aka *#%$ +r*!' !+* aa! &'%!"*ar$r*'+'6
•
Mal-union
: Pr*'%' &%%!$a %r,a"+ %a&+ +"ak %!a'ka (a"a
&%r!a$a %!k) 6 ?ar+-a #!ak •
U#k!' "%k!+!'
•
M+*'++' *'++ka'
•
T%"+++' "a r!&!r% %"*
•
T%kaa "a %r,%&+a 'ara
•
K*rak!r *#ka
6 S%"+ •
K%+"ak'a+#a
•
K%kak!a
•
A#-*"+'r*+
Pa'+% "%-a rak!r intertrochanter %!r %&!a+ r%'+k* %"%r+a &%ak+ r**%*#+ "a %&!a+ r%'+k* k%a+a 'aa $a#a &a"a rak!r colum %!r6 S%#a+ +! r%'+k* *'%*%kr*'+' "a nonunion ++a# kar%a '!&#a+ "ara$
a- a+k &a"a r%-+*%!r6
G. PEMERIKSAAN DIAGNOSTIK U!k
%"+a-*'+' rak!r
"+&%r#!ka a"aa
aa%'+'
&%%r+k'aa +'+k '%ra &%%r+k'aa &%!,a- '%a-a+ %r+k!: 16 Aa%'+' +a'aa %r"a&a r+/aa %"%ra (a-a+aa &r*'%' %"%raa) "++k!+ "%-a k%+"aka&!a %--!aka !-ka+ a- %-a#a+ %"%ra6 S%%#a$ ,a!$ +"ak "a&a %r"+r+ kak+ #%+$ &%"%k "a #%+$ %r*a'+
k%#!ar "+a"+-ka &a"a rak!r collum (kar%a rak!r %r'+a %k'raka&'!#ar) "a &a'+% +"ak "a&a %-a-ka kak+a6 26 P%%r+k'aa F+'+k S%"a-ka a"a<a"a #*ka# &a"a rak!r aka "+"a&aka aara #a+: a6 P%a&+#a (#**k) P%%-kaka %ar "%*r+a' !-k+ %r#+$a ,%#a' %a&+ $a# a- &%+- a"a#a$ a&aka$ k!#+ +! %r#+$a !!$ aa! +"ak 6 Ra'a (%%#) T%r"a&a %r+ %ka '%%&a %a&+ &%r#! ,!-a %%r+k'a a-+a "+'a# "ar+ rak!r !!k %ra'aka a"+ "a %-!,+ '%'a'+ 6 G%raka (*%%) Kr%&+!' "a a*ra# "a&a "+%!ka %a&+ #%+$ *%+- !!k %aaka a&aka$ &a'+% "a&a %--%rakka '%"+<'%"+ "+ a-+a "+'a# %"%ra6 Kr%a++: ra!a ** %+-kaka %a kr%a++ !!k -+,a# 36 P%%r+k'aa P%!,aP%%r+k'aa ra"+*#*-+ &a"a &a--!# %#+&!+ ** &*#*' &%#+' '%ara a%r*&*'%r+*r (AP) "a ar%a a- %rk%a %"%ra "a "a&a &!#a ** &a--!# '%ara lateral view6 Pa"a %%ra&a ka'!' CT scan !-k+ "+&%r#!ka !!k %%!ka #*ka'+.#!a'a rak!r.ra!a6 H+!- "ara$ #%-ka&: H !-k+ %+-ka ($%*k*'%ra'+) aa! %!r! (&%r"ara$a %raka &a"a '+'+ rak!r aa! *r-a ,a!$ &a"a ra!a !#+&#%)6 P%+-kaa ,!#a$ SDP a"a#a$ r%'&*' 'r%'' *ra# '%%#a$ ra!a6 H. PENATALAKSANAAN MEDIS 16 R%k*-+'+: %a-k! "+a-*'a rak!r &a"a %&a k%,a"+a k%%#akaa "a k%!"+a "+r!a$ 'ak+6 a6 R+/aa k%%#akaa 6 Para$ +"aka #!ka 6 D+'kr+&'+ k%,a"+a *#%$ &a'+%
"6 M%%!ka k%!-k+a !#a- a- &aa$ %6 Kr%&+!' 26 R%"!k'+: r%&*'+'+ ra-% rak!r '%"%ka !-k+ "%-a #%ak *ra#a6 R%"!k'+ %ra-+ %,a"+ "!a a+!: a6 R%"!k'+ %r!!&: !!k %'%,a,arka !#a- '%ara a!a# "%-a rak'+ aa! -+&' 6 R%"!k'+ %r!ka: "%-a %*"% +'+'+ "+!a "a "+#!r!'ka %#a#!+ &%%"a$a +a'aa%#a#!+ +%ra# +k'a'+ "%-a a#a +'a#a= &+ &#a a- #a-'!- k%"a#a %"!#a !#a-6 6 R%%'+: %aaka %*"%<%*"% a- "+#ak'aaka !!k %&%ra$aka ra-%<ra-% %r'%! '%#aa &%%!$a (-+&'.rak'+) "6 R%$a+#+a'+: #a-'!- "+!#a+ '%-%ra "a '!"a$ "+#ak'aaka %r'aaa "%-a &%-*aarak!r kar%a '%r+- ka#+ &%-ar!$ %"%ra "a &r*-ra &%-*aa $a'+#a k!ra- '%&!ra(#a+$a -%rak "%-a kr!k)6 TINDAKAN PEMEDAHAN 16 Or+ (*&% r%"!+* a" +%ra# +@a+*) a6 I'+'+ "+#ak!ka &a"a %&a a- %-a#a+ %"%ra "a "+%r!'ka '%&a,a- +"a-aa*+k %!,! %&a a- %-a#a+ rak!r 6 Frak!r "+&%r+k'a "a "+%#++ 6 Fra-% a- %#a$ a+ "+#ak!ka +r+-a'+ "ar+ #!ka "6 Frak!r "+r%&*'+'+ a-ar %"a&aka &*'+'+ a- *ra# k%a#+ %6 Sa'!"a$ r%"!k'+ ra-%<ra-% !#a- "+&%ra$aka "%-a a#a *r*&%"+k %r!&a= &+'%kr!& &#a% "a &ak! K%!!-a: a6 R%"!k'+ ak!ra 6 Sa+#+a' r%"!k'+ +--+ 6 P%%r+k'aa 'r!k!r %!r*a'k!#%r "6 %rk!ra-a k%!!$a a#a +*+#+'a'+ %k'%ra#
%6 P%a!a '%"+ a- %r"%kaa "%-a !#a- a- &aa$ %,a"+ #%+$ %&a 6 Ra/a +a& #%+$ '+-ka -6 Da&a #%+$ %&a k%a#+ k% &*#a k%$+"!&a *ra# K%r!-+a : a6 K%!-k+a %r,a"+ +%k'+ 6 O'%*+%#++' 26 Ek'%ra# +k'a'+ M%*"% a#%ra+ aa,%% rak!r "%-a +k'a'+ %k'%ra# +a'aa &a"a %k'r++a' "a +"ak !!k rak!r #aa P*' %k'%ra# +k'a'+ "+a,!rka &%--!aa -+&'6 S%%#a$ r%"!k'+ "+#ak!ka +'+'+ &%rk!a !!k +&#aa'+ &% k% !#a- L!a- k%+# "+!a "ar+ &% %a# %#%/a+ !#a- "a "+k!aka &%a6 P%ra/aa 1<2 ka#+ '%$ar+ '%ara k$!'!' aara #a+: •
O'%ra'+ #%ak &% "a ar%a
•
O'%ra'+ k%%ra$a a'a$ "a r%%'
•
O'%ra'+ 'a!' %!r*a'k!#%r "+'a# rak!r
•
F+k'a'+ %k'%ra# F+k'a'+ I%ra# P%+"a+a
TERAPI FRAKTUR 16 O&%ra+ O&% R%"!+* I%ra# F+@a+* (ORIF) 26 R%$a+#+a'+ M%"+k R%$a+#+a'+ %"+k !!k %ra&+ rak!r intertrochanter %#+&!+ : W%&$ Har+ &%raa 'a&a+ 1 +--!
T/#%$(#$ T"'%&% ##*%% M%-$+"ar+ &a''+% ROM R%*# ,5 M,$", ROM7 A+% ROM &a"a $+& "a k%% "%-a #%k'+ %k'%'+ a"!k'+ "a a""!k'+ K#&%$% ,$,$ I'*%r+ %@%r+'%' &a"a 6-#!%!' "a 6!a"r+%&'
A&$"+"$%! 5*!",% Tra'%r k% stand-pivot ,+ka *
ra'%r6 M%--!aka a#a a! !!k a!#a'+6 Weight bearing Weight bearing '%'!a+ *#%ra'+ !!k rak!r a- 'a+#6 Toe-
touch 'a&a+ partial weight bearing aa! non-weight bearing
!!k rak!r +"ak 'a+#6 T"'%&% ##*%% M%-$+"ar+ %r"+r+ &a"a kak+ a- %"%ra a&a a!a6 M%-$+"ar+ &a''+% ROM6 Range of Motion
A+% ROM &a"a $+& "a k%%6 H+& "+#%k'+ka %a&a+ ;0 06 K#&%$% ,$,$ I'*%r+ %@%r+'%' &a"a -#!%+ !a"r+%&' "a $a'r+-'6
2 M+--! A&$"+"$%! 5*!",% T%r-a!- &a"a weight bearing &a+% %#ak!ka ra%r stand-pivot aa! %--!aka %k'r%+a' a- "%rk%a '%#aa
ra'%r6 U!k a!#a'+ %--!aka a#a a!6 Weight bearing
T%r-a!- &r*'%"!r weight bearing '%'!a+ *#%ra'+6 Nonweight bearing 'a&a+ partial weight bearing 'a&a+ toetouch !!k rak!r a- +"ak 'a+#6
4 'a&a+ T"'%&% ##*%% M%-$+"ar+ &!+ra aa! &!ara &a"a '+'+ rak!r6 +--! Range of Motion
A+% a+%
'%#aa ra'%r6 A!#a'+ "%-a a#a a!6 Weight bearing
9%+-$ %ar+- '%'!a+ *#%ra'+ !!k rak!r a- 'a+#6 Partial weight bearing, non-weight bearing 'a&a+ toe-touch
!!k rak!r a- +"ak 'a+#6 T"'%&% ##*%% T+"ak a"a Range of Motion
M%#a,!ka a+% a+%
'a&a+
ROM "a &%aa'a &a"a $+& "a k%%6 K#&%$% ,$,$ Progressive resistive exercises &a"a $+& "a k%%6
12 +--! A&$"+"$%! 5*!",% Pa'+% %--!aka %k'r%+a' a- "+#+&!+ "%-a weight bearing '%'!a+ *#%ra'+ aa! weight bearing a- &%!$ '%#aa
ra'%r "a a!#a'+6 M%-$%+ka &%--!aa a#a a!6 Weight bearing
P%!$ 12 'a&a+ 1 +--!
T+"ak %r!a$
KONSEP ASUHAN KEPERWATAN FRAKTUR INTERTROCHANTER A. PENGKAJIAN 16 I"%+a' M%#+&!+ !'+a (k%aaka %r,a"+ &a"a !'+a !"a) ,%+' k%#a+ (k%aaka %r,a"+ &a"a #ak+<#ak+ +a'aa
'%r+- %-%! 'aa
%-%"ara+ **r a&a %--!aka $%#)6 26 K%#!$a !aa N%r+ ak+a "ar+ &*' *&%ra'+ rak!r %!r "a rak!r a%ra$++ 36 R+/aa &%ak+ '%kara-6 +a'aa k#+% "aa- "%-a k%#!$a ,a!$ aa! ra!a #a+ 46 R+/aa &%ak+ "a$!#!6
P%ak+<&%ak+ %r%! '%&%r+ kak%r !#a- "a &%ak+ Pa-% %%aka rak!r &a*#*-+' '%$+--a !#a- '!#+ %a!-6 S%#a+ +! k#+% "+a%%' "%-a #!ka "+kak+ 'a-a %r%'+k* %-a#a+ *'%*+#++' ak! "a kr*+' "a &%ak+ "+a%%' %-$aa &r*'%' &%%!$a !#a-6 56 R+/aa &%ak+ k%#!ar-a6 P%ak+ k%#!ar-a a- %r$!!-a "%-a &aa$ !#a- a"a#a$ ak*r &r%"+'&*'+'+ %r,a"+a rak!r '%&%r+ *'%*&*r*'+' a- '%r+- %r,a"+ &a"a %%ra&a k%!r!a "a kak%r !#a- a- "+!r!ka '%ara -%%+ 6 R+/aa &'+k*'*'+a# '&+r+!a# Tak! %a' %raa'a ak++a'6 76 P%%r+k'aa F+'+k a6 Pr% O&%ra'+ 1 ( breathing ) &a"a &%%r+k'aa '+'% &%ra&a'a +"ak %-a#a+ -a--!a 2 (blood ) &a"a &%%r+k'aa '+'% kar"+*a'k!#%r "a&a %r,a"+ &%+-kaa %kaa "ara$ &%+-kaa a"+ "a r%'&+ra'+
*#%$
kar%a %r+ &%+-kaa '!$! !!$ kar%a %r,a"+ +%k'+ %r!aa &a"a rak!r %r!ka 3 (brain) +-ka k%'a"ara +a'aa k*&*'%+' 4 (bladder ) +a'aa k#+% rak!r +"ak %-a#a+ k%#a+a &a"a '+'% ++6 5 (bowel, &%%!$a !r+'+ "a +'+- !'!' +a'aa *ra# &*#a "%%ka'+ +"ak a"a k%#a+a (bone) a"aa "%*r+a' a"aa %r+ %ka &a"a "a%ra$ ra!a6 6 Ira O&%ra'+ 1 (breathing ) r+'+k* &*#a aa' a- #!k!a+ "a a&%! ak+a aa'%'+a 2 (blood ) #!k!a'+ %kaa "ara$ "a&a 'a-a r%"a$ ak+a aa'%'+a "a k%$+#a-a "ara$ r%kaa EKG "a&a #!k!a+ 3 (brain) +-ka k%'a"ara %!r! ak+a +"aka aa'%'+ 4 (bladder ) &r*"!k'+ !r+%
5 (bowel, ak+a "ar+ -%%ra# aa'%'+ %r,a"+ &%!r!a &%r+'a#+k (bone) +%-r+a' k!#+ +"ak !!$ ak+a +'+'+ 6 P*' O&%ra'+ 1 (breathing ) +a'aa %r,a"+ r%#%k a!k +"ak %%k+ '%$+--a %r,a"+ &%!r!a ak!!#a'+ '%r% +'a %r,a"+ a&%! #+"a$ k%%#aka- ak+a -%%ra# aa'%'+ RR %+-ka kar%a %r+ 2 (blood ) &a"a &%%r+k'aa '+'% kar"+*a'k!#%r "a&a %r,a"+ &%+-kaa %kaa "ara$ &%+-kaa a"+ "a r%'&+ra'+
*#%$
kar%a %r+ &%+-kaa '!$! !!$ kar%a %r,a"+ +%k'+ %r!aa &a"a &r*'%' &%%"a$a6 3 (brain) "a&a %r,a"+ &%!r!a k%'a"ara ak+a +"aka aa'%'+ %r+ ak+a &%%"a$a 4 (bladder ) +a'aa kar%a -%%ra# aa'%'+ %r,a"+ r%%'+ !r+ 5 (bowel ) ak+a "ar+ -%%ra# aa'%'+ %r,a"+ &%!r!a &%r+'a#+ (bone) ak+a &%%"a$a k#+% %-a#a+ -a--!a *+#+a' +'+k6
B. DIAGNOSA KEPERAWATAN P/# ,#/%$"5 16 R+'+k* k%k!ra-a *#!% a+ra "6" a"aa ak*r r+'+k* &!a'a '%%#! &%%"a$a 26 A'+%a' 6" k%ak!a k%%r$a'+#a "a k%'%#aaa &%%"a$a 36 R+'+k* +""%ra 6" k%#%a$a !!$ I$/% ,#/%$"5 16 R+'+k* +"%ra "6" a"aa ak*r r+'+k* &%!r!a k%'a"ara %r&a&ar "%-a +'r!% %"a$ 26 P%!r!a !ra$ ,a!- 6" %%k aa'%'+ %r$a"a& ,a!36 K%+"ak%%k+a %r'+$a ,a#a aa' 6" %%k aa'%'+ %r$a"a& &ar!<&ar! 46 H+&*%r+ 6" %r&a&ar '!$! #+-k!-a
56 R+'+k* &%r"ara$a "6" a"aa ak*r r+'+k* +'+'+ 6 R+'+k* +%k'+ "6" a"aa ak*r r+'+k* &*r "% %r+ 'aa +'+'+ P,!$ ,#/%$"5 16 N%r+ ak! 6" &%!r! %%k aa'%'+ 26 R+'+k* &%r"ara$a "6" a"aa ak*r r+'+k* &%a'a-a "ra+a-% C. INTERVENSI KEPERAWATAN P/# ,#/%$"5 N, 16
D"%*,!% K##/%8%$% R+'+k* k%k!ra-a *#!% a+ra "+a"a+ "%-a a"aa ak*r r+'+k* &!a'a '%%#! &%%"a$a
T% '%
I$#/+#!"
K/"$#/"% H%!" NOC
NIC F"' M%%*#(#$ E#$/,"$ %' %"' 16 M*+*r $a'+# H a- '%'!a+ "%-a )%!# )%%# r%%'+ a+ra (UN F"' )%%# H
H'/%$", S%%#a$
"+#ak!ka
+"aka k%&%ra/aa '%#aa (6) Pa'+% +"ak
O'*#a#+a'
!r+) 26 M*+*r
+"+ka'+
r%%'+.k%#%+$a a+ra (ra#%' >P %"%a
"+'%'!
%-a#a+
%r+
"+'%'+
%a
+ak%
,!-!#ar+'
r%#%k
%#++a'+ 26 T%!ka
%a a'+%') "%-a kr+%r+a $a'+#: 36 K*#a*ra'+ 16 T%r%a' "ar+ &%%r+a "+!r%+ %"%a %!'+ "a 46 aa'+ a'!ka aa'kara a+ra &a"a k%a"aa 26 !+ aa' $+&*ar%+ %r'+$ +"ak a"a Fluid Monitoring r+/aa "'&%a.*r*&%! 16 T%!ka 36 T%r%a' "ar+ ,!#a$ "a +&%
$%&a*,!-!#ar () 46 M%%#+$ara %kaa
%a
a+ra
"a
k%!-k+a ak*r r+'+k*
"ar+
'%ra#
%kaa
ka&+#%r
&ar!
*!&!
,a!-
"a
k%+"ak'%+a-a a+ra ($+&%r%r+a %ra&+
"+!r%+
+a#'+-
k%#a+a r%a# -a-a#
aa'
,a!- "+a&$*r%'+'
"a#a *ra# 56 T%r%a'
"+'!-'+ $a+ "##) "ar+ 36 M*+*r %ra a"a 46 M*+*r '%r!
k%#%#a$a k%%a'a
"a
k%+-!-a
*'*#a#+a'
"a
%#%kr*#+ !r+% 56 M*+*r %kaa "ara$ *r$*'a+ "a &%r!a$a
+raa
,a!6 M*+*r a"a "a 26
A'+%a' 6" k%ak!a
NOC 9
-%,a#a %"%a A:"#$ R#'$",
k%%r$a'+#a "a
16 K*r*#
#/% &##(%!%7
k%'%#aaa &%%"a$a
k%%a'a
16
26 K*&+-
G!aka &%"%kaa
a-
%%a-ka S%%#a$
"+#ak!ka
a'!$a '%#aa ()
26
Naaka "%-a
,a k#+% k%%a'a
,%#a'
%raa'+
%r$a"a&
"%-a
kr+%r+a $a'+#: 16 K#+%
$ara&a &%#ak!
&a'+% a&!
36
?%#a'ka
'%!a
%-+"%++ka'+
&r*'%"!r "a a&a
"a
a-
%-!-ka&ka
'%#aa &r*'%"!r
"+ra'aka
-%,a#a %a' 46 26 +a# '+- "a#a aa' *ra#
T%a+
&a'+%
!!k %%r+ka k%aaa
"a
36 P*'!r %k'&r%'+
!!$
%-!ra-+ ak!
/a,a$
a$a'a !!$ "a
56
%r+ka +*ra'+
+-ka ak++a'
ak!a#
%!,!kka
"+a-*'+' +"aka
%rk!ra-a
&r*-*'+'
k%%a'a
6
%-%a+
L+aka k%#!ar-a !!k %"a&+-+ k#+%
76
I'r!k'+ka &a"a &a'+%
!!k
%--!aka %$+k r%#ak'a'+ 6
D%-arka "%-a
&%!$
&%r$a+a ;6
I"%++ka'+ +-ka k%%a'a
106
a!
&a'+%
%-%a#
'+!a'+
a- %+!#ka k%%a'a 116
D*r*-
&a'+%
!!k %-!-ka&ka &%ra'aa k%ak!a &%r'%&'+
126
K%#*#a &%%r+a *a a+ %a'
36
R+'+k* +"%ra "+a"a+
NOC
NIC
"%-a a"aa ak*r
R"!& K,$/,
E+"/,(#$
r+'+k* &%!r!a
S%%#a$
k%'a"ara %r&a&ar
a'!$a k%&%ra/aa 1. S%"+aka #+-k!-a
"%-a +'r!% %"a$
'%#aa
"+#ak!ka (%%*#(#$ (6)
"+$ara&ka
,a &a'+%
a-
aa
!!k
&a'+%
%r%a' "ar+ %"%ra 2. I"%++ka'+ "%-a kr+%r+a $a'+#:
k%!!$a k%aaa
16 K#+%
&a'+%
%r%a'
"ar+ %"%ra 26 K#+%
3. M%-$+"arka
a&!
%,%#a'ka ara %%-a$ %"%ra 36 K#+%
a&!
%,%#a'ka ak*r r%'+k* "ar+ #+-k!-a
a-
%ra$aa 4. M%a'a- '+"% ra+# %&a +"!r ;. M%%"+aka %&a +!r a- aa 6. M%%&aka 'ak#ar
.&%r+#ak! &%r'*a# 46 Ma&!
#a&! "++%&a a!"a$ "+,a-ka!
%*"++ka'+ -aa
#+-k!-a
$+"!&
%-a$ +,!r 56 M%--!aka a'+#+a' a- a"a
<. M%aa'+ &%-!,!=. M%-a,!rkak%#!ar -a %%a+ &a'+% >. M%-*r*# #+-k!-a
"ar+
k%+'+-a 10. M%+"a$ka ara ara%a$aaka
a-
I$/% ,#/%$"5 N, 16
D"%*,!% K##/%8%$%
T% '%
I$#/+#!"
R+'+k* +"%ra "+a"a+
K/"$#/"% H%!" NOC 9
NIC 9
"%-a a"aa ak*r
R"!& K,$/,
E+"/,(#$
r+'+k* &%!r!a
S%%#a$
k%'a"ara %r&a&ar
a'!$a k%&%ra/aa
"%-a +'r!% %"a$
'%#aa
"+#ak!ka (%%*#(#$ (6)
"+$ara&ka
,a &a'+%
%r%a' "ar+ %"%ra "%-a kr+%r+a $a'+#: 16 K#+% %r%a' "ar+ %"%ra 26 K#+%
#+-k!-a
a&!
ara %%-a$ %"%ra
aa !!k &a'+% 2. I"%++ka'+ k%!!$a k%aaa &a'+% #+-k!-a
4. M%a'a- '+"% ra+# %&a +"!r
a&!
;. M%%"+aka %&a
ak*r
aa
r%'+k*
"ar+
+!r
#a&!
.&%r+#ak!
a-
&%r'*a#
"+,a-ka!
46 Ma&!
"++%&a !"a$
<. M%aa'+
%*"++ka'+ $+"!&
%-a$ +,!r+ 56 M%--!aka a"a
a-
6. M%%&aka 'ak#ar
#+-k!-a
a'+#+a'
a-
%ra$aa
%,%#a'ka
-aa
a-
3. M%-$+"arka
%,%#a'ka
36 K#+%
1. S%"+aka
a-
&%-!,!=. M%-a,!rka k%#!ar-a %%a+ &a'+% >. M%-*r*# #+-k!-a
"ar+
k%+'+-a 10. M%+"a$ka ara- ara- a%a$aaka 26
P%!r!a !ra$ ,a!- NOC 9
NIC 9
6"
V"$% S"*! M,"$,/"*
%%k
%r$a"a& ,a!-
aa'%'+ V"$% S"*! S$%$!
16 M*+*r %kaa
S%%#a$
"+#ak!ka
a'!$a k%&%ra/aa '%#aa
(6)
,a
"ara$ a"+ '!$! "a RR6 26 >aa a"aa
"+$ara&ka +a# '+-
#!k!a'+ %kaa
*ra#
"ara$6
"%-a
kr+%r+a $a'+#:
36 M*+*r %kaa
16 T%&%ra!r !!$ "a#a
aa'
*ra#
(35<
375*>) "a#a
aa' *ra# (0< 100 @.%+) (12<20
@.%+) 46 T%kaa
aa! %r"+r+ '%'!"a$ &%r!a$a &*'+'+6 46 A!'k!#a'+ %kaa "ara$ &a"a k%"!a
36 RR "a#a aa' *ra#
%rar+- "!"!k '%%#! "a
26 Fr%k!%'+ ,a!a&+ka#
"ara$ 'aa &a'+%
#%-a "a a"+-ka6 56 M*+*r %kaa
"ara$
"ara$ a"+ RR
'+'*#+k
(TDS)
'%%#! '%#aa
"a#a
aa'
*ra#
(J120
H-) 56 T%kaa
6 M*+*r k!a#+a' "ar+ a"+6
"ara$
"+a'*#+k (TDD) "a#a
"a '%%#a$ ak++a'6
aa'
76 M*+*r a"aa &!#'!' &ara"*k'!'6 6 M*+*r a"aa
*ra#
(J0
H-)
&!#'!' a#%ra'6 ;6 M*+*r ,!#a$ "a +raa ,a!-6 106 M*+*r !+ ,a!-6 116 M*+*r r%k!%'+ "a +raa &%ra&a'a6 126 M*+*r '!ara &ar!< &ar!6 136 M*+*r &*#a &%ra&a'a a*ra#6 146 M*+*r '!$! /ara "a k%#%aa k!#+6 156 M*+*r '+a*'+' &%r+%r6 16 M*+*r a"aa !'$+- r+a" (%kaa a"+ a%#%ar ra"+kar"+ &%+-kaa '+'*#+k) 176 I"%++ka'+ &%%a "ar+
36
K%+"ak%%k+a
NOC 9
&%r!a$a +a# '+-6 NIC 9
%r'+$a ,a#a aa' 6" R#!"/%$,/ !$%$! 9 A"/8% M%%*#(#$ %%k aa'%'+ %r$a"a& A"/8% P%$# &ar!<&ar!
16 !ka ,a#a aa'
S%%#a$ "+#ak!ka
%--!aka $%a"
+"aka
+# $+ #+ aa! ,a/
k%&%ra/aa '%#aa
$r!' +#a &%r#!
()6 ,a "+$ara&ka
26 P*'+'+ka &a'+%
a&!
!!k
%&%ra$aka
%ak'+a#ka
k%%r'+$a ,a#a
%+#a'+
aa' "%-a
36 I"%++ka'+ &a'+%
kr+%r+a:
&%r#!a
16 P%raa'a "a#a
&%a'a-a a#a
aa' *ra#
,a#a aa' !aa
26 Iraa &%raa'a
(NPA OPA ETT
%ra!r 36 K%"a#aa
%+#a*r) 46 %r'+$ka '%r%
&%raa'a
"%-a '!+* +#a
*ra#
"+&%r#!ka
46 T+"ak a"a
56 A!'k!#a'+ '!ara
ak!!#a'+
aa' aa a"aa
'&!!
'!ara aa$a 6 K*#a*ra'+ &%%r+a *k'+-% 76 M*+*r RR "a
46
H+&*%r+ 6" 6" %r&a&ar '!$! #+-k!-a
NOC 9
'a!' *k'+-%a'+ NIC 9
T#/(,/#*%$",
T#(#/%$/ /#*%$",
S%%#a$ "+#ak!ka a'!$a k%&%ra/aa
16 M*+*r TDNa"+ "a RR
'%#aa (6) "+"a&aka kr+%r+a $a'+# : 16 S!$! !!$ %+-ka 26 S!$! !!$ "a#a r%a*ra#
26 M*+*r /ara "a '!$! k!#+ 36 M*+*r a"a "a -%,a#a $+&*%r+ 46 T+-kaka +ak% a+ra "a !r+'+
36 Na"+ "a RR "a#a r%a*ra#
56 S%'!a+ka '!$! #+-k!-a "%-a k%!!$a &a'+% 6 G!aka ara' &%-$a-a $a"!k $a-a "a '!$! #+-k!-a a$a-a !!k %+-kaka '!$! !!$ 76 %r+ka a+&+r%+k
56
R+'+k* &%r"ara$a "+a"a+ "%-a a"aa ak*r r+'+k* +'+'+ &%a'a-a r%"* "ra+
,+ka &%r#! NIC
NOC B,,' ,!# !#+#/"$ S%%#a$
"+%r+ka
B##'"* /#%$", 16 M*+*r TD "a &ara%%r
a'!$a k%&%ra/aa '%#aa (666)
,a
"+$ara&ka
$%*"+a+k 26 Paa! k%a"aa a#!a #!ka *&%ra'+
k%k!ra-a *#!%
36 Paa! k%#!ara
a+ra "a&a %raa'+
"ara$ &a"a "ra+
"%-a kr+%r+a $a'+#:
a- "+&a'a-
1. T+"ak
%r,a"+
&%r"ara$a &a"a #!ka
a-
"+*&%ra'+ 2. a#!a
#!ka
a&ak %r'+$ 6
R+'+k* +%k'+ "+a"a+ "%-a a"aa ak*r r+'+k* &*r "% %r+ 'aa
NOC
NIC
Immune status
I5#$", C,$/,
+'+'+ Knowledge
:
16 P%ra$aka +"aka '%r+#
infection control
'%#aa
&%a'a-a Risk control
"a.aa!
a#a +"aka
&%%"a$a
K/"$#/"% %!"
16 K#+% %a' "ar+ I5#$", /,$#$", a"a "a -%,a#a +%k'+
a6 M*+*r
k%r%aa
%r$a"a& +%k'+ 6 P%ra$aka
%k+k
a'&%'+' &a"a &a'+% a- %r%'+k* P,!$ ,#/%$"5 N,
D"%*,!% K##/%8%$%
T% '%
16
K/"$#/"% H%!" N%r+ ak! 6" &%!r!a NOC
NIC
%%k aa'%'+
P%" L#+#
A%*#!"
16 M%#a&*rka
A'(""!$/%$",
-%,a#a
I$#/+#!"
%r+ 1 T%!ka
%rk*r*#6
#*ka'+
karak%r+'+k
26 M%#a&*rka
k!a#+a' "a "%ra,a
k%aaa +'+k
%r+
'%%#!
"a &'+k*#*-+'6
&%%r+a *a
36 M%-%a#+ ak*r 2 >%k +'r!k'+ "*k%r a-
%a- ,%+' *a
%%aka
"*'+' "a r%k!%'+
%r+6
3 >%k r+/aa a#%r-+
46 M%#a&*rka %r+ 4 P+#+$ aa#-%'+k a%rk*r*# ('ka#a
"+&%r#!ka
aa!
%r+
k*+a'+
"ar+
J4
"ar+
r%a- 0<10)6
aa#-%'+k
k%+ka
56 T+"ak
&%%r+a #%+$ "ar+
%!,!kka
'a!
r%'&* * %ra# 5 T%!ka a"aa %r+6
aa#-%'+k %r-a!-
6 M%--!aka %ra&+
&+#+$a
aa#-%+k
+&%
"a
%raa
%r+
"a * aa#-%+k T%!ka 76 Ta"a<a"a +a# "a#a
aa'
*ra#6
aa#-%'+k
&+#+$a
r!%
&%%r+a "a "*'+' *&+a# 7 P+#+$ r!% &%%r+a '%ara I IM !!k &%-*aa
%r+
'%ara %ra!r M*+*r +a# '+- '%%#! "a '%'!"a$ &%%r+a aa#-%'+k &%raa ka#+ ; %r+ka
aa#-%'+k
%&a /ak! %r!aa 'aa %r+ $%a 10 Ea#!a'+
%%k++a'
aa#-%'+k a"a "a 26
R+'+k* &%r"ara$a "+a"a+ "%-a a"aa ak*r r+'+k* +'+'+ &%a'a-a r%"* "ra+
-%,a#a (%%k 'a&+-) NIC
NOC B,,' ,!# !#+#/"$ S%%#a$
"+%r+ka
a'!$a k%&%ra/aa '%#aa (666)
,a
"+$ara&ka
B##'"* /#%$", 46 M*+*r TD "a &ara%%r $%*"+a+k 56 Paa! k%a"aa a#!a #!ka *&%ra'+
k%k!ra-a *#!%
6 Paa! k%#!ara
a+ra "a&a %raa'+
"ara$ &a"a "ra+
"%-a kr+%r+a $a'+#: 3. T+"ak
a- "+&a'a-
%r,a"+
&%r"ara$a &a"a #!ka
a-
"+*&%ra'+ 4. a#!a
#!ka
a&ak %r'+$
ASUHAN KEPERAWATAN PERIOPERATIF PADA N? @KS DENGAN CF INTERTROCHANTER FEMUR SINISTRA DILAKUKAN TINDAKAN HEMIARTOPLAST? BIPOLAR DI RUANG IBS RSUP SANGLAH TANGGAL 24 OKTOBER 2016 A. A!% K##/%8%$% P#/",#/%$"5 16 I"%+a' Pa'+% Naa
: N6 KS
N*6RM
: 1044532
U!r
: 5 a$!
?%+' K%#a+
: Lak+ Lak+
A-aa
: H+"!
A#aa
: ?#6 K%&!"!- G- II 3 D&'6
Ta--a# a'!k
: 15 Ok*%r 201
Ta--a# &%-ka,+a : 24 Ok*%r 201 S!%r +*ra'+
: R%ka %"+' &a'+% "a k%#!ar-a &a'+%
26 R+/aa K%'%$aa D@ M%"+'
: >F +%rr*$a%r %!r '++'ra
R%aa O&
: $%+ar*&#a' +&*#ar
?%+' A%'%'+ : -%%ra# a%'%'+ K%#!$a Uaa: Saa MRS: Pa'+% %ra'aka %r+ &a"a kak+ k+r+ Saa &%-ka,+a: Pa'+% %aaka &%ra'aaa a-ak ak! kar%a $ar+ ++ aka "+*&%ra'+ R+/aa &%ak+ '%%#!a : K%#!ar-a &a'+% %-aaka %+#+k+ r+/aa &%ak+ -a--!a ,+/a &a'+% ,a!$ %r&%#%'% "a %ra'aka %r+ $%a &a"a &a$a k+r+6 '%%#a$ +! &a'+% "+a/a k% RSUP Sa-#a$ a--a# 15 Ok*%r 201 P%%r+k'aa &%!,a- : #a*ra*r+! ra"+*#*-+
B. P/,!#! K##/%8%$% 1. D" R%* P#/!"%% O#/%!" T%% P/# O#/%!"7 %. P#*&%"% 17 K%#%-ka&a a"++'ra'+ %7 F*r !nformed consent a"a "a '!"a$ "+a"aa-a+ *#%$ k%#!ar-a &a'+% "*k%r "a 'ak'+6 )7 F*r &%r'+a&a *&%ra'+ a"a "a '!"a$ "++'+ #%-ka&6 P%r'+a&a &a'+% %#+&!+ &!a'a !#a+ &!k!# 24600 /+a &r%*& R%ka %"+' $a'+# #a*ra*r+! $a'+# r*-% >T Sa 1
#%ar $a'+# k*'!# a%'%'+ "a kar"+*a'k!#%r '!"a$ a"a6 P%--!aa &aka+a k$!'!' &r*-ra *a a- "+*&%rka !!k &r%%"+ka'+ '!"a$ KIO ()6 2) Daa +* RR 1 @. SaO2 ;; ) Pa'+% %aaka &%ra'aaa ak! aka %,a#a+ *&%ra'+ ") K#+% %ra-aa H+"! 3) P%-ka,+a 1 (r%a$) *ra# 2 ( #**") *ra# 3 (ra+) G>S E45M 4 (#a""%r) *ra# 5 (*/%#) *ra# (*%) rak!r %r&a'a- 'k+ rak'+ %a 5k-6 4) P%r'+a&a 'aa "+ r!a- &%%r+aa: a) P%ra/a %#ak!ka '+- + '%%#! &a'+% "+a/a k% %,a *&%ra'+ ) D+#ak!ka &%a'a-a IFD "a &%%r+a a+ra &ar%%ra# %r!&a R+-%r Laa% "%-a k%%&aa a#+ra 20 %%' . %+ ). D%$% F,&! 1) Pa'+% %aaka &%ra'aaa ak! %,a#a+ *&%ra'+ kar%a k%ak!a k%%r$a'+#a "a k%'%#aaa &%%"a$a 2) Pa'+% a&ak '%"+k+ %a' 3) TD120.0 H4) RR 1@.%+ .
A%"!% D%$% T%**% S%+ 24 201
D%$% <
P##)%)
M%!%%
Pr% O&%ra'+
A!"#$%!
Ok*%r DS: Pa'+% %aaka &%ra'aaa ak! %,a#a+ *&%ra'+ kar%a k%ak!a k%%r$a'+#a "a
K!ra+*ra'+
k%'%#aaa
A!"#$%!
&%%"a$a < DO: Pa'+% a&ak '%"+k+ %a' TD120.0 H- RR 1@.%+ '. D"%*,!% K##/%8%$% A'+%a' %r$!!-a "%-a k!ra- +*ra'+ "+a"a+ "%-a &a'+% %aaka &%ra'aaa ak! %,a#a+ *&%ra'+ kar%a k%ak!a k%%r$a'+#a "a k%'%#aaa &%%"a$a &a'+% a&ak '%"+k+ %a' TD120.0 H- RR 1@.%+ #. I$#/+#!" H%/"T* S%+ 24 Ok*%r 201
N,
T% '% K/"$#/"%
D:
H%!"
1
NOC 9 < K*r*# k%%a'a < K*&+S%%#a$ "+#ak!ka a'!$a '%#aa 1 @ 0 %+ k%%a'a k#+% %raa'+ "- kr+%r+a $a'+#: 16 K#+% a&! %-+"%++ka'+ "a %-!-ka&ka -%,a#a %a' 26 M%-+"%++ka'+
I$#/+#!" A:"#$
R#'$",
#/% &##(%!%7 16 G!aka
&%"%kaa
a- %%a-ka 26 Naaka "%-a ,%#a' $ara&a &%#ak! &a'+% 36 ?%#a'ka
%r$a"a& '%!a
&r*'%"!r "a a&a a"+ra'aka
'%#aa
&r*'%"!r 46 T%a+ &a'+% !!k %%r+ka k%aaa "a %-!ra-+ ak! 56 %r+ka +*ra'+
%-!-ka&ka "a
ak!a#
%!,!kka %$+k
"+a-*'+'
%-%a+ +"aka
!!k %-**# %a' 36 +a# '+- "a#a aa' *ra# 46 P*'!r !!$
&r*-*'+' 6 L+aka !!k
k%#!ar-a %"a&+-+
k#+% 136 I'r!k'+ka
&a"a
%k'&r%'+ /a,a$
&a'+%
a$a'a !!$ "a
%--!aka %$+k
+-ka ak++a'
r%#ak'a'+
%!,!kka
!!k
146 D%-arka "%-a
%rk!ra-a
&%!$ &%r$a+a
k%%a'a
156 I"%++ka'+ +-ka k%%a'a 16 a!
&a'+%
%-%a#
'+!a'+
a- %+!#ka k%%a'a 176 D*r*- &a'+% !!k %-!-ka&ka &%ra'aa k%ak!a &%r'%&'+ 16 K%#*#a
&%%r+a
*a a+ %a' 5. I(#(#$%!" H%/" T* S%+
N, D: 1
I(#(#$%!" 16 M%%r+
k%'%&aa
24 Ok*%r
k%&a"a
k#+%
201
%-!-ka&ka
P#%&!%%
T%'%
%
T%*%
!!k
&%ra'aaa6 26 M%%r+ka &%,%#a'a &a"a
k#+%
%a-
&%r'+a&a &r%<*&%ra+ "+ r!a- &%r'+a&a *&%ra'+6 36 M%-a,!rka !!k
k#+%
%r"*a
k%ak+a
'%'!a+
'%%#!
+"aka "+#ak!ka6 46 M%,%#a'ka
'%!a
&r*'%"!r "a a&a a"+ra'aka
'%#aa
&r*'%"!r 56 %-+'r!k'+ka
&a"a
&a'+%
!!k
%--!aka
%$+k
r%#ak'a'+
*. E+%%!" H%/"T* S%+ 24
N, D:
E+%%!"
1
S: Pa'+% %-aaka '+a&
Ok*%r 201
!!k "+*&%ra'+ O: <
k#+% a&ak #%+$
<
%a- "a r+#%k' k#+% a&ak k**&%ra'+
A: T!,!a %ra&a+ P: P%ra$aka k*"+'+ &a'+% &a'+% a'!k r!aOK
T$'
2. D" R%* O#/%!" T%% I$/% O#/%!"7 %. P#*&%"% 17 P%-ka,+a 1 (r%a$) %r+!a'+ 2 (#**") $%*"+a+k 'a+# 3 (ra+) DPO 4 (#a""%r) ka%%r !r+% 5 (*/%#) &!a'a (*%) %r&a'a- "ra+ rak'+ 27 P%r'+a&a &%ra/a9 %7 P%ra/a '!"a$ %&%r'+a&ka &%ra#aa
&%%"a$a
a- '%r+# "a *a aa'%'+6 S% +'r!%'r%r+# a"+&%r'+a&ka: '% "a'ar '% k$!'!' *r$*&%"+ 1 '% +&*#ar '% ,a' *&%ra'+ '% "ra&&+)7 M%#ak!ka +% *! 7 M%a-+ !-a' '%a-a+ &%ra/a '+rk!#%r &%ra/a +'r!% "a &%ra/a a%'%'+ 37 P%r'+a&a &a'+%: Pa'+% %rar+- %a- "%-a &*'+'+ #a%ra# kaa Pa'+% %rar+- %a- "%-a &*'+'+ '!&+% +!' RL '!"a$ %r&a'a- "+#ak!ka &%a'a-a *+*r ,a!- '%%#a$ %r*+*r k%!"+a "+#ak!ka +"!k'+ %--!aka O2 N2O "a %!r*+! '%ara '!-k!& !ka6 S%%#a$ k#+% +"!r "a#a "+%r+ka r%#ak'a "+'&%r+"* 1 - I '%%#a$ &a'+% "a#a &%-ar!$ aa'%'+ "a ** r%#ak' k%!"+a "+#ak!ka &%a'a-a OPA "a +!a'+ *r*ra$%a# (OTT)6 S%#a,!a a&a' k#+% "+k*r*# %'+ "%-a T RR 1 @.6 S%#aa +"!k'+ RR 1 @. "a Na"+ 100 @.6 S&O2 ;;6 47 Pr*'%"!r O&%ra'+ %7 Aa'%'+ "+!#a+ "ar+ &!k!# 0645 ) O&%ra'+ "+!#a+ &!k!# 0;625 /+a "a *&%ra'+ '%#%'a+ &!k!# 11620 /+a ) ?%+' a%'%'+ : -%%ra# a%'$%'+a
") Oa &r%%"+ka'+ : D+%r+ka r+'&%r+"* 1 %) Oa %"+ka'+ : I,%k'+ %r+a@* 2 -r ) D!ra'+ *&%ra'+ C3 ,a -) Pr*'%"!r *&%ra'+ "%-a %--a+ka 'a! '%%-a$ "ar+ '%"+ "%-a &%r!kaa !aa6 D+#ak!ka "%-a %!a- k%&a#a %!r "a %--a+a "%-a #*-a aa! k*&*'+ &r*'%'+'6 D%-a %--!aka ,%+' +&#a : %ra#+Q%r A>P #*- %%%" %*ra# '% r%'r+*r AK +&*#ar AK
D%
%$S%+ 24 DS:< Ok*%r 201
DO: <
P%--!aa a%'%'+a: -%%ra#
I$/##$%!"
D"%*,!%
(%!%% Pr*'%'
R"!"&,
&%%"a$a
C#'#/%
%--!aka a%'%'+
OTT
P%!r!a
<
Na"+ 20@.%+
+r+a+#+a'
<
L+-k!-a +ra
%r$a"a&
*&%ra+
ra-'a-a
<
&%!r!a k%'a"ara R"!"&, C#'#/%
S%+ 24 DS :< Ok*%r 201
DO : <
Pr*'%'
R"!"&,
&%%"a$a
"5#&!"
I'+'+
I,%k'+ %r+a@* 2 -r
P*r "% %r+ R"!"&, "5#&!"
'. D: K##/%8%$% 17 R+'+k* %"%ra %r$!!-a &%!r!a k%'a"ara %r&a&ar "%-a +'r!% %"a$ "6" &%--!aa a%'%'+a: -%%ra# OTT Na"+ 140@.%+ #+-k!-a +ra *&%ra+ 27 R+'+k* +%k'+ "6" a"aa ak*r r+'+k* &*r "% %r+ 'aa +'+'+ #. I$#/+#!" H%/"T*
N,
T% '% K/"$#/"%
D:
H%!"
I$#/+#!"
S%+ 24 1
S%%#a$
Ok*%r
+"aka k%&%ra/aa
"%-a
201
'%#aa 1 @ 3 ,a
&r*'%"!r a%'$%'+a "a
"+$ara&ka
&%%"a$a
+"ak
"+%r+ka 16 P*'+'+ka
&a'+% %-a#a+
&a'+% %&a
!!k
&%ra$aka &*'+'+6
%"%ra "%-a kr+%r+a 26 Paa! "a &%ra$aka $a'+# : 16 Pa'+%
+-ka
k%'a"ara
&a'+% 36 O'%ra'+ a"a +a#
%r%a' "ar+ %"%ra
&a'+% &a"a *+*r 46 P%ra$aka #+-k!-a
26 TT "a#a
+ra*&%ra+
aa' *ra#
56 Paa! k*"+'+ &a'+%
(TD : 110<
"%-a %&a '%%#!
140.0<;0
"+k%#!arka "ar+ r!a-
H- N :
*&%ra'+ '%a-a+ **$ :
0<100@
.
K*"+'+ r%'&+ra*r+ :
%+ RR :
%raa' "%-a !"a$
1<24@
(a"+r+ aa! "+a!)=
%+)
.
K*"+'+ k!#+ : /ara a+k
!-'+
'%#a-
+a'+ : I6 6 K*#a*ra'+ *a "*'+'
&%%r+a
aa'%'+
'%'!a+
&%ra#aa
#+-k!-a *&%ra'+ S%+ 24 Ok*%r 201
2
NO> R+'k *r*# S%%#a$ "+%r+ka a'!$a k%&%ra/aa '%#aa 1 @ 3 ,a "+$ara&ka +%k'+ +"ak %r,a"+ "%-a kr+%r+a $a'+# : a6 T+"ak a"a a"a +%k'+ 6 L+-k!-a *&%ra'+ '%r+#
"a r!a-
"+'+a&ka
"%-a %ar6 NI> I%+* &r*%+* a6 S+a&ka #+-k!-a *&%ra'+ 6 Lak!ka -%%ra# &r%a!+* 6 S+a&ka a#a *&%ra'+ a- '%r+# "6 Lak!ka "%'+%k'+ ar%a *&%ra'+ %6 Lak!ka &%!!&a ar%a *&%ra'+ "%-a ka+ '%r+# 6 K*#a*ra'+ &%%r+a
a++*+k 5. I(#(#$%!" H%/" T* S%+ 24
N, D: 1
P#%&!%%%
I(#(#$%!"
T%*%
16 M%&*'+'+ka
Ok*%r
&a'+%
201
%&a
"%-a !!k
&r*'%"!r a%'$%'+a
"a
&%%"a$a &%ra$aka k%#!r!'a
!!$
'%'!a+ !-'+ 26 M%aa!
"a
&%ra$aka &*'+'+ &a'+%
'%aa
!-k+ a&aka$ +a
%r+"!r
aa!
'a"ar6 36
M%-*'%ra'+ a"a +a# &a'+%
&a"a *+*r6 46 %r+"ak '%a-a+ a"*ka
&a'+%
"%-a
%r+ka
&r+a'+ +'+k ,a-a k%ra$a'+aa
"a
%r+ka k%'%#aaa
T%'%
"a
k%aaa +'+k6 56 M%aa! k*"+'+
&a'+%
"%-a
%&a
'%%#!
"+k%#!arka
"ar+
r!a-
*&%ra'+
'%a-a+
**$
:K*"+'+ r%'&+ra*r+
:
%raa'
"%-a
!"a$
(a"+r+
aa!
"+a!)
K*"+'+
k!#+
:
/ara a+k F!-'+ S%+ 24
2
Ok*%r
'%#a- +a'+ : I 16 M%+a&ka
#+-k!-a *&%ra'+ 26 M%#ak!ka -%%ra#
201
&r%a!+* 36 M%+a&ka a#a
*&%ra'+ a- '%r+# 46 M%#ak!ka
"%'+%k'+ ar%a
*&%ra'+ 56 M%#ak!ka &%!!&a ar%a
*&%ra'+ "%-a ka+ '%r+# 6 K*#a*ra'+ &%%r+a a++*+k
%r+a@*% 2 -r
*. E+%%!" H%/"T*
N, D:
E+%%!"
TT'
S%+ 24
1
Ok*%r
S:< O:
201
16 T%r&a'a- "ra+ 26 P%r"ara$a: 00 36 >a+ra +!' 2000 46 Ur+% : 100 56 TD : 114.5 H- N: 102. %+ RR : 1@ . %+ 6 O&%ra'+ %r,a#a "%-a #aar (C 3 ,a) A : T!,!a %ra&a+ a'a#a$ %raa'+ P : P%ra$aka k*"+'+ &a'+% &a'+% "+a/a k% RR6 S%+ 24 Ok*%r 201
2
S: O: <
T+"ak a"a a"a +%k'+
<
Ar%a *&%ra'+ '%r+#
<
L+-k!-a *&%ra'+ '%r+#
<
O&%ra*r '!"a$ %aka+ -a! '%r+#
A : T!,!a %ra&a+ P : P%ra$aka k*"+'+ &a'+% &a'+% "+a/a k% RR6
3. D" R%* RR T%% P,!$ O#/%$"5 7 %. P#*&%"% 17 P#*&%"% 6B 9
1 (r%a$) %"a&a %ra&+ *k'+-% 2 (#**") *ra# 3 (ra+) *ra# 4 (#a""%r) ka%%r !r+% 5 (*/%#) &!a'a (*%) rak!r %r&a'a- "ra+6 ). D%$% F,&! Pa'+% %r&a'a- R+-%r!"+ 30 %%'.%+6 TT : TD : 110.0 H- N 0 @. S3> RR 1 @. 'a!ra'+ *k'+-% ;;6 T%r&a'a"ra+a-% &a"a #!ka *&%ra'+ a#!a #!ka %r'+$ akra# %raa "+-+ . A%"!% D%$% H%/"T* S%+
A%"!% D%
%$24 Daa S!,%k+ :
*k*%r 201
I$#//#$%!"
M%!%%
P*' O&%ra'+
R"!"&, #/'%/%%
Daa O,%k+ : <
T%r&a'a- "ra+ &a"a
T%r&a'a- "ra+
#!ka
*&%ra'+ <
a#!a
#!ka
R"!"&, #/'%/%%
%r'+$ '. D: K##/%8%$%M%!%% K,%),/%!"6 R+'k* &%r"ara$a 6" &%a'a-a "ra+ "6" %r&a'a- "ra+ &a"a #!ka *&%ra'+ a#!a #!ka %r'+$ #. I$#/+#!" H%/"T*
N,
T% '% K/"$#/"% H%!"
I$#/+#!"
D: S%+ 24 1
S%%#a$
a'!$a
16 Paa!
k%a"aa
*k*%r
k%&%ra/aa
1@0
a#!a
#!ka
201
%+ "+$ara&ka +"ak %r,a"+
*&%ra'+
&%r"ara$a
"+%r+ka '%#aa &a"a
&a'+%
"%-a kr+%r+a $a'+# : 1. T+"ak %r,a"+ &%r"ara$a &a"a #!ka a- "+*&%ra'+
26 Paa!
k%#!ara
"ara$ &a"a "ra+ a- "+&a'a-
2. a#!a #!ka a&ak %r'+$
H%/"
N,
T*
D:
S%+ 24
1
I(#(#$%!" 1.
Ok*%r
M%aa!
&%r"ara$a
&a"a #!ka *&%ra'+
201
2.
M%aa! k*"+'+ a#!a
3.
M%aa! TD
P#%&!%%
T%'%
%
T%*%
5. I(#(#$%!"
*. E+%%!" H%/"T* S%+ 17 Ok*%r 201
N, D: 1
E+%%!" S: < O : T%r&a'a- "ra+ &a"a #!ka *&%ra'+ a#!a #!ka %r'+$ TD : 110.0 HA : P%r"ara$a +"ak %r,a"+ P : P%ra$aka k*"+'+ &a'+% (%-$!!-+ r!a-a %&a
TT'
