PANDUAN PENGGUNAAN ALAT BANTU HIDUP DASAR
RSIA CATHERINE BOOTH Jl. Arief Rate Rate No.15 No.15 MAKASSAR
DAFTAR ISI
DAFTAR ISI.....................................................................................1 BAB I............................................................................................2 DEFINISI........................................................................................2 BAB II...........................................................................................3 RUANG LINGKUP............................................................................3 BAB III............................................................................................5 TATA LAKSANA...............................................................................5 BAB I.........................................................................................1!
BAB I DEFINISI
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A. DEFINISI 1. Alat Ba"t# $i%#& a%ala' &eralata" (e%i) *a"+ %i&erl#,a" &a)ie" #"t#, (e(-a"t# (e(e"#'i ,e-#t#'a" 'i%#& %a)ar )eara /)iolo+i) #"t#, (e(&erta'a",a" ,e'i%#&a". 2. Ke-#t#'a" %a)ar (a"#)ia (er#&a,a" #")#r0#")#r *a"+ %i-#t#',a" ole' (a"#)ia %ala( (e(&erta'a",a" ,e)ei(-a"+a" /)iolo+i (a#&#" &)i,olo+i). Me"#r#t Teori A-ra'a( Ma)lo Hierarchy of Needs $irar,i Ke-#t#'a"4 (a"#)ia (e(ili,i 5 (aa( ,e-#t#'a" *ait# physiological needs ,e-#t#'a" /)iolo+i)64 safety and security needs ,e-#t#'a" a,a" ra)a a(a"64 love and belonging needs ,e-#t#'a" a,a" ra)a ,a)i' )a*a"+ %a" ra)a (e(ili,i64 esteem needs ,e-#t#'a" a,a" 'ar+a %iri64 %a" selfactualization ,e-#t#'a" a,a" a,t#ali)a)i %iri6. 3. Ke-#t#'a" /)iolo+i) P'*)iolo+ial6 %ala( 'irar,i ,e-#t#'a" %a)ar (a"#)ia a%ala' 7e"i) ,e-#t#'a" *a"+ -er'#-#"+a" %e"+a" &e(e"#'a" ,e-#t#'a" %a)ar )e(#a (a"#)ia )e&erti4 (a,a"4 (i"#(4 (e"+'ir#& #%ara4 %a" )e-a+ai"*a. Ter(a)#, 7#+a ,e-#t#'a" #"t#, i)tira'at4 -#a"+ air -e)ar ata# ,eil4 (e"+'i"%ari ra)a )a,it4 %a" )e,). !. e"tila)i (e,a"i, a%ala' alat &er"afa)a" -erte,a"a" "e+atif ata# &o)itif *a"+ %a&at (e(&erta'a",a" 8e"tila)i %a" &e(-eria" o,)i+e" %ala( a,t# *a"+ la(a. 5. e"tilatorre)&irator a%ala' )#at# alat *a"+ %i+#"a,a" #"t#, (e(-a"t# )e-a+ia" ata# )el#r#' &ro)e) 8e"tila)i #"t#, (e(&erta'a",a" o,)i+e"a)i. B. TUJUAN 1. Ma(&# (ela,#,a" ),ri"i"+ %a" a)e)(e" ter'a%a& &a)ie" *a"+ (e(erl#,a" &eralata" -a"t# 'i%#& %a)ar 2. Ma(&# (ela,#,a" a)#'a" &a%a &a)ie" %e"+a" alat -a"t# 'i%#& 3. Ma(&# (ela,#,a" (o"itori"+ %a" (e(-eri,a" ra)a "*a(a" ,e&a%a &a)ie" %e"+a" alat -a"t# 'i%#& !. Ma(&# (e"+i%e"ti/,a)i ri)i,o *a"+ a,a" ter7a%i )e-a+ai a,i-at &e"++#"aa" &eralata" -a"t# 'i%#& %a)ar 5. Ma(&# (ela,)a"a,a" #&a*a &e"e+a'a"4 &e"+#ra"+a" %a" &e"a"+a"a" ri)i,o *a"+ ti(-#l a,i-at &e"++#"aa" &eralata" -a"t# 'i%#& %a)ar 9. Ma(&# (e(-eri,a" i"for(a)i %a" e%#,a)i ,e&a%a &a)ie" %a" ,el#ar+a &a)ie" :. Ma(&# (ela,#,a" &e"atata" ata) &e"+elolaa" *a"+ %i-eri,a" &a%a -er,a) re,a( (e%i) &a)ie".
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BAB II RUANG LINGKUP A. JENIS ALAT BANTU HIDUP DASAR 1. Je"i) alat -a"t# 'i%#& %a)ar a. Alat -a"t# 'i%#& %a)ar (a"#al 16 Alat -a"t# &e(-e-a)a" 7ala" "afa) aira*6 ;rofari"+eal T#-e Na)ofari"+eal T#-e S#tio" ,ateter To"+#e S&atel Tra'eo)to(* t#-e Tra'eal t#-e 26 Peralata" -a"t#a" 8e"tila)i -reat'i"+6 Ba+ 8al8e (a), Ja,)e" Ree) Ma),er ,etat Ber-a+ai alat -a"t#a" o,)i+e"a)i "a)al a"#l4 )i(&le (a),4 NRBM6 -. Je"i) 8e"tila)i (e,a"i, 16 No" I"8a)if 26 I"8a)i8e 2. I"%i,a)i &e(-eria" &eralata" -a"t#a" 'i%#& %a)ar %a" 8e"tila)i (e,a"i, a. Ga+al Na&a) Re)&irator* Fail#re -. $e"ti Nafa)Re)&irator* Arre)t . I")#/)ie")i Ja"t#"+ %. Di)f#"+)i Ne#rolo+i) e. Ga"++#a" "e#ro(#),#ler f. Ti"%a,a" o&era)i 3. Kriteria &e(a)a"+a" 8e"tilator &a%a +a+al "afa) a,#t6 a. Fre,#e")i "afa) < 35 ,ali (e"it -. ital =a&ait* > 15 (lK+ . Pa ;2 > 5? (($+ #%ara6 ata# Pa ;2 > :? (($+ %e"+a" (a),er o,)i+e"6 %. Pa =;2 < 5? (($+ e. A0a6 D;2< 35? (( $+ %e"+a" Fi ;2 1?? @ !. Pe"++olo"+a" e"tilator. Me"#r#t )ifat ,er7a"*a4 8e"tilator %i-a+i (e"7a%i ti+a ti&e4 *ait# a. ol#(e =*le% e"tilator • • • • • •
• • • •
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Si,l#) ,er7a -er%a)ar,a" 8ol#(e. I")&ira)i -er'e"ti %a" (#lai ter7a%i e,)&ira)i )etela' (e"a&ai 8ol#(e *a"+ %ite"t#,a". -. Pre))#re =*le% e"tilator Pri")i& ,er7a (e"++#"a,a" te,a"a"&re))#re. I")&ira)i -er'e"ti )etela' (e"a&ai te,a"a" *a"+ %ite"t#,a"4 %a" (#lai aal fa)e e,)&ira)i )eara &a)if. . Ti(e =*le% e"tilator Me,a"i)(e ,er7a -er%a)ar,a" a,t# i")&ira)i %a" e,)&ira)i *a"+ %ite"t#,a". Maa( 8e"tilator )aat i"i )#%a' -a"*a, *a"+ (e"++#"a,a" +a-#"+a" (e,a"i)(e ,er7a *a"+ tela' %i)e-#t,a" %i ata). 5. Mo%e e"tilator. Pa%a -e-era&a 8e"tilator )aat i"i )#%a' -a"*a, *a"+ (e"+e(-a"+,a" (o%e ,er7a 8e"tilator. Be-era&a (o%e %a)ar &a%a 8e"tilator )e-a+ai -eri,#t a. Mo%e =o"trol =M =o"trolle% Ma"%ator* e"tilatio"IPP6 Per"afa)a" )eara ,e)el#r#'a" %i,e"%ali,a" ole' (e)i" -. S6IM S*"'ro"ie%6 I"ter(itte" Ma"%ator* e"tilatio" Ba"t#a" (e)i" %i)e)#ai,a" %e"+a" &er"afa)a" &a)ie". Per"afa)a" )&o"ta" ter7a%i %ia"tara (a"%ator*. . Mo%e ASB A))i)te% S&o"ta"e#) Breat'i"+6 PS Pre))#re S#&&ort6 Me"+o"trol )e(#a &er"afa)a" *a"+ %i,iri(,a" )e)#ai %e"+a" 8ol#(e&re))#re *a"+ %i)et. %. =PAP =o"ti"#o#) Po)iti8e Aira* Pre))#re6 Me)i" 'a"*a (e(-eri,a" te,a"a" &o)itif %a" %i-eri,a" &a%a &a)ie" *a"+ -i)a -er"afa) a%e,#at4 #"t#, (e"e+a' atele,ta)i). B. UNIT KERJA 1. U"it I"te")if 2. U"it Ka(ar;&era)i C. KEWENANGAN PELAKSANA 1. Do,ter S&e)iali) A"a)t'e)i 2. Peraat
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BAB III TATA LAKSANA A. TATA LAKSANA ASESSMENT PASIEN DENGAN ALAT BANTU HIDUP 1. Ria*at &e"*a,it ria*at ,e)e'ata" I"for(a)i (e"+e"ai latar -ela,a"+ %a" ria*at &e"*a,it *a"+ )e,ara"+ %a&at %i&erole' (elal#i ora"+ lai" ,el#ar+a4 ti( (e%i) lai"6 ,are"a ,o"%i)i &a)ie" *a"+ %a&at -a"t#a" 8e"tilator ti%a, (#"+,i" #"t#, (e(-eri,a" %ata )eara %etail. Pe"+,a7ia" i"i %it#7#,a" #"t#, (e"+eta'#i ,e(#"+,i"a" &e"*e-a- ata# fa,tor &e"et#) ter7a%i"*a +a+al "afa) %i&a)a"+"*a 8e"tilator Data ria*at ,e)e'ata" ter,ait %e"+a" ,o"%i)i +a+al "afa) *a"+ (elatar-ela,a"+i &a)ie" (e(erl#,a" alat -a"t# 'i%#& a"tara lai" a. Ria*at &e"*a,it ter,ait +a"++#a" )*araf &#)at 16 Tra#(a ,e&ala (i)al"*a =o"t#)io ere-ri 26 Ra%a"+ ota, (i)al"*a E"e&'aliti) 36 Ga"++#a" 8a),#ler (i)al"*a &er%ara'a" ota,4 i"far, !6 ;-at0o-ata" "ar,oti,a4 o-at )e%a)i *a"+ (e"++a"++# f#"+)i )*araf ota, -. Kelai"a" Ne#ro M#),#ler 16 G#illia" Bare S*"%ro( 26 Teta"#) 36 Tra#(a =er8ial !6 ;-at &ele(a) otot (#)le relaa"6 . Ga"++#a" 7ala" "afa) 16 ;-)tr#,)i 7ala" "afa) 26 A)(a Bro",iale %. Kelai"a" %i &ar# 16 E%e(a &ar# 26 Atele,ta)i) 36 ARDS e. Kelai"a" t#la"+ i+at'ora 16 Fra,t#r o)tae 26 P"e#(ot'ora 36 $ae(ot'ora f. Kelai"a" 7a"t#"+ 16 Ke+a+ala" 7a"t#"+ ,iri
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2. Kel#'a" U"t#, (e"+eta'#i ,el#'a" &a)ie"4 -ila &a)ie" %ala( ,ea%aa" )a%ar -ai, -i)a %ila,#,a" %e"+a" ara &a)ie" %i-eri alat t#li) #"t#, (e"*a(&ai,a" ,el#'a""*a. Kel#'a" &a)ie" *a"+ &erl# %i,a7i a%ala' ra)a )e)a, "afa)4 "afa) tera)a -erat4 ,elela'a" %a" ,eti%a, "*a(a"a" 3. Si)te( &er"afa)a" a. Setti"+ 8e"tilator 16 Mo%e 8e"tilator 26 Fi
. Pro)e"ta)e o,)i+e" *a"+ %i-eri,a"
36 PEEP . Po)iti8e E"% E&irator* Pre))#re !6 Fre,e")i "afa) -. Gera,a" "afa) a&a,a' )e)#ai %e"+a" ira(a 8e"tilator. . E&a")i %a%a ,a"a" %a" %a%a ,iri a&a,a' )i(etri) ata# ti%a,. %. S#ara "afa). A%a,a' ro"'i4 ee'i"+4 &e"#r#"a" )#ara "afa). e. A%a,a' +era,a" #&i"+ 'i%#"+ %a" &e"++#"aa" otot -a"t# "afa). f. Se,ret J#(la'4 ,o")i)te")i4 ar"a %a" -a#. +. $#(i%i/er ,e'a"+ata" %a" -ata) aC#a. '. T#-i"+ =ir#it 8e"tilator a%a,a' ,e-oora" terte,#4 ata# le&a). i. $a)il a"ali) +a) %ara' tera,'ir )at#ra)i o,)i+e". 7. $a)il foto t'ora tera,'ir. !. Si)te( =ar%io8a),#ler Pe"+,a7ia" ar%io8a)#ler %ila,#,a" #"t#, (e"+eta'#i a%a"*a +a"++#a" 'e(o%i"a(i, *a"+ %ia,i-at,a" )etti"+ 8e"tilator PEEP terlal# ti"++i6 ata# %i)e-a-,a" ,are"a 'i&o,)ia. Pe"+,a7ia" (eli&#ti te,a"a" %ara'4 "a%i4 ira(a 7a"t#"+4 &erf#)i4 a%a,a' )*a"o)i) %a" -a"*a, (e"+el#ar,a" ,eri"+at. 5. Si)te( "e#rolo+i Pe"+,a7ia" (eli&#ti ti"+,at ,e)a%ara"4 a%a,a' "*eri ,e&ala4 ra)a "+a"t#,4 +eli)a'4 ata# ,e,aa#a" (e"tal. 9. Si)te( Uro+e"ital A%a,a' &e"#r#"a" &ro%#,)i #ri"e Ber,#ra"+"*a &ro%#,)i #ri"e (e"#"7#,,a" a%a"*a +a"++#a" &erf#)i +i"7al6. :. Stat#) aira" %a" "#tri)i Stat#) aira" %a" "#tri)i &e"ti"+ %i,a7i ,are"a -ila a%a +a"++#a" )tat#) "#tri)i %a" aira" a,a" (e(&er-erat ,ea%aa". Se&erti aira" *a"+ -erle-i'a" %a" al-#(i" *a"+ re"%a' a,a" (e(&er-erat oe%e(a &ar#. . Stat#) P)*o)o)ial 8ii
Pa)ie" *a"+ %iraat %i I=U %a" %i&a)a"+ 8e"tilator )eri"+ (e"+ala(i %e&re)i (e"tal *a"+ %i(a"ife)ta)i,a" -er#&a ,e-i"+#"+a"4 +a"++#a" orie"ta)i4 (a)ala' teri)ola)i4 ,ee(a)a" %a" ,eta,#ta" a,a" ,e(atia". Stat#) &)i,o)o)ial (e"+ara',a" re"a"a &ela*a"a" a,a" ,e-#t#'a" -a"t#a" ro'a"i4 &ere"a"aa" i"ter8e")i &)i,olo+i) ter,ait re)&o" &)i,i) (e"7ela"+ ,e(atia" &a%a ,o"%i)i fa)e a,'ir 'i%#& &e"*a,it ter(i"al6
B. TATALAKSANA AWAL PEMBERIAN ALAT BANTU HIDUP (VENTILATOR) Se-el#( (e(a)a"+ 8e"tilator &a%a &a)ie"4 la,#,a" -e-era&a la"+,a' aal )e-a+ai -eri,#t 1. La,#,a" o&erati"+ 8eri/atio" te)t;T )e)#ai &et#"7#, o&era)io"al (a)i"+0(a)i"+ 7e"i) alat #"t#, (e(a)ti,a" alat -erf#"+)i %e"+a" -ai, 2. La,#,a" te)t l#"+ te) &ar# #"t#, (e"ilai ,e)e)#aia" )etti"+ alat 3. Para(eter &e"+e)eta" aal a%ala' )e-a+ai -eri,#t a. Fi ;2 i")&ira)i 1??@ -. ol#(e Ti%al 1? (lK+ BB . Fre,#e")i "afa) 1? 15 ,ali(e"it %ea)a6 ata# 3? !? ,ali(e"it -a*i6 %. PEEP 5 ( $2 ; e. Flo i")&ira)i !? 9? liter%eti, f. Mi"#te 8ol#(e 12? 15? (lK+ BB !. Pe"+e)eta" %a" &e"e"t#a" (o%e 8e"tila)i %ite"t#,a" )e)#ai t#7#a" tera&i %o,ter %a" re)&o" &a)ie" *a"+ %it#"7#,,a" )eara ,li"i) %a" -er%a)ar,a" 'a)il a"ali)a +a) %ara' A"ali)a Ga) Dara'6 5. La,#,a" (o"itori"+ )ela(a &a)ie" ter&a)a"+ 8e"tilator C. TATA LAKSANA MONITORING PASIEN YANG MENGGUNAKAN ALAT BANTU HIDUP (VENTILATOR) Seara +ari) -e)ar &e(a"ta#a" *a"+ %ila,#,a" (eli&#ti 1. S#(-er te"a+a 2. e"tilator 3. Ko"%i)i +a) i")&ira)i !. Pa)ie" 16 SUMBER TENAGA
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S#(-er +a) -erte,a"a"4 )#(-er o,)i+e" %a" )#(-er li)tri, 'ar#) %ala( ,o"%i)i -ai, %a" #,#& #"t#, (e(e"#'i ,e-#t#'a" 26 ENTILAT;R 0 TE ol#(e Ti%al E,)&ira)i6 *ait# 8ol#(e #%ara *a"+ %i,el#ar,a" %ala( )at# )i,l#) "afa) 0 Fre,#e")i "afa) ,a7i ,e)e)#aia" fre,#e")i "afa) &a)ie" %e"+a" *a"+ %ite"t#,a" &a%a 8e"tilator 0 PAP Pea, Aira* Pre))#re6 *ait# -e)ar"*a te,a"a" *a"+ %i&erl#,a" #"t#, (e(o(&a 8ol#(e #%ara *a"+ tela' %ite"t#,a" 0 Fratio" I")&iratio" Fi ;26 *ait# ,o")e"tra)i o,)i+e" *a"+ (a)#, ,e %ala( &ar#.
36 K;NDISI GAS INSPIRASI 0 Kete&ata" alira")ir,#it #%ara 0 Ke-oora" #%ara 0 $#(i%i/er -erf#"+)i -ai, 0 Sela"+-reat'i"+ ir#it -ila teri)i &e"#' ole' air ,o"%e")a)i 'ar#) %i,el#ar,a" 0 Po)i)i ater tra& 'ar#) le-i' re"%a' %ari &a)ie" !6 PASIEN 0 Mo"itori"+ &a)ie" 'ar#) (eli&#ti 9 e"a(6 )*)te( t#-#' *ait# BREAT$ )*)te( &er"afa)a"64 BLEED )*)te( ,ar%io8a),#ler64 BRAIN )*)te( )*araf64 BLADDER )*)te( )al#ra" ,e"i"+64 B;EL )*)te( )al#ra" (a,a"a"64 B;NE )*)te( t#la"+otot6 0 $a)il foto t'ora *a"+ (e"ilai &o)i)i ETT E"%otra'eal T#-e6 %a" ,o"%i)i 7a"t#"+ %a" &ar# 0 $a)il la-oratori#( &e(eri,)aa" A"ali)a Ga) Dara' BGA Bloo% Ga) A"al*)i)6 Pe(eri,)aa" )e%i,it"*a %ila,#,a" %#a ,ali *ait# )e-el#( &a)ie" %ila,#,a" i"t#-a)i %a" %ila,#,a" &e(a)a"+a" 8e"tilator )erta )aat (o"itori"+ 1 2 7a( )etela' &a)ie" ter&a)a"+ 8e"tilator %a" &a%a a,t# &e"ilaia" ,e(a(&#a" ea"i"+&e"*a&i'a"6 D. TATA LAKSANA PERAWATAN PASIEN DENGAN ALAT BANTU HIDUP (VENTILATOR) 1. Mo"itor %a" a(a",a" &o)i)i ETT (eli&#ti /,)a)i *a"+ -ai,4 #,#ra"4 ,e%ala(a"4 ,e-oora" i)i -alo"# 2. La,#,a" &e(eri,)aa" 8e"tilator tia& 102 7a(
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3. A#),#lta)i -#"*i "afa) )etia& 20! 7a(. !. La,#,a" &e"+'i)a&a" -ila ter%e"+ar ro"'i 5. Perta'a",a" )#'# '#(i%i/er teta& 'a"+at 35 3:4 =6. 9. At#r &o)i)i ti%#r %e"+a" (e"ai,,a" -a+ia" ,e&ala te(&at ti%#r4 ,e#ali a%a ,o"trai"%i,a)i :. La,#,a" oral hygiene )etia& 9 7a( . Mo"itor a%a"*a ,e(#"+,i"a" terte,#, ata#&#" -#"t# H. Mo"itor &ara(eter re)&irator ter'a%a& ,e)e)#aia" %e"+a" &a)ie" (eli&#ti 8ol#(e ti%al e,)&ira)i4 fre,#e")i "afa)4 airway pressure4 alar( *a"+ (#"#l 1?. Mo"itor ,o"%i)i &a)ie" (eli&#ti ta"%a 8ital4 &erf#)i %a" 'e(o%i"a(i,4 'a)il &e(eri,)aa" a"ali)a +a) %ara' 11. La,#,a" re)trai" /,)a)i -ila &a)ie" +eli)a' 12. =e+a' ter7a%i"*a /+'ti"+ ,ala# &erl# ,ola-ora)i %e"+a" %o,ter #"t#, (e(-eri )e%a)i 13. Beri,a" o-at (#,oliti, )e)#ai i"%i,a)i ata# &ro+ra(. 1!. E8al#a)i ar"a4 7#(la' ,o")i)te")i %a" -a# )&#t#( )etia& ,ali &e"+i)a&a" 15. La,#,a" &e(eri,)aa" ,#lt#r )&#t#( %a" te) )e")iti8ita) )e)#ai i"%i,a)i 19. Beri,a" a"ti-ioti,a )e)#ai &ro+ra( %o,ter E. TATA LAKSANA PENYAPIHAN/WEANING VENTILATOR Pe"*a&i'a" %a&at %ila,#,a" a&a-ila (e(e"#'i riteria )e-a+ai -eri,#t 1. Ka&a)ita) 8ital 1? 15 (lK+ BB 2. ol#(e Ti%al ! 5 (lK+ BB 3. Pre))#re i")&ira)i (i"i(al 2? ( $2; !. Fre,#e")i "afa) < ,ali(e"it %a" > 2? ,ali(e"it F. TATA LAKSANA NYERI PADA PASIEN KRITIS DENGAN PEMASANGAN ALAT BANTU HIDUP DASAR Asesme N!e"# P$%$ P$s#e De&$ Pe"$'$$ K"##s Ti"+,at "*eri &a%a &a)ie" %e"+a" &eraata" ,riti) (i)al"*a &a)ie" %i I=U I"te")i8e =are U"itI 'ar#) %i(o"itor )eara r#ti". A)e)(e" &a%a &a)ie" %e"+a" &eraata" ,riti) (e"++#"a,a" alat #,#r CPOT (C"##$* C$"e O+,se"-$#+ T++*). Kriteria &e"+#,#ra" ter%iri %ari e(&at ,riteria *ait# 1. E,)&re)i a7a' 2. Per+era,a" T#-#' 3. M#)le Te")io" re)i)te")i *a"+ %ira)a,a" &eraat )aat &a)ie" %ir#-a' &o)i)i (iri"+ ,a"a",iri ata# %e"+a" e8al#a)i e,)i %a" e,)te")i &a)if %ari e,)tre(ita) ata)6
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G. TATA LAKSANA PELAYANAN PSIKOLOGIS PADA PASIEN Pa)ie" %e"+a" alat -a"t# 'i%#& (e"+ala(i -e-era&a &er(a)ala'a" &)i,olo+i) )e&erti ,ee(a)a"4 ,eti%a, ta'#a" a,a" ti"%a,a" *a"+ %ila,#,a" &a%a %iri"*a4 %e&re)i ,are"a a"a(a" (e"+'a%a&i ,e(atia" )erta +a"++#a" ,o(#"i,a)i 8er-al a,i-at &e(a)a"+a" &eralata".
ii
Be-era&a tatala,)a"a -a"t#a" &)i,olo+i) &a%a &a)ie" %a&at %ila,#,a" %e"+a" 1. La,#,a" ,o(#"i,a)i tera&e#ti, 2. Doro"+ &a)ie" a+ar (a(&# (e"+e,)&re)i,a" &era)aa""*a 3. Beri,a" )#&&ort (e"tal4 7i,a &erl# fa)ilita)i -a"t#a" ro'a"i !. Beri,a" ,e)e(&ata" &a%a ,el#ar+a %a" ora"+0ora"+ *a"+ %e,at %e"+a" &a)ie" #"t#, (e"+#"7#"+i &a%a )aat0)aat terte"t# 5. Beri,a" i"for(a)i reali)ti) &a%a ti"+,at &e(a'a(a" ,lie" te"ta"+ t#7#a" &e(a)a"+a" alat4 7ela),a" &a%a &a)ie" -a'a ETT a,a" %ile&a) 7i,a ,o"%i)i &a)ie" )ta-il (e(-ai,6 9. a,i",a" ,lie" -a'a )#ara a,a" ,e(-ali -ila ETT %ile&a) :. A7ar,a" ,lie" #"t#, -er-iara )eara "o" 8er-al -a'a)a i)*arat6 H. TATA LAKSANA IDENTIFIKASI RISIKO Ri)i,o *a"+ (#"+,i" ter7a%i &a%a &a)ie" %e"+a" &eralata" -a"t# 'i%#& %a)ar a"tara lai" 1. Ri)i,o *a"+ %ia,i-at,a" ole' ,o"%i)i (e)i"8e"tilator a. Ke-oora" t#-i"+ &i&a6-reat'i"+ )ir#it -. Sla"+ e"%o tra'eal -#"t# ata# &#" terte,#, %a&at -era,i-at ,#ra"+"*a )#&lai #%ara ,e&a%a &a)ie" . Sla"+ e"%otra,'eal tera-#t 2. Ri)i,o ter7a%i "e,ro)i) %i #7#"+ -i-ir %a" tra,'ea 3. Ri)i,o a,i-at &ro)e) 8e"tila)i (e,a"i) *a"+ ter7a%i &a%a &ar# a. Barotra#(a -. Atele,ta)i) . I"fe,)i &ar# APVentilator Assosiated Pneumonia6 !. A)&ira)i aira" la(-#"+ 5. Ko(&li,a)i )i)te( &e"er"aa" %i)te")i la(-#"+4 &er%ara'a" la(-#"+ I. TATA LAKSANA PENCEGAHAN PENGURANGAN DAN PENANGANAN RISIKO 1. Ri)i,o ,e-oora" t#-i"+ a. La,#,a" &e"+ee,a" aal )e-el#( (e)i" )ia& %io&era)i,a" %e"+a" (ela,#,a"te) ,ali-ra)i;T ;&erati"+ eri/atio" Te)t6. -. A&a-ila ter7a%i ,e-oora" &a%a )aat &erio%e &e"++#"aa" alat4 a(-il ali' 8e"tila)i )eara (a"#al %e"+a" bag valve mask Ja,)o" ree) 4 ,e(#%ia" )e+era la,#,a" &e"+ee,a" alat4 &a)a"+ alat %e"+a"
iii
,#at #"t#, (e"+'i"%ari ,e-oora" #la"+4 -ila %i&erl#,a" +a"ti %e"+a" breathing sircui t *a"+ -ar#. 2. Sla"+ e"%otra,'eal -#"t# ata# &#" terte,#, %a&at -era,i-at ,#ra"+"*a )#&lai #%ara ,e&a%a &a)ie" a. La,#,a" &e(eri,)aa" 8e"tilator tia& 102 7a( -. Beri ta"%a &a%a &o)i)i ,e%ala(a" ETT . Mo"itor %a" a(a",a" &o)i)i ETT (eli&#ti /,)a)i *a"+ -ai,4 #,#ra"4 ,e%ala(a"4 ,e-oora" i)i -alo"# %. La,#,a" '#(i%i/,a)i %a" ,ala# &erl# "e-#li)a)i )etia& e"a( 7a(. e. La,#,a" )#tio" e"%otra,'eal )etia& ti+a 7a( )e,ali )e)#ai i"%i,a)i f. Ja+a )#'# '#(i%i/er teta& 'a"+at 35? = 3:4? =6 3. Ri)i,o )la"+ tera-#t Pa)a"+la' re)trai" (e,a"i, &a%a &a)ie" %e"+a" (e"++#"a,a" (itela&e"+i,at. Jela),a" &a%a &a)ie" t#7#a""*a 7i,a &a)ie" )a%ar6 a+ar &a)ie" le-i' ,oo&eratif. Ji,a %i&erl#,a"4 -eri,a" )e%a)i ata# &#" relaa" )e)#aia %8i) %o,ter !. Ri)i,oter7a%i"e,ro)i) %i #7#"+ -i-ir %a" tra,'ea a. Ga"tila' /,)a)i ETT )etia& 'ari -. G#"a,a" ;rofari"+eal t#-e (a*o t#-e )e)#ai #,#ra" %a" &a%a &o)i)i *a"+ te&at . Ke(&i),a" -alo"# cued o 6 )etia& 2 'ari )e,ali )ela(a 15 (e"it 5. Ri)i,o ter7a%i -arotra#(a) a. Beri,a" -a"t#a" 8e"tila)i )e)#ai i"%i,a)i %a" ,o"%i)i &ar# )e'i"++a )etti"+ (o%e *a"+ %i-eri,a" te&at. Ja"+a" (e(-eri,a" te,a"a"&re))#re *a"+ terlal# -e)ar 7i,a ti%a, a%a i"%i,a)i. -. La,#,a" a#),#l ta)i"afa) )eara r#ti" )etia& 20! 7a(. =e, a%a"*a ,re&ita)i e(/)e(a )#- ,#ti)6 9. Ri)i,oter7a%i &"e#(o"ia AP e"tilator A))oiate P"e#(o"ia6 %a" atele,ta)i) a. La,#,a" &ro)e%#r #i ta"+a" *a"+ te&at &a%a li(a (o(e"t #i ta"+a". -. La,#,a" )#tio" e"%otra,'eal %a" )#to"orofari"+ )eara r#ti" )etia& 3 7a( )e,ali a&a-ila ti%a, a%a ,o"tra i"%i,a)i . La,#,a" '#(i%i /,a)i %a"" e-#li)a)i %. La,#,a" /)iotera&i "afa) %e"+a" la&&i"+4 8i-rati"+ ata# &#" i"fra re% #"t#, (e(o-ili)a)i a,#(#la)i )eret %i )al#ra" &er"afa)a"
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e. R#-a' &o)i)i &a)ie" )etia& %#a 7a( #"t#, (e"+'i"%ari &e"#(&#,a" )eret ,are"a &o)i)i )tati) f. La,#,a" oral '*+ie"e )etia& 9 7a( +. Ga"ti -reat'i"+ )ir,#it)etia& 3 'ari '. Ga"ti )la"+ ETT )etia& : 'ari i. A&a-ila &e(a)a"+a" 8e"tilator %i+#"a,a" le-i' %ari 1! 21 'ari4 re"a"a,a" &e"++a"tia" -a"t#a" &er"afa)a" %e"+a" (e"++#"a,a" tra'eo)to(* :. Ri)i,o a)&ira)i aira" la(-#"+ a. La,#,a" a)&ira)i aira" la(-#"+ )e-el#( &e(-eria" %iit )o"%e #"t#, (e"+eta'#i ,e(a(&#a" &e"+o)o"+a" la(-#"+ %a" re)i%# *a"+ ter)i)a -. Beri,a" %iit )o"%e )etela' %ila,#,a" )#tio" ETT %a" orofari"+ #"t#, (e"+'i"%ari ra"+)a"+ Ga+ ree, *a"+ (e"+a,i-at,a" (#"ta' %a" ter7a%i ri)i,o a)&ira)i . At#r &o)i)i &a)ie" 'ea% #& 3?? 7i,a ti%a, a%a ,o"tra i"%i,a)i %. Ji,a &erl# +#"a,a" )la"+ e"%otra,'eal *a"+ %ile"+,a&i %e"+a" &i&a a)&ira)i)#tio" ETT )aet6 J. TATA LAKSANA PEMBERIAN INFORMASI DAN EDUKASI KEPADA PASIEN DAN KELUARGA 1. I"%i,a)i 2. Je"i) ti"%a,a" %a" &e"+o-ata" *a"+ %i-eri,a" 3. Ri)i,o ata) ti"%a,a" *a"+ %i-eri,a"
BAB IV DOKUMENTASI 1. E%#,a)i %a" &e"%i%i,a" ,e&a%a &a)ie" %a",el#ar+a"*a te"ta"+ i"%i,a)i4 %a" re)i,o %i%o,#(e"ta)i,a" &a%a le(-ar i"for(a)i %a" e%#,a)i.
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2. Per"*ataa" &er)et#7#a" ti"%a,a" i"for(e% o")e"t6 %i%o,#(e"ta)i,a" &a%a Le(-ar Per)et#7#a" Ti"%a,a". 3. Per"*ataa" &e"ola,a" &e(a)a"+a" alat -a"t# 'i%#& %i%o,#(e"ta)i,a" %ala( Le(-ar Pe"ola,a" Ti"%a,a" !. Do,#(e"ta)i &ela*a"a" re)#)ita)i &a%a re,a( (e%i). 5. Do,#(e"ta)i,a" )etia& 'a)il a)e))(e" %a" ti"%a,a" *a"+ %ila,#,a" &a%a &a)ie" ,o(a *a"+ (e"++#"a,a" -a"t#a" 'i%#& %a)ar (eli&#ti a,t# &e(a)a"+a"4 7e"i) %a" #,#ra" alat *a"+ %i+#"a,a"4 8ol#(e # *a"+ %i-eri,a"4 ,o(&li,a)i re)i,o *a"+ ter7a%i4 fre,#e")i %a" 'a)il ti"%a,a" )#tio" (eli&#ti ,ara,teri)ti,4 7#(la' %a" ar"a )&#t#( &a%a le(-ar o-)er8a)i %a" le(-ar =PPT.
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