LAPORAN PENDAHULUAN ASUHAN KEPERAWATAN PADA PASIEN CHOLELITIASIS
Oleh :
MADE MADE AYU RISM RISMA AYANTHI NTHI
(P07 (P0712 1202 0215 1504 043) 3)
2-B / D-IV KEPERAWATAN
SEMESTER III
KEMENTERIAN KESEHATAN REPUBLIK INDONESIA POLITEKNIK KESEHATAN KESEHATAN DENPASAR JURUSAN JURU SAN KEPERAW KEPE RAWA ATAN TAN PRODI DIV 2016
LAPORAN PENDAHULUAN
1
ASUHAN KEPERAWATAN PADA PASIEN CHOLELITIASIS
A. Pen Pene! e!"# "#$n $n Ch!"!#$#%&# Ch!"!#$#%&#&& '#&"$ *+% %$ ","'. ","'. gallstones. gallstones. biliary calculus calculus I&$#!%h
!"!#$#%&#& '#,%&'% $ ","$% %$ '# '%!%, %'+ ","' B%$ %' %'+ + ","' ","' ,"% ,"%% % +%+ +%+% % ""% ""%%% & & %+ %+ ,"," ,","$ $ &%$ &%$ ,%$"#%! ,## %$ %+ $""$ '# '%!%, %'+ ","' B%$ ","' %'%!%h $#,% #&$%! '# '%!%, %'+ ","' %$% '# '%!%, &%!% ","' B%$ %+ '#$",% '# '%!%, %'+ ","' '#&"$ !"!#$#%&#&. &"'%+% %$ '# '%!%, &%!% ","' '#&"$ !"'!#$#%&#& (N!"& P"#&" N"&!"$$". "'#&# 72. 2011) Ch!"!#$#%&#& %'%!%h %'%% %$ %+ $"'%%$ '#'%!%, %'+ ","' %$% &%!% ","' ('$& h!"'&) %$% "'%% B%$ ","' #&% $"'%%$ %'% %$+ ","'. &%!% ","' "&$% h"%$#. %$% &%!% ","' #$% h"%$# B#!% B#!% $"!"$ $"!"$% % '# '%!%, '%!%, %$ %$+ + ","' ","' &%*% '#&" '#&"$$ h!"&# h!"&#&$ &$!#$ !#$#%&# #%&#&. &. '% %+ %+ $"! $"!"$% "$% '# '%!%, '%!%, &%! &%!% % "," ","' ' "&$ "&$% % h"% h"%$# $# (' ('$ $&& h! h!"' "' $ $&) &) '#&" '#&"$ $ h! h!"' "' ! !#$ #$#% #%&#& &#&.. &"'% &"'%+ + #!% #!% $"'% $"'%% %$$ '# '%!% '%!%, , &%! &%!% % "," ","' ' #$ #$%% h"% h"%$# $# '#&" '#&""! "!%h %h &#, &#,%! %! '$ '$& & h"% h"%$# $# && %% %% '% '% ## ## '#&" '#&"$ $ h"% h"%$ $!# !#$#% $#%&# &#& & h!"&#&$!#$ h!"&#&$!#$#%&#& #%&#& '% h!"'h! h!"'h!#$#%&#& #$#%&#& '#&"$ '"+% h!"!#$#%&#& h!"!#$#%&#& (M$$%6# (M$$%6# '% S%#. 2011) Ch!"!#$#%&#& ,"%% %'%% %$ '# %'+ ","' %+ %'% ,,% ,&#&# $%,%% %'%!%h !"&$"! (W#!!#%,&. 2003) M"$ M"$ +%,% +%,%% % ,%& ,%&# #&& '% , ,&#&# &#&# #,#% #,#%%. %. %$ %$ ","' ","' '# +!+% %$%& 3 +!+% 1) B%$ B%$ !" !"&$ &$" "! ! B""$ 8%!. ,!$#9%! %$% ,!" '% ,"+%'+ !"#h '%# 70: !"&$"! 2) B%$ B%$ %!&#, %!&#, #!# #!## #% % (#+," (#+," !%$) !%$) B"%% !%$ %$% !%$ $%. !%. ,'%h '#h%% '% ,"+%'+ %!&#,-#!##%$ &"%+%# ," $%,% 3) B%$ B%$ #+, #+," " h#$ h#$%, %, B"%% h#$%, %$% h#$%, "!%$%. $#'% ""$. &""$# - '% %% %% &#&% ;%$ h#$%, %+ $% $""&$%&# (W#!!#%,&. 2003) 1 B. T$n%$ %$n &e' &e'$l$ $l$ T%'% +"*%!% ,"$ W#, '" <+ (2005) %'% %&#" Ch!"!#$#%&#& %'%!%h &"%+%#
"#$ 1 S"%+# S"%+#% % " % " %$$ %&#,$, %&#,$,%$# %$#
2
2 N"# $"% %'% %% %$% %$%& ,#'"#+%&$# &%,% %+ ,"*%!% " +++ %$% "+# %h %% 3 S"%+#% %&#" %&% "# % " %$ !# ,"!%#% "&#&$" 4 M%! '% ,$%h &"$% '",%, 5 I$"& &$&# "+%!#% +"$%h ","'# " '%!%, ''", %% ,"#,!% +"*%!% %+ h%&. %#$ +"$%h ","' %+ $#'% !%+# '#%% "'%!%, ''", %% '#&"% !"h '%%h '% ""%% ","' ## ,",%$ !#$ '% ,",%" ,&% "%% #+ K"%'%% ## &"#+ '#&"$%# '"+% +"*%!% +%$%!-+%$%! %'% !#$ = P"%h% %% # '% 9"&"& E&"&# #+," ","' !"h +#*%! %% ,",%$ # "%% &%+%$ +"!% >"&"& %+ $#'% '#%%# !%+# !"h #+," ","' %% $%,% "!%. '% #%&%% "%$ %+ '#&"$ ?C!% !"'@ 7 R"++#$%&# +%& 9!%$& '% &"'%% D"9#&#"&# 8#$%,# &$&# %!#% ","' *+% %% ,"++%++ %&&# 8#$%# A. D. E. K %+ !%$ '%!%, !",% K%"% #$ %&#" '%%$ ,","!#h%$% +"*%!% '"9#&#"&# 8#$%,#-8#$%,# ## *#% &$&# %$% &,%$% #!#" "!%+&+ !%,% P"% *,!%h 8#$%,# K '%%$ ,"++%++ ","% '%%h %+ ,%! C. P(h(n M$)$l$h
Resiko syok hi ovolemik
Ketidakefektifan nutrisi kurang dari kebutuhan tubuh Resiko kekuran an
"akanan tertahan di lambung
Nyeri akut
0airan shi$
&enurunan peristaltic
/yeri hebat pada kuadran atas dan nyeri tekan daerah 'erabut sara$ e$eren hipotalamus
&ermeabilitas kapiler
"enekan s.
%asilkan substansi &
ermostrat
"erangsang u#ung sara$ e$eren simpatis
Imfamasi
Inter$ensi
Iritasi lumen
&ort de entre pasca
Bag. Fundus menyentuh bag. Abdomen kartilago
asa mual
"erangsang nerus Hipertermi
&eningkatan suhu
3 Aliran balik getah empedu (duktus kolekditus ke
Bersi$at iriati$ disaluran cerna *n+yme ',- dan
Resiko Infeksi
istensi kandung
"enyumbat aliran getah pankreas Batu empedu D. &engendapan
&eradangan dalam! sekresi kolesterol kantong empedu
&roses degenerasi &enurunan $ungsi hati penyakit %,%hati 1 ?Ph M%&%!%h Ch!"!#$#%&#&@
sintesis ,angguan
S," N%%#9. A H.K&,%. H (201=). NANDA (2015-2017) E. Pe*e!#+)$$n D#$n()"#+ P","#&%% '#%+&$# ,"$ S,"!$;" '% B%" (2002) %'% %&#" Ch!"!#$#%&#& "% 1 P","#&%% %%$#, B%$ %'+ ","' %+ %&#,$,%$#& ,,% $#'% ,"*% "!%#% %'% ","#&%% !%%$#, A%#!% $"*%'# "%'%+% %$. '%%$ $"*%'# !"&#$&#& A%#!% $"*%'# &#',% ,##;;#. %% '#$",% "%#% #+% #!## &", %#%$ ""%% '$& !"'& !"h %$ K%'% #!## &", %+ $#++# ,+# '#&"%% !"h %$ '#'%!%, '$& !"'& K%'% 9&9%$%&" %!%!# &", '% ,+# *+% %'% %,#!%&" &", #%&%% ,"#+%$ &"'%+ &"$#% %!# $"*%'# &"%+% %$ E;#, h%$# AST (ST). AT (SPT). DH %+% ,"#+%$ K%'% $,# ," #!% &$&# %!#% ","' '%!%, && ,"% %&& 8#$%,# K 2 P","#&%% &#%- %'," P","#&%% &#%- %'," #&% '#!%% *#% %'% "#+%% %% "%#$ %'+ ","' '% $ ,"#+#% ""% +"*%!% %+ !%# N%, '",##%. h%% 15-20: %$ ","' %+ ,"+%!%,# %! #%&# $ '%%$ $%,% ,"!%!# ","#&%% &#%- 3 >$ !& %'," >$ !& %'," #%&%% $#'% ,","#% +%,%% %+ h%& %"% h%% &"#$% 10-15: %$ %'+ ","' %+ " %$ %'#% K%'%+ %'+ ","' %+ ,"+%'+ %#% ","' "%'% %!&#, $#++# '%%$ '#!#h%$ '"+% 9$ !& P%'% "%'%+% %$ '"+% %'+ ","' %+ ,","&% %$% h#'&. %'+ ","' %'%+ $"!#h%$ &"%+%# ,%&&% *%#+% !% '# %'% %% %$%& %+ ,""% +%,%%
'%% '%!%, && "&% '# 9!"&% h"%$#% W%!% $"# ## ,%h. $"$%# *%%+ '#!%% %'% !# #!#" &"% #!%# '#%+&$#% "'%h 4 U!$%&+%9# (US) P","#&%% US $"!%h ,"++%$#% !"&#&$+%9# %! &"%+%# &"' '#%+&$# #!#h% %"% ","#&%% ## '%%$ '#!%% '"+% "%$ '% %%$. '% '%%$ '#+%% %'% "'"#$% '#&9+&# h%$# '% #$"& D#&%,#+ #$. ","#&%% US $#'% ,",%$ %&#" $"%*% %'#%&# ##&%&# P&"' ## %% ,","#% h%&#! %+ %!#+ %%$ *#% %&#" &'%h "%&% %'% ,%!%, h%#% &"h#++% %'+ ","'% "%'% '%!%, "%'% '#&$"&# P"++%% !$% &' "'%&%% %'% +"!,%+ &%% %+ '#%$!% ",%!# P","#&% US '%%$ ,"'"$"&# %!!# '%!%, %'+ ","' %$% '$& !"'$& %+ ,"+%!%,# '#!%$%&# 5 R%'#+%9# K!"&#&$+%9# K!"&#&$+%9# '#+%% #!% US $#'% $"&"'#% %$% #!% h%&#! US ,"%+% K!%+#+%9# %! '%%$ '#!%% $ ,"'"$"&# %$ ","' '% ,"+%*# ",%,% %'+ ","' $ ,"!%% "+#&#%. ,","%$% #&#%. "$%&# &"$% ,"+&+% #&#% %! !"&#&$+%9# $#'% '#+%% #!% %&#" *%'#" %"% !#8" $#'% '%%$ ,"+h%$%% ,"'#% $%& " %'+ ","' %+ ,"+%!%,# &$&# = S+%, S+%, '%%$ ,"'"$"&# %$ '% ,""$% %%%h '#'#+ %'+ ","' $"!%h ,""%! 7 ERCP (E'&# R"$+%'" C!%+#%"%$+%9#) P","#&%% ## ,",+#% 8#&%!#&%&# &$$ &"%% !%+&+ %+ h%% '%%$ '#!#h%$ %'% &%%$ !%%%$,# P","#&%% ## ,"!#$# #&"&# "'& &"%$ $# %+ 9!"&#"! " '%!%, "&9%+& h#++% ,"%%# ''", %& '"&"'"& S"%h %!% '#,%&% " '%!%, '$& !"'$& &"$% '$& %"%$#&. ",'#% %h% $%& '#&$#% " '%!%, '$& $"&"$ $ ,""$% ""%'%% %$ '# '$& '% ,",+#% 8#&%!#&%&&# &"$% "8%!%&# "%%+% #!#" P"$%"& T%&h"%$# Ch!%+#+%h (PTC) P","#&%% !%+#+%9# ## ,"!#$# "$#% $%& &"%% !%+&+ " '%!%, %%+ #!#" K%"% &"$%&# %h% $%& %+ '#&$#% "!%$#9 "&% ,%% &",% ," &#&$", #!#" ('$& h"%$#&. D !"'&. D &#&$#& '% %'+ ","') '%%$ $"!#h%$ M"&# %+%
4
,!#%&# '%# !%+#+%, "'%h %, #&% ""&# "#$#$#& #!#". "&# &"&#& '% & &"$#
F C,$"' T,+%9# (CT) CT &% *+% ,"%% ,"$'" ","#&%% %+ %%$ $ ,""$% %'%% %$ ","'. "!"%% &%!% ","' '% !"'!#$#%&#& W%!% '",##%. $"# ## *%h !"#h ,%h%! '#%'#+ US ,. Pen$"$l$+)$n$$n Me%#) M"$ R"""+" (1FF). "%+%% h!"!#$#%&#& '#"'%% ,"*%'# '%
%#$ "%+%% "'%h '% "'%h $- Pen$n$n$n N(ne%$h % P"%+%% "'+ '% '#"$ K%+ !"#h 0: '%# %&#"-%&#" #9!%,%&# %$ %'+ ","'
&",h
'"+%
#&$#%h%$.
%#%
#9&.
"+h#&%%
%&+%&$#. %%!+"&# '% %$##$# I$"8"&# "'%h h%& '#$'% &%,%# +"*%!% %$ ,""'% '% "8%!&# %+ !"+% '%%$ '#!%&%%%. "%!# *#% '#&# %&#" ,",
M%%*","
$"%# # D#"$ "'%h !",%. $#++# %!#. $#++# $"# ## P",%&%+% #% !%,+ #!% $"*%'# '#&$"&# "$ ### &"8%&# "%'%% ,, '% ","#&%% 8#$%! &#+ #8 D#%&%+ #9& +%, %#% "!"$!#$ '% +!&% $ ,"+%$%&# & 8 P","#% %$##$# &#&$",# '% 8#$%,# K (%$# %+!%$#) D#&!&# ,"'#& Oral Dissolution Therapy %'%!%h %% "+h%% %$ '"+% ","#% %$-%$% %! Ursodeoxycholic acid !"#h '##!#h '%!%, "+%$% '%#%'% chenodeoxycholic %"% "9" &%,#+ %+ !"#h %% %'% "++%%
chenodeoxycholic &""$#
$"*%'#% '#%". "#+%$% aminotransfrase '% h#"!"&$"!",#% &"'%+ H%& ,","h# #$"#% $"%# "%$#9. &""$# %$ !"&$"! '#%,"$"% G20 ,, '% %$ G 4 %$. 9+&# %'+ ","' %#. '% '$& &#&$# %$" D#&!&# $% T"%# contact dissolution
%'%!%h
&%$
%%
$
,"+h%% %$ !"&$"! '"+% ,",%&% &%$ %#% "!%$ " '%!%, %'+ ","' ,"!%!# %$"$" "$%"& ,"!%!# h"% %$% %!$"%$#9 !%# ,"!%!# %$"$" %&#!#" %$% %+
5
'#%%# %'%!%h methyl terbutyl eter %$% ## '#,%&% '"+% &%$ %!%$ h&& " '%!%, %'+ ","' '% #%&%% ,%, ,"+h%% %$ %'+ ","' '%!%, 24 *%, K"!",%h% $"# ## h%% ,%, '#+%% $ %&& '"+% %$ %+ !"&$"! %+ %'#!&" %$% %+ '#+%% '%%$ ,""%% ##$%&# ,&%. &"'%&# #+% '% %'%% "%,h% $""$% ",%!# %$ %'+ ","' ' #$$#&# "!,%+ E!"$& (ESW) P&"' #8%" ## ,"++%% +"!,%+ "*$ "!%+ ( Repeated Shock Wave) %+ '#%%h% %'% %$ ","' '#'%!%, %'+ ","' %$% '$& !"'& '"+% ,%&' ,","%h %$ $"&"$ ,"*%'# ""%% &"*,!%h 9%+," (S,"!$;" B%". 2002) ESW &%+%$ !" '#+%% ""%% $%h %+ !%! A%!#&#& #%%-,%9%%$ %'% &%%$ ## ,","!#h%$% %h% &"' ## h%% $"%$%& %'% %&#" %+ $"!%h "%-"% '#"$#,%+% $ ,"*%!%# $"%# ## " E'&# R"$+%'" Ch!%+#%"%$+%h (ERCP) P%'% ERCP. &%$ "'& '#,%&% ,"!%!# ,!$. "++%. !%,+ '% " '%!%, && h%!& &"h#++% %$ '%%$ "!% "&%,% $#*% %$ $%& %'#% ,%& " '%!%, &%!% ","' ,"!%!# &"%h &"!%+ '# '%!%, &9#+$" ''# P%'% &9#+$"$,#. $$ &9#+$" '#% %+% !"% &"h#++% %$ ","' %+ ,",%$ &%!% %% "#'%h " && h%!& U$ %$ "&%. %$ %+ $"*"#$ '# &%!% ","' %$% %$ %+ $"!"$% '# %$%& &%!% ","' %+ &",#$ '#"!% &"' "'&# $%,%h% &"&'%h &9#+$"$,# &""$# ","%h% %$ '"+% !#$$#&# ,"%# '% !#$$#&# !%&" ERCP '% &9#+$"$,# $"!%h "h%&#! '#!%% %'% F0: %&& K%+ '%# 4 '%# &"$#% 1000 "'"#$% %+ ,"#++%! '% 37: ,"+%!%,# ,!#%&#. &"h#++% &"' ## !"#h %,% '#%'#+% ","'%h%
"$ ERCP &%*% #%&%%
"9"$#9
'#!%% %'% "'"#$% %$ &%!% ","' %+ !"#h $%. %+ %'+ ","'% $"!%h '#%+%$ - Pen$n$n$n Be%$h % K!"&#&$"$,# $"%
6
"%&# ## ,"%% &$%'% $"%# $ "%+%% %&#"
'"+% !"!#$#%&#&
&#,$,%$# K,!#%&# %+ %!#+
",%% %+ '%%$ $"*%'# %'%!%h "'"% '$& #!#%#& %+ $"*%'# %'% 0.2: %&#" A+% ,$%!#$%& %+ '#!%% $ &"' ## %+ '%# 0.5: I'#%&# %+ %!#+ ,, $ !"&#&$"$,# %'%!%h !# #!#%#& "". '##$# !"h !"&#&$#$#& %$ K!"&#&$"$,# !%%&# K!"&#&$"$,# !%%&# ,!%# '#""%!% %'% $%h 1FF0 '% &"%%+ ## &"#$% F0: !"&#&$"$,# '#!%% &"%% !%%&# 0-F0: %$ ","' '# I++#& '#%+ '"+% %% ## %"% ,",""#! "&# ",%$#% '#%'#+ "%&# ,%! (0.10.5: $ "%&# ,%!) '"+% ,"+%+# ,!#%&# %'% *%$+ '% % K%'+ ","' '#%+%$ ,"!%!# &"!%+ %+ '#,%&% !"%$ &%%$% "#! '# '#'#+ "$ I'#%&# %%! h%% %&#" '"+% !"!#$#%&#& &#,$,%$# $%%
%'%% !"&#&$#$#&
%$ K%"% &",%# "$%,%h%
"+%!%,%. %% %h!# "'%h ,!%# ,"!%% &"' ## %'% %&#" '"+% !"&#&$#$#& %$ '% %&#" '"+% %$ '$& !"'& I'#%&# ","'%h% %"% ,"%'%% &$%'#, !%*$. %$% %'+ ","' '"+% %$ "&%. "'#%,"$" !"#h '%# 2 , "!"#h% %+ '#"!"h %&#" !% "%&# "#! (2-10 ,,) &"h#++% "# %&% "'%h ,##,%! M%&%!%h %+ "!, $""%h% %'%!%h "%,%% '%# &"' ##. "h+% '"+% #&#'" ,!#%&# &""$# "'"% '$& #!#%#& %+ ,+# '%%$ $"*%'# !"#h &"#+ &"!%,% !"&#&$"$,# !%%&# &. Pen+$'#$n Ke/e!$$"$n %) I'"$#$%& % I'"$#$%& P%&#" M"!#$# %,%. ,. *"#& "!%,#. &/%+&%. %+%,%. "'#'#%.
""*%%. $%++%! ,%&. $%++%! "+%*#%. , "+#&$". '#%+&% ,"'#. %!%,%$. &",% '%$% ,"+"%# #'"$#$%& !#" $"&"$ $ ,""$% $#'%% &"!%*$% I'"$#$%& P"%+++ <%% I'"$#$%& "%+++ *%% ## &%+%$ "! $ ,",'%h% '% *%'# "%+++ *%% !#" &"!%,% "%%$%. '%$% %+ $",!
7
,"!#$# %,%. ,. "'#'#%. ""*%%. h+% '"+% !#" '% %!%,%$ ) R#%%$ "&"h%$% % K"!h% U$%,% M"%% "!h% %+ %!#+ $%,% %+ '#%&%% !"h !#" &%%$ "+%*#% B#%&%% "!h% $%,% %+ !#" %&%% %'%!%h "# %'," %'% %'% %% %$%& R#%%$ "&"h%$% &"%%+ M"%% "+",%+% '## '%# "!h% $%,% ,"!%!# ,"$'" PJRST. %!#%$#9 %$% 8%$#9 (P) %#$ 9& $%,% "!h% !#". 6%!#$ %$% %!#$%& (J) %#$ %+%#,%% "#/+%$%! '#%&%% !"h !#". "+#%! (R) %#$ "#/+%$%! ,"*%!% ",%%. S%9"$ (S) %#$ &#&# %+ %+%#,%% %+ '%%$ ,"+%+# "#/+%$%! %$% !#" ,"%&% %,% '% T#," (T) %#$ &"*% %% !#" ,"%&%% "#/+%$%! $"&"$ (P) N"# &"$"!%h ,%%. $"$%,% ,%%% %+ "!",% (J) N"# '#%&%% h"%$ (R) N"# '#%&%% %'% %'," %'% %% %$%& '% ,"*%!% " +++ %$% %h %% (S) N"# $"%&% &%%$ ,"!%% #&#%&# (T) N"# '#%&%% &"*% '% h%# %+ !%! R#%%$ "&"h%$% '%h! # P"%#$ %% %+ "%h '#'"#$% %&#" ## A%%h %&#" ,",#!## "#%&%% ,#, %!h! ### A%%h %&#" "%h ,"*%!%# "%&# %$ ","' ' R#%%$ "&"h%$% "!%+% M"+%*# %'% %$% $#'%% "!%+% !#" "%h ,"'"#$% "%#$ h!"!#$#%&#& ) D%$% #-&#-&&# M"$ !% 9+&# ' 1F2. $"'%%$ 11 "+%*#% !% 9+&# "&"h%$% (P$$". P%$##% A 1FF=) 1 P!% P"&"&# D% P","!#h%%% K"&"h%$% P%'% %&#" h!"!#$#%&#& %'% !% "&"&# '% ","!#h%%% "&"h%$% %+ '#%*# ,"+"%# % A%%h %&#" ,"+"$%h# $"$%+ "%#$ h!"!#$#%&#& A%%h %&#" ,",%h%,# "%'%% "&"h%$% '##% A%%h *#% &%#$ %&#" &"+"% "%$ " '$". %$%%h ,"++%% %$ $%'#&#%! ' A%%h %&#" &'%h ,","#&%% '##% &""!, " ,%h &%#$
8
2 P!% N$#&# : P%'% !% ##. $ %&#" h!"!#$#%&#&. 9& %+ '%%$ '#%*# ,"+"%# % A%%h %&#" ,"+%!%,# "h#!%+% %9& ,%% (%"&#%) A%%h %&#" ,"+%!%,# "% %$% "#+%$% "%$ %'% A%%h %&#" ,%+%!%,# ,%! ,$%h ' A%%h $"*%'# "#,% %#% '# "$ %&#" 3 P!% E!#,#%&# P%'% !% "+%*#% %&#" h!"!#$#%&#&. 9& %+ '#%*# ,"+"%# % A%%h #" %&#" "%% +"!% A%%h %&#" ,"+%!%,# &$#%&# %$% '#%" B%+%#,%% &#&$"&# '%# 9"&"& %&#" ' A%%h 9"&"& %&#" "%% &""$# $%%h !#%$ 4 A$#8#$%& '% %$#h% P%'% !% ## %&#" h!"!#$#%&#&. 9& %+ '#%*# ,"+"%# K",%,% "%%$% '## Tabel 1
A$#8#$%&
0
SMRS 1 2
3
4
MRS 0 1
2
3
4
M%'# B"%%#%/"'%'% E!#,#%&#/$#!"$#+ M#!#$%& '# $",%$ $#' B"#'%h B"*%!% N%# $%++% B""!%*% M",%&% P","!#h%%% ,%h SS
0 L ,%'##
3 L '#%$ %+ !%#
%!%$ 1 L %!%$ %$
4 L $"+%$+/$#'% ,%,
2 L '#%$ %+ !%#
A$#8#$%& &"h%#-h%# % B%+%#,%%%h %&#" "%$#9#$%& '%!%, ""*%%%
19
A%%h $%'% +"*%!% '%# "%#$ h!"!#$#%&#& ,"++%++ %$#9#$%&% A%%h %&#" ,"+%!%,# "!",%h%. "!"!%h% '% ,%!%#&" ,, &"!%,% "%$#9#$%& !%h %+% % A%%h %&#" #&% ,"!%% "+#%$% !%h %+% <#% #%. *"#& !%h %+% %% %+ '#!%% %&#" 5 T#' '% I&$#%h%$ : P%'% !% "+%*#% %&#" h!"!#$#%&#&. 9& %+ '#%*# ,"+"%# % B%+%#,%%%h !% $#' %&#" &"!%,% &%#$ Y%+ '#+%,%% '"+% ! "%% %&#" ,!%# $#' '% &%,%# ! "%% %&#" $#' &%%$ ,%!%, h%# B%+%#,%% 9""&# $#' %&#" &"!%,% &%#$ Y%+ '#+%,%% '"+% "%% !%,% %&#" $#' ,%!%, A%%h %&#" ,"+%!%,# !% $#' NREM (N-R%#' E" M8","$) A$%%h %&#" ,"+%!%,# !% $#' REM (R%#' E" M8","$)
= S"&#. P"&"&# '% K+#$#9 P%'% !% ## h!"!#$#%&#&. 9& %+ '#%*# ,"+"%# % B%+%#,%% %% ",%%% %&#" &%%$ #%% A%%h ,%!. +%+%. %$% "#%% $% *"!%& B%+%#,%%%h $#+%$ %&#"$%& %'% %&#" A%%h %&#" ,"+%!%,# "# <#% #%. !%% "+%*#% '"+% ,"++%% P ( provoking %$% ",%)
h%! 9%$ %+ ,","%%h %$% ,"#+%% "#
J (!uality %$% %!#$%&)
%!#$%&
"#
(,#&%!%.
$,!. $%*%,. ,"") R (region %$% '%"%h)
'%"%h "*%!%% "#
S ( severity %$% "+%%&%)
#'"$#$%&
(#$"&#$%&)
'%#
"!h% $%,% %%%h &%,%# ,"++%++ $#'%
11
%$#8#$%&
%$%
T (time %$% %$)
&"%+%. !%,%%. 9""&#. '% &"%
7 K&" '## P%'% !% ## %&#" h!"!#$#%&#& %'% ,,% '#%*# ,"+"%# B' #,%+"/+%,%% '## " A'%%h &"' "+%$% %+ ,"+%h 9+&# %!%$ $h 9 A%%h %&#" ,",#!## "%h% % 9#&# + A'%%h "%h% 9#&#!+#& $,h ",%+ h A'%%h $%&!%$%&# %!%$ $h # A%%h "%h "%&# * B%+%#,%% &"& %$!+# "%#$ A%%h %&#" ,"!% "%% ! A%%h 9+&# %!%$ $h %&#" $"+%++ , A'%%h "!h% %"% '#&# $h R!"/"% A%%h %&#" ,"+%!%,# 8"!%' "% A'%%h "%h% "% %'% %&#" I'"$#$/#'"$#$%& '## A%%h %&#" ,"%&% %+ "%% '## 6 M%,%h %&#" ,""#,% "%h% A%%h %&#" ,"%&% %+ ,",#!## $"&# & A%%h %&#" %+ ,%, ,""$% #!#h% S"!9 "&$"",/h%+% '## $ A%%h %&#" ,"'% $+%& &"!%,% &%#$ A%%h %&#" ,"%!%h+%% ;%$ S"!9 #'"%!&/#'"%! '## 8 A%%h %&#" $#'% #+# "&%h% &"!%,% &%#$ S"&%! '% R"'&# P%'% !% ## %&#" h!"!#$#%&#& %'% ,,% '#%*# ,"+"%# % K%% $"%h# ,"&$%&# A%%h %'% "!h% &%%$ ,"&$%&# A%%h $# ,"!%% ","#&%% %'%% ' A%%h %'% #%%$ "%#$ &""!,%
F P!% P"% H+% P%'% !% ## %&#" h!"!#$#%&#& %'% ,,% '#%*# ,"+"%# %) A%%h ""*%% %&#" ) B%+%#,%%%h %!#$%& ""*%% %&#" ) B%+%#,%%%h %&#" "h+% '"+% %+ !%#
12
10 M%%*"," K#+ S$"&& P%'% !% ## %&#" h!"!#$#%&#& %'% ,,% '#%*# ,"+"%# %+%#,%% %&#" ,"%+%# ,%&%!%h %+ '#,#!## '% %+%#,%% %% %&#" ,"++%% &&$", "'+ '%!%, ,"+h%'%# ,%&%!%h
11 S#&$", N#!%# D% K"%#% P%'% !% ## %&#" h!"!#$#%&#& %'% ,,% '#%*# ,"+"%# %+%#,%% %&#" ,",%'%+ &"%% &##$%! &"$% "%#%% ,%&#+-,%&#+
') P","#&%% >#&# P"'"%$% '"+% ,"$'" =B % B1-B"%$h P"%%&% $"$"% '#$%'%# '"+% %%& "'" '% '%+%!. $"*%'# "#+%$% 9""&# "%%&% &"%+%# ,"&%&# B2-B!' T%#%'# '% ""#+%$ %"% "#+%$% &h %#%$ "& #9!%,%&# B3-B%# ' B4-B!%''" U#" "%$ '% "%% +"!%. %#%$ '%# #+," ","' " B5-B"! >"&"& "%% "!% "clay colored# %#%$ &$&# '$& #!#%#& &"h#++% #+," ","' $#'% '#%+ ,"!%!# 9"&"& 9
B=-B"
H. D#$n()$ Ke/e!$$"$n M"$ NANDA. (2015-2017) D#%+&% %+ ,! %'% h!"!#$#%&#&
%'%!%h &"%+%# "#$ 1) N"# %$ ' %+" "'"% #!+#& &$&# %$% &%&," '$&. &"& #9!%,%&#. #&",#% *%#+% %$% "&#& (",%$#% *%#+%) 2) H#"$",#% ' "#+%$% !%* ,"$%!#&,. &"& "%#$ (#9!%,%&#)
13
3) K"$#'%&"#,%+% $#&# %+ '%# "$h% $h ' $#'% %'"%$% #$%" $#&# ($& $$/"#&$%!$# ,") 4) R"&# "%+% 8!," %#% '#$#% '"+% "h#!%+% %#% %$#9 5) R"&# & '#$#% '"+% h#8!",# =) R"&# #9"&# '#$#% '"+% "$#'%%'"%$% "$%h%% &"'" &"&# "& #9!%,%&# I. Ren$n$ Ke/e!$$"$n
N(.
1
D#$n()$ Ke/e!$$"$n
N"# %$ ' %+" "'"% #!+#& &$&# %$% &%&," '$&. &"& #9!%,%&#. #&",#% *%#+% %$% "&#& (",%$#% *%#+%)
T'$n K!#"e!#$
%$n H$)#l In"e!4en)# 3NIC-
R$)#(n$l
3NOC-
S"$"!%h '#!%% P$#n M$n$e*en" P$#n M$n$e*en" 1 A+% %&h% ""%%$% 1 %% &"!%,% 224 *%,. "+%*#% ,"+"$%h# '#h%%% "# "# &"%% '"%*%$ "# %'% %&#" '%%$ ,"h" '% $#'%% $"%$%&# '"+% #$"#% h%&#! &"%+%# $",%& !%*$% %+ "#$ !%&#. '#"#% NOC %%$"#&$#. P%# "8"! P%# C$! '%&#. C,9$ "8"! 9""&#. K!#"e!#$ H$)#l : 2 A+% 1 M%, %!#$%& '% ,"+"$%h# ,"+$! 9%$ "& "# ($%h "&##$%&# 8"%! ""% "#. 2 &"8%&# $"h%'% "# "%&# ,%, 3 A+% %&#" 8"%! '%# ,"++%% %,% '% "$#'%%,% $"# '%%$ % 9%,%!+# ,","#% 3 %% $ #9,%&# $"# ,"+%+# ,"+"%# ,#%&# "#. ,"%# "#% '! $"%"$# %$%) $ 4 A+% 2 M"!%% %h%
"#
1
,"+"$%h#
,"+"$%h#
"%+
"+%!%,%
'"+%
"# %&#" 4 K%*# !$
,"++%%
,","+%h#
"# 3 M%,
"& "# 5 E8%!%&#
,"+"%!# "#
(&%!%.
#$"&#$%&. 9""&#
'%
$%'% "#) 4 M"%$%% %&% %,% &"$"!%h "# "%+
5 A+% ,"+"$%h#
%+
,%%*","
&," "#
h%&#!
%h#
$"h%'% $!
"&%,%
%+
%&#" '% $#,
'#!%%
"&"h%$% !%# $"$%+ "$#'%"9"$#9% $! "# ,%&% !%,% = C$! !#++% %+
"#
,%&% '! = M"+%+# &,"&,"
%+
,""%% "# $#,! 7 A+% ,"+%+#
,","+%h# "#
&""$#
%+
&h
"#
%+
$"*%'# '"+% $"# $"%#
%+%. "%h%%% '% "#&#+% 7 P#!#h '% !%% "%+%% "# (9%,%!+#.
,"+%+# "#
'%
$%%
%$-
%$ #,#% F B""*% &%,%
'"+% '$"
9%,%!+#
*#%
'%
"#
#$"
"&%!) A*%% $"# 9%,%!+#
14
A+%
$#'%% $#'%
"h%&#! An$le)# A%*#n#)"!$"#(n 1 A+%
,"+"$%h# F K!%%&#% '"+% '$" *#%
%'%
"!h%
'%
$#'%% "# $#'% "h%&#! An$le)# A%*#n#)"!$"#(n 1 T"$%
!%&#. %%$"#&$#. %!#$%& '% '"%*%$ "# &""!, ","#% %$ 2 C" #&$&# '$" $"$%+ *"#& %$.
'"%*%$ "# '% %$ %+ '#"#% 2 A+% $#'% &%!%h '%!%, ","#% %$ 3 A+% ,"+%+# ,!#%&# ","#% %$ 4 A+% %$ %+ '#"#% &"&%# '"+% '"%*%$ "# %&#"
'&#& '% 9""&# 3 C" #%%$ %!"+#
5 A+% ,"+"$%h# "+%h %$ $"h%'% $%'%
4 P#!#h %%!+"&# %+ '#"!% %$% ,#%&# %%!+"&# "$#% ","#% !"#h '%# &%$ 5 M#$ 8#$%!
15
8#$%! = A+% ,"+"$%h# ""h%&#!% %$ '% $#'% '#$",%% $%'% +"*%!% !%#
&#+ &""!, '% &"&'%h ","#% %%!+"&# = E8%!%&# "9"$#8#$%& %%!+"&#. $%'% '% +"*%!% 2
H#"$",#%
' S"$"!%h
"#+%$% !%* ,"$%!#&,. &"&
'#!%% ,e4e! T!e$"*en" 1 M#$ 8#$%! %&h% ""%%$% &#+ &"!%,% 224 *%,.
h#"$",#%
%'%
%&#" '%%$ $"%$%&#
2 M#$ %% '% &h !#$
'"+% #$"#% h%&#! &"%+%# "#$ NOC Th","+!%&# K!#"e!#$ H$)#l : 1 Sh $h '%!%,
"$%+
,%! 2 N%'# '% '%!%,
,"+"$%h# "%h%
"%#$ '#h%%%
(#9!%,%&#)
,e4e! T!e$"*en" 1 A+%
,%! 3 T#'%
3 M#$ WBC.
"%h%
H. '% K$
%% '%
4 M#$ #$%
"%h%
,"+"$%h# "%h%
5 B"#%
$#'% %'% &#+
#$%" '%
""%
$$
'",%, = S"!#,$#
,","+%h# "%h%
%&#" 7 B"#% #"$#
WBC. H '% K$ 4 K"&"#,%+%
$ ,"+%$%&#
%% !#$ '%
&h $h %&#" 3 A+%
'% $$
"+%$% %'%
%&#" 2 A+% ,"+"$%h#
RR
"$%+
$%'% 8#$%!
%$#
&h 5 P","#% %$ $ ,"%
16
'",%, %% $%#' &+"
= M"*%+% &h
F K!%%&# ","#% %#% IV 10 K,"& %&#"
$h %+% $"$% h%+%$ 7 P","#% %$ "
%'%
%%& $
!#%$ %h% '%
,"+%+#
%&#!%
'",%, P","#% ,"& $ ,"% '",%, F A+% %#% '% $#&# $"$% $""h# 19. P","#% ,"& %'% $#$# %%& $h
3
K"$#'%&"#,%+
S"$"!%h
% $#&# %+
%&h% ""%%$%
'%#
"$h% &"!%,%
'#!%%
224
$h ' $#'% '#h%%% %'"%$% #$%"
%'%
*%,. $#&#
%&#"
M$n$e*en" 1 K%*# %'%%
,%%%
,"++%++
($&
#$"#% h%&#! &"%+%#
'"+% %h!#
$$/"#&$%!$#
"#$ NOC N$#$#%!
+#;# $
S$%$&
,""$% *,!%h %!# '% $#&# 9'
%' 9!#' #$%" N$#$#%!
17
M$n$e*en" 1 A!"+#
,%%%
2 K!%%&#
S$%$& N$#$#%!
N"!#"#(n
%!"+#
'"+%
,")
$#&# $"%$%&#
'%%$
N"!#"#(n
%+ '#$h%
#$%" $$ $#&# 2 A+% ,""$% *,!%h %&% %+ '#$h% %&#" $ ,","h#
S$%$& $#"$ I$%" W"#+h$ $! K!#"e!#$ H$)#l : 1 A'%% "#+%$% "%$ &"&%#
%'% '"+%
$*% 2 BB #'"%! &"&%# '"+%
$#++#
%'% 3 T#'%
%'%
%&#" 3 A*% %&#" $
"$h% ;%$
#$%" >"
"&# '%!%,
4 A*% %&#" $ ,"#+%$% $"# '% 8#$%,# C 5 B"#%
'%%h $""h# 4 A+% $#'% ,"+%!%,# &%#%% %#%$ "%+% 8#$%,# C 5 A+%
,%!$#&# 4 M"*% = Y%#% '#"$
"#+%$%
%+ '#,%%
9+&# "+"%% '%# ,""!% 5 T#'% $"*%'# "% "%$ %'%
$h 3 A+%
,"#+%$%
&&$%&# +!%
$%'%-$%'%
"$h%
%+
"%$#
,"+%'+ $#++# &"%$ $ ,""+%h &$#%&# 7 B"#% ,%%% %+ $"#!#h (&'%h '#&!$%&#% '"+% %h!# +#;#) N"!#"#(n M(n#"(!#n 1 M#$
%'%% "% "%$ %'% 2 M#$ !#++%
18
,",%$ ,","h# "$h% $#&# '%!%, $h = A+% ,"+%+# ,!#%&# %#%$ "%+% &"%$ 7 A+% %&% $#&# &"&%# '"+% %+ '#$h% %&#" &"!%,% &%#$ N"!#"#(n M(n#"(!#n 1 A+%
,"+%$%h#
&"!%,% ,%%
3 M#$ $+ !#$
"%h% BB %+ $"%*%'# 2 #++% %+
%+
"&#h 4 M#$ ,%! '% ,$%h
'%%$
,","+%h# %9&
,%%
5 M#$ %'%
%&#" 3 T+
%!,#. $$%!
!"$
$"#. H.
,"%'%%
'% %'% H$
"$h%
= M#$ %$. ","%h% '% ""%+% *%#+% *+$#8%
!#$
%#% 4 M%! ,$%h ,"++%++ "&"#,%+% $#&# $h 5 A&% %#% $"# *#% H$
'%!%,
'%%h
$#'%
"$%! = P%$
'%
""#+% *+$#8% ,"%'%# &"&"%+ %+ %&% %#% 4
R"&#
S"$"!%h
"%+%
%&h% ""%%$%
8!,"
%#% &"!%,%
'#!%%
224
*%,.
'#$#%
'#h%%%
"&#
'"+%
"%+%
%#%
"h#!%+% %#% %'%
%&#"
'%%$
29
,l#% M$n$e*en" 1 M#$ &$%$&
,l#% M$n$e*en" 1 A+%
h#'%&#
,"+"$%h#
("!",%%
$%'% h#'%&#
,",%"
%&#" '%
%$#9
'#"+%h
'"+%
,&%. %'#
","#%
#$"#% h%&#! &"%+%#
%'"%$. TD)
$#'%%
"#$ NOC >!#' B%!%" H'%$# N$#$#%! S$%$&
*#% '#"!% 2 M#$ 8#$%! &#+
9'
3 M#$ #$%" '% $$
#" $$
4 K!%%&#
'"+%
&#% '% BB 2 V#$%! &#+ '%!%, %$%& ,%! 3 T#'% %'% $%'%-$%'%
%#%
%'% %&#" 3 A+% $"$%
","#% %#% IV
5 D+ ,%&% %!
"&"#,%+% %#% '%!%, $h %&#" 4 A+% $#&# '% %#% '%!%, $h %&#"
"!%&$#&#$%& $+ %#.
$""h# = T%%% &% (*&
,",%"
%h. %h
,&% !",%.
&"+%)
$#'% %'% %&% h%&
$%'% 8#$%!
,"*%+%
'"h#'%&#.
!#$
,"+"$%h# "%h%
%' 9!#' #$%" K!#"e!#$ H$)#l : 1 M","$%h%%
&"&%#
!%*$% 2 A+%
%+
"!"#h%
,%%% ,",%$ ,","h#
7 K!%%&# '"+% '$"
H5/(4(le*#$ M$n$e*en" 1 P"!#h%% IV
!#"
2 M#$
"$h% $#&# %&#" = M",%$ ,"%,%h %&% $#&# '%!%, $h %&#" 7 K!%%&# '"+% '$"
$#+%$ H '%
'%!%,
H",%$#$
,","h#
3 D+ %&#"
21
5 A&%
$#&# %&#" H5/(4(le*#$
$ ,"%,%h #$%" %!
M$n$e*en" 1 M"+%+#
$"*%'#% #9"&# %'%
4 P","#%
%&#"
%#% IV ,#$ %'%% $%'% '% +"*%!% "!"#h% 8!," %#%
2 A+% ,"+"$%h# ""$%!% '%%h %&#" 3 A+% ,",%$ ,","h# "$h% $#&# %&#" . A+% ,",%$ '%!%, ,","h# $#&# $h '% ,"+"$%h# $%'% "!"#h% %#%
5
R"&#
& S"$"!%h
'#!%%
'#$#%
%&h% ""%%$%
'"+%
&"!%,%
h#8!",#
'#h%%%
"&#
&
%&#"
'%%$
224
%'%
*%,.
'#"+%h
S5(+ /!e4en"#(n 1 M#$ %%
!#$. &h
,"+"$%h#
!#$. '"$
"%h%
*%$+. %'#
%%
"#9"
&h.
'"+% #$"#% h%&#!
2 M#$ #$
&"%+%# "#$ NOC S "8"$# S
'% $$
22
S5(+ /!e4en"#(n 1 A+%
!#$. '"$
*%$+ %&#" 2 K"&"#,%+% %&%
'%
"+"!%% $
,%%+","$ K!#"e!#$ H$)#l : 1 N%'# '%!%, %$%&
%+
'#h%%% 2 I%,% *%$+ '%!%,
3 M#$ $%'% '% +"*%!% %&#$"&
%$%&
%+ '#h%%% 4 I%,%
4 #h%$ '% "!#h%% "%$"% *%!% %9%&
"%9%&% '%!%,
,!#%&# '%!%, $h 3 P",% '%!%,
%'," '%%$ ,"++%++ "&"#,%+% %#% $h 4 <%!% %9%& %+ %# %%
%$%&
%+ '#h%%% H#%!$)# I'#%$ 1 M%$% "+ $#'% '#$",% 2 D",%, $#'% '#$",% 3 TD '%!%, %$%& ,%! 4 H",%$#$ '%!%,
$"*%'#%
%#%
%$%&
%+ '#h%%% 3 >""&# %9%& '%!%,
,""+%h
5 B"#% %#% IV '% %$% %! %+ $"%$
S5(+ M$n$e*en" 1 M#$
$"%% %'#
,"+%+# $"*%'#% "%+% &#+" 5 A&% %#% '% %! %+ $"%$
$
,"*%+% "&"#,%+%
2 M#$ &$%$& %$%&
,%!
%#%. #$ $$
%&% '%!%, $h S5(+ M$n$e*en" 1 A+%
3 M#$ +"*%!% +%+%! "%%&% 4 M%&% '% ,","!#h%% %&"& IV
,"+"$%h# "%h% %'# %+ $"*%'# 2 K"&"#,%+% %&% '% "+"!%% %#% '%%$ ,","+%h#
23
'#&# $h 3 M""+%h $"*%'#% +%+%! %9%& %'% %&#" 4 A&% %#% ,"!%!# IV '% ","!#h%%% %&"& IV $ ,""+%h $"*%'#% #9"&# =
R"&#
#9"&# S"$"!%h
'#$#% '"+% "$#'%%'"%$% "$%h%% &"'" &"&# "& #9!%,%&#
'#!%% Ine"#(n C(n"!(l Ine"#(n C(n"!(l 1 B"&#h% 1 A+% %&h% ""%%$% !#++% ,"+%+# &"!%,% 224 *%,. &"$"!%h '#%%# $"#9"&# '#h%%% "&# %&#" !%# "%#$ !%# #9"&# %'% %&#" 2 P"$%h%% 2 A+% '%%$ '#"+%h !#++% ,"+%+# '"+% #$"#% h%&#! %&"$# &"!%,% ,%&% &"%+%# "#$ ",%&%+% 8#& " '%!%, NOC I,," &$%$& %!%$ $h %+ K!"'+" $"#9"&# 3 T#+%$% 3 A+% #9"$# $! #$%" $#&# R#& $! ,",%$ K!#"e!#$ H$)#l : ,","h# 1 K!#" "%& '%# $%'% '% +"*%!% #9"&# 2 M"'"&#&#%
&"&
"!%% "%#$. 9%$ %+ ,","+%h# "!%% &"
%$2
4 B"#% $"%#
%#%
'%!%,
$h
$
%$##$#
,"+%+#
#!%"!
$"*%'#% '"h#'%&# 4 M",%$
5 D+ ,%&% $#&#
,""% %+
&"&
%+
,""%%
"%$%!%&%%% = D+
% 3 M"*% ",%,% $ ,""+%h
,%&%
,","h#
%#% 7 M#$
"$h%
+%!&#$ '%
#9"&# 4 <,!%h !"&#$ %$%&
WBC
%&#"
h#'
$
,#, %$##$#
&"h%$
%+
h#!%+ = M"+h#'%# $"*%'#%
I&$&#%
,%! 5 M"*% "#!%
$h
h#$+
$#,!%
'%!%,
#9"&# 5 M",%$
&"&%# "&"
'"h#'%&# 7 P"#+%$% &"! '%%h $#h &"%+%# #'#%$ $"*%'#% #9"&# A$##$# %+
&"&%#
'%%$ ,""% &"& $"*%'#% #9"&# NANDA I$"%$#%! (2015) N&#+ $,"& C!%& #%$#(2015) N&#+ I$"8"$#& C!%& #%$# (201=) J. I*/le*en"$)# D#!%% "'%&%% #$"8"&# K. E4$l$)# M"$ P" (2012). &"& "8%!%&# '#%+# ,"*%'# 2 $%h% %#$ % E8%!%&# >,%$#9 (M""9!"&#% &"8%&# "%%$ '% %%!#&#& $"h%'%
!#" $"h%'% "& !%+&+ %'% #$"8"&# ""%%$%) E8%!%&# S,%$#9 (M""9!"&#% "%#$!%&# '% &#&#& %%!#&#& ,"+"%# &$%$& "&"h%$% !#" $"h%'% %$) L. Re!en)#
B!"h". M B$h". HK Dh$",%. <M W%+". CM 201= $ursing %nterventions &lassification '$%&( S#+%" E!&"8#" !%! R#+h$&
24
H",%. TH 2015-2017 $)$D) %nternasional %nc Diagnosis *epera+atan, definisi - klasifikasi ./10./12 <%%$% EC
Mh"%'. S <h&. M M%%&. M S%&. E 201= $ursing Outcomes &lassification '$O&( S#+%" E!&"8#" !%! R#+h$&
M$$%6#. A#9 '% S%#. K,%!% 2011 3angguan 3astrointestinal, )plikasi )suhan *epera+atan 4edikal 5edah <%%$% S%!",% M"'#%
N!"& P"#&" N"&!"$$" 2011 5atu 6mpedu <%%$% PTN!"& P"#&"
N%#9. A H. K&,%. H 201= A&h% K""%%$% P%$#& E' R"8#&# <#!#' 2 Y+%%$% M"'# A$#
P$$". PA 1FF= 7engka8ian *esehatan 6d 9 <%%$%EC
R"""+" N<. I&&"!%h" K< 1FF Diseases of the 3allbladder and 5ile Ducts D%!%, H%#&& P##!"& 9 I$"%! M"'##". E'#&# " 14 E'#$ >%# ' M% H#!!
S,"!$;". &;%% C 2002 5uku )8ar *epera+atan 4edikal 5edah 5runner Suddart edisi : volume 1;.;9 EC <%%
%$W#!!#%,&. S. H". PD 2003 Understanding 4edical Surgical $ursing; Second edition; <) D%8#& C,% Ph#!%'"!h#%
W#, '" <+ "$ %! 2005 5uku )8ar %lmu 5edah EC <%%
%$P". M 2012 4akalah Dokumentasi *epera+atan "Dokumentasi 6valuasi# (!#") A8%#!%!" %$ h$$&//&#',/'/10=424735/,%%!%h',"$%&#-"8%!%&#-""%%$% D#'h %'% 1 S"$"," 201=
25
26
