PROSEDUR PERAWATAN LUKA SEDERHANA
D I S U S U N Oleh : PUTRI MUNAWWARAH YOLANDA VEGA W SILABAN OINIKE KRISTIANI BUULOLO
PROGRAM STUDY NERS FAKULTAS FARMASI DAN ILMU KESEHATAN UNIVERSITAS SARI MUTIARA INDONESIA
KATA PENGANTAR
Puji syuku k!"i u#!$k!% ke$!&! Tuh!% Y!%' M!h! Es! !(!s !h"!( &!% hi&!y!h)Ny!* "!k!l!h y!%' k!"i susu% &e%'!% ju&ul +P,se&u Pe!-!(!% Luk! Se&eh!%!. &!$!( (eseles!ik!% &e%'!% /!ik &!% (e$!( -!k(u0 Tei"! k!sih k!"i u#!$k!% ke$!&! (e"!%)(e"!% kel,"$,k y!%' iku( se(! "e"/!%(u &!l!" $,ses $e"/u!(!% "!k!l!h i%i* /!ik &!l!" $e"/ei!% '!'!s!% "!u$u% $e"/ei!% s!!%! &!% $!s!%!0 K!"i "e%y!&!i !$!/il! "!k!l!h y!%' k!"i susu% i%i j!uh &!i se"$u%!0 M!k! &!i i(u k!"i "e",h,% s!!% se(! ki(ik /!ik &!i B!$!k1I/u D,se% "!u$u% (e"!%)(e"!%* su$!y! k!"i &!$!( "ee2isi "!k!l!h k!"i sehi%''! "e%j!&i le/ih /!ik0 Se",'! "!k!l!h y!%' k!"i susu% i%i &!$!( /e"!"2!!(* "e"/eik!% (!"/!h!% -!-!s!% /!'i (e"!%)(e"!% "!h!sis-! ke$e!-!(!% &!% se",'! /is! "e%j!&i /!h!% e2isi u%(uk $e"/el!j!!% ki(! /es!"!0
Me&!%* 33 Ok(,/e 4536
Pe%yusu%
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DAFTAR ISI KATA PENGANTAR777777777707777777777777777700 i DA8TAR ISI 7777777077777777777777777777777000ii BAB I PENDAHULUAN777777777777777777777777700 3 303 Pe%&!hulu!%77777777777777777777777777000 3 304 Tuju!%77777777777777777777777777777 3 BAB II PROSEDUR PERAWATAN LUKA SEDERHANA7777777777770004 403 Pe%'e(i!% Luk!7777777777777777777777777 4 404 Mek!%is"e Tej!&i Luk!77777777777777777777700 9 409 Me%uu( (i%'k!( K,%(!"i%!si (eh!&!$ luk!777777777777770 9 40 P,ses Pe%ye"/uh!% Luk!777777777777777777777 9 40; 8!k(, Y!%' Me"$e%'!uhi P,ses Pe%ye"/uh!% Luk!7777777770 406 Pe"ilih!% B!lu(!% Luk!7777777777777777777777 ; 40< Pe!-!(!% Luk! Besih77777777777777777777770000 ; A0 Pesi!$!%7777777777777777777777777770 6 B0 Mel!kuk!% Pe!-!(!% Luk!7777777777777777700000000000 6 =0 D,ku"e%(!si77777777777777777777777777< 40> Pe!-!(!% Luk! B!s!h77777777777777777777700000000 < BAB III PENUTUP77777777777777777777777777770035 903 Kesi"$ul!%777777777777777777777707777000 35 904 S!!%7777777777777777777777777777700 35 DA8TAR PUSTAKA77777777777777777777777777700 33
ii
BAB I
PENDAHULUAN
1.1.Latar belaka!
P!&! s!!( i%i* $e!-!(!% luk! (el!h "e%'!l!"i $eke"/!%'!% y!%' s!%'!( $es!( (eu(!"! &!l!" &u! &ek!&e (e!khi i%i0 Tek%,l,'i &!l!" /i&!%' keseh!(!% ju'! "e"/eik!% k,%(i/usi y!%' s!%'!( u%(uk "e%u%j!%' $!k(ek $e!-!(!% luk! i%i0 Dis!"$i%' i(u $ul!* isu (eki%i y!%' /ek!i( &e%'!% "!%!je"e% $e!-!(!% luk! i%i /ek!i(!% &e%'!% $eu/!h!% $,2il $!sie%* &i"!%! $!sie% &e%'!% k,%&isi $e%y!ki( &e'e%e!(i2 &!% kel!i%!% "e(!/,li# se"!ki% /!%y!k &i(e"uk!%0 K,%&isi (ese/u( /i!s!%y! sei%' "e%ye(!i kek,"$leks!% su!(u luk! &i"!%! $e!-!(!% y!%' (e$!( &i$eluk!% !'! $,ses $e%ye"/uh!% /is! (e#!$!i &e%'!% ,$(i"!l0 De%'!% &e"iki!%* $e!-!( &i(u%(u( u%(uk "e"$u%y!i $e%'e(!hu!% &!% ke(e!"$il!% y!%' !&eku!( (ek!i( &e%'!% $,ses $e!-!(!% luk! y!%' &i"ul!i &!i $e%'k!ji!% y!%' k,"$ehe%si2* $ee%#!%!!% i%(e?e%si y!%' (e$!(* i"$le"e%(!si (i%&!k!%* e?!lu!si h!sil y!%' &i(e"uk!% sel!"! $e!-!(!% se(! &,ku"e%(!si h!sil y!%' sis(e"!(is0 Isu y!%' l!i% y!%' h!us &i$!h!"i ,leh $e!-!( !&!l!h /ek!i(!% &e%'!% cost effectiveness0 M!%!je"e% $e!-!(!% luk! ",&e% s!%'!( "e%'e&e$!%k!% isu (ese/u(0 H!l i%i &i(u%j!%' &e%'!% se"!ki% /!%y!k%y! i%,?!si (e/!u &!l!" $eke"/!%'!% $,&uk)$,&uk y!%' /is! &i$!k!i &!l!" "e!-!( luk!
1.".T#$#a
A'! "!h!sis-! &!$!( "e%'e(!hui (e%(!%' Pe!-!(!% Luk!: Luk! Besih* Luk! B!s!h0 U%(uk "e"e%uhi s!l!h s!(u (u'!s "!(! kuli!h I%(e'u"e%
3 BAB II
PERAWATAN LUKA
".1. Pe!ert%a L#ka
Se#!! &e2i%isi su!(u luk! !&!l!h (e$u(us%y! k,%(i%ui(!s su!(u j!i%'!% ,leh k!e%! !&!%y! #e&e! !(!u $e"/e&!h!%0 Luk! i%i /is! &ikl!si2ik!sik!% /e&!s!k!% s(uk(u !%!(,"is* si2!(* $,ses $e%ye"/uh!% &!% l!"! $e%ye"/uh!%0 Luk! !&!l!h us!k%y! kes!(u!%1k,"$,%e% j!i%'!%* &i"!%! se#!! s$esi2ik (e&!$!( su/s(!%si j!i%'!% y!%' us!k !(!u hil!%'0 Ke(ik! luk! (i"/ul* /e/e!$! e2ek !k!% "u%#ul : 30 Hil!%'%y! seluuh !(!u se/!'i!% 2u%'si ,'!% 40 Res$,% s(es si"$!(is 90 Pe&!!h!% &!% $e"/eku!% &!!h 0 K,%(!"i%!si /!k(ei ;0 Ke"!(i!% sel Se&!%'k!% kl!si2ik!si /e&!s!k!% s(uk(u l!$is!% kuli( "eli$u(i: su$e2isi!l* y!%' "eli/!(k!% l!$is!% e$i&e"is@ partial thickness* y!%' "eli/!(k!% l!$is!% e$i&e"is &!% &e"is@ &!% full thickness y!%' "eli/!(k!% e$i&e"is* &e"is* l!$is!% le"!k* 2!s#i! &!% /!hk!% s!"$!i ke (ul!%'0 Be&!s!k!% $,ses $e%ye"/uh!%* &!$!( &ik!(e',ik!% "e%j!&i (i'!* y!i(u: !0 Healing by primary intention Te$i luk! /is! "e%y!(u ke"/!li* $e"uk!% /esih* /i!s!%y! (ej!&i k!e%! su!(u i%sisi* (i&!k !&! j!i%'!% y!%' hil!%'0 Pe%ye"/uh!% luk! /el!%'su%' &!i /!'i!% i%(e%!l ke ekse(e%!l0 /0 Healing by secondary intention Te&!$!( se/!'i!% j!i%'!% y!%' hil!%'* $,ses $e%ye"/uh!% !k!% /el!%'su%' "ul!i &!i $e"/e%(uk!% j!i%'!% '!%ul!si $!&! &!s! luk! &!% seki(!%y!0 #0 Delayed primary healing (tertiary healing) Pe%ye"/uh!% luk! /el!%'su%' l!"/!(* /i!s!%y! sei%' &ise(!i &e%'!% i%2eksi* &i$eluk!% $e%u(u$!% luk! se#!! "!%u!l0 Be&!s!k!% kl!si2ik!si /e&!s!k!% l!"! $e%ye"/uh!% /is! &i/e&!k!% "e%j!&i &u! y!i(u: !ku( &!% k,%is0 Luk! &ik!(!k!% !ku( jik! $e%ye"/uh!% y!%' (ej!&i &!l!" j!%'k! -!k(u 4)9 "i%''u0 Se&!%'k!% luk! k,%is !&!l!h se'!l! je%is luk! y!%' (i&!k (!%&!)(!%&! u%(uk se"/uh &!l!" j!%'k! le/ih &!i )6 "i%''u0 Luk! i%sisi /is! &ik!(e',ik!% luk! !ku( jik! $,ses $e%ye"/uh!% /el!%'su%' sesu!i &e%'!% k!i&!h $e%ye"/uh!% %,"!l (e(!$i /is! ju'! &ik!(!k!% luk! k,%is jik! "e%'!l!"i ke(el!"/!(!% $e%ye"/uh!% (delayed healing) !(!u jik! "e%u%jukk!% (!%&!)(!%&! i%2eksi0
2 ".". Meka%&'e Ter$a(%)a L#ka
30 Luka insisi (Incised wounds) (ej!&i k!e%! (eiis ,leh i%s(u"e% y!%' (!j!"0 Mis!l y!%' (ej!&i !ki/!( $e"/e&!h!%0 Luk! /esih !se$(ik /i!s!%y! (e(u(u$ ,leh su(u! se(e!h seluuh $e"/uluh &!!h y!%' luk! &iik!( Li'!si 40 Luka memar (Contusion Wound) (ej!&i !ki/!( /e%(u!% ,leh su!(u (ek!%!% &!% &ik!!k(eis(ikk!% ,leh #e&e! $!&! j!i%'!% lu%!k* $e&!!h!% &!% /e%'k!k0 90 Luka lecet (Abraded Wound) (ej!&i !ki/!( kuli( /e'esek!% &e%'!% /e%&! l!i% y!%' /i!s!%y! &e%'!% /e%&! y!%' (i&!k (!j!"0 0 Luka tusuk (Punctured Wound) (ej!&i !ki/!( !&!%y! /e%&!* se$e(i $eluu !(!u $is!u y!%' "!suk ke&!l!" kuli( &e%'!% &i!"e(e y!%' ke#il0 ;0 Luka gores (Lacerated Wound) (ej!&i !ki/!( /e%&! y!%' (!j!" se$e(i ,leh k!#! !(!u ,leh k!-!(0 60 Luka tembus (Penetrating Wound) y!i(u luk! y!%' "e%e"/us ,'!% (u/uh /i!s!%y! $!&! /!'i!% !-!l luk! "!suk &i!"e(e%y! ke#il (e(!$i $!&! /!'i!% uju%' /i!s!%y! luk!%y! !k!% "ele/!0 ,
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,
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7. Luka Bakar (Combustio) ".*. Me#r#t t%!kat K+ta'%a&% ter,a(a- l#ka
30 Clean Wounds (Luka bersih) y!i(u luk! /e&!h (!k (ei%2eksi y!%' "!%! (i&!k (ej!&i $,ses $e!&!%'!% i%2l!"!si &!% i%2eksi $!&! sis(e" $e%!2!s!%* $e%#e%!!%* 'e%i(!l &!% ui%!i (i&!k (ej!&i0 Luk! /esih /i!s!%y! "e%'h!silk!% luk! y!%' (e(u(u$@ jik! &i$eluk!% &i"!sukk!% &!i%!se (e(u(u$ "is!l@ C!#ks,% P!((0 Ke"u%'ki%!% (ej!&i%y! i%2eksi luk! seki(! 3 ) ;0 40 Cleancontamined Wounds (Luka bersih terkontaminasi) "eu$!k!% luk! $e"/e&!h!% &i"!%! s!lu!% es$i!si* $e%#e%!!%* 'e%i(!l !(!u $eke"ih!% &!l!" k,%&isi (ek,%(,l* k,%(!"i%!si (i&!k sel!lu (ej!&i* ke"u%'ki%!% (i"/ul%y! i%2eksi luk! !&!l!h 9 ) 330 "./. Pr+&e& Pe)e'b#,a L#ka
30 Luk! !k!% se"/uh sesu!i &e%'!% (!h!$!% y!%' s$esi2ik &i"!%! /is! (ej!&i (u"$!%' (i%&ih (overlap) 40 P,ses $e%ye"/uh!% luk! (e'!%(u%' $!&! je%is j!i%'!% y!%' us!k se(! $e%ye/!/ luk! (ese/u(
9 90 8!se $e%ye"/uh!% luk! :
!0 8!se i%2l!"!si : 30 H!i ke 5); 40 Res$,% se'e! se(el!h (ej!&i i%jui 90 Pe"/eku!% &!!h 0U%(uk "e%#e'!h kehil!%'!% &!! ;0 K!!k(eis(ik : (u",* u/,* &,l,* #,l,* 2u%#(i, l!es! 60 8!se !-!l (ej!&i h!e",s(!sis <0 8!se !khi (ej!&i 2!',si(,sis >0 L!"! 2!se i%i /is! si%'k!( jik! (i&!k (ej!&i i%2eksi /0 8!se $,li2e!si , e$i(elis!si 30 H!i 9 3 40 Dise/u( ju'! &e%'!% 2!se '!%ul!si !&!%y! $e"/e%(uk!% j!i%'!% '!%ul!si $!&! luk! 90 Luk! %!"$!k "e!h se'!* "e%'kil!(* 0 C!i%'!% '!%ul!si (e&ii &!i k,"/i%!si : 8i/,/l!s(s* sel i%2l!"!si* $e"/uluh &!!h y!%' /!u* 2i/,%e#(i% !%& hyul!,%i# !#i& ;0 E$i(elis!si (ej!&i $!&! 4 j!" $e(!"! &i(!%&!i &e%'!% $e%e/!l!% l!$is!% e$i&e"is $!&! (e$i!% luk! 60 E$i(elis!si (ej!&i $!&! > j!" $e(!"! $!&! luk! i%sisi #0
8!se "!(u!si !(!u remodelling 30 Bel!%'su%' &!i /e/e!$! "i%''u s!"$!i &e%'!% 4 (!hu% 40 Te/e%(uk%y! k,l!'e% y!%' /!u 90 Te/e%(uk j!i%'!% $!u( s#! (issue 0 ;5)>5 s!"! ku!(%y! &e%'!% j!i%'!% se/elu"%y! ;0 Te&!$!( $e%'u!%'!% se#!! /e(!h!$ $!&! !k(i?i(!s selul!
".0. Fakt+r Ya! Me'-e!ar#,% Pr+&e& Pe)e'b#,a L#ka
30 S(!(us I"u%,l,'i 40 K!&! 'ul! &!!h i"$!ie& -hi(e #ell 2u%#(i,% 90 Hi&!si sl,-s "e(!/,lis" 0 Nu(iisi ;0 K!&! !l/u"i% &!!h F/uil&i%' /l,#ks 2, e$!i* #,ll,i& ,s",(i# $essue ,e&e"! 60 Su$l!i ,ksi'e% &!% ?!skul!is!si <0 Nyei #!uses ?!s,#,%s(i#(i,% >0 =,(i#,s(e,i&s &e$ess i""u%e 2u%#(i,%
".. Pe'%l%,a Bal#ta L#ka
B!lu(!% luk! wound dressings se#!! khusus (el!h "e%'!l!"i $eke"/!%'!% y!%' s!%'!( $es!( sel!"! h!"$i &u! &ek!&e i%i0 Re?,lusi &!l!" $e!-!(!% luk! i%i &i"ul!i &e%'!% !&!%y! h!sil $e%eli(i!% y!%' &il!kuk!% ,leh P,2ess, G0D Wi%(e $!&! (!hu% 364 y!%' &i$u/lik!sik!% &!l!" ju%!l Nature (e%(!%' ke!&!!% li%'ku%'!% y!%' ,$(i"!l u%(uk $e%ye"/uh!% luk!0 Me%uu( Gi(!j! 4554* !&!$u% !l!s!% &!i (e,i $e!-!(!% luk! &e%'!% su!s!%! le"/!/ i%i !%(!! l!i%: 30 Me"$e#e$!( 2i/i%,lisis 8i/i% y!%' (e/e%(uk $!&! luk! k,%is &!$!( &ihil!%'k!% le/ih #e$!( ,leh %e(,2il &!% sel e%&,(el &!l!" su!s!%! le"/!/0 40 Me"$e#e$!( !%'i,'e%esis D!l!" ke!&!!% hi$,ksi! $!&! $e!-!(!% luk! (e(u(u$ !k!% "e!%'s!%' le/ih $e"/e%(uk!% $e"/uluh &!!h &e%'!% le/ih #e$!(0 90 Me%uu%k!% esik, i%2eksi Kej!&i!% i%2eksi (e%y!(! el!(i2 le/ih e%&!h jik! &i/!%&i%'k!% &e%'!% $e!-!(!% kei%'0 0 Me"$e#e$!( $e"/e%(uk!% G,-(h 2!#(, Growth factor /e$e!% $!&! $,ses $e%ye"/uh!% luk! u%(uk "e"/e%(uk s(!(u" #,%eu" &!% !%'i,'e%esis* &i"!%! $,&uksi k,"$,%e% (ese/u( le/ih #e$!( (e/e%(uk &!l!" li%'ku%'!% y!%' le"/!/0 ;0 Me"$e#e$!( (ej!&i%y! $e"/e%(uk!% sel !k(i20 P!&! ke!&!!% le"/!/* i%?!si %e(,2il y!%' &iiku(i ,leh "!k,2!'* ",%,si( &!% li"2,si( ke &!e!h luk! /e2u%'si le/ih &i%i0
".2. Pera3ata L#ka Ber&%, Pe!-!(!% luk! /e(uju!% u%(uk "e%i%'k!(k!% $,ses $e%ye"/uh!% j!i%'!% ju'! u%(uk "e%#e'!h i%2eksi0 Luk! y!%' sei%' &i(e"ui ,leh /i&!% &i kli%ik !(!u u"!h s!ki( /i!s!%y! luk! y!%' /esih (!%$! k,%(!"i%!si "is!l luk! se#si, #!es!i!* &!% !(!u luk! ,$e!si l!i%%y!0 Pe!-!(!% luk! h!us "e"$eh!(ik!% (ek%ik s(eil* k!e%! luk! "e%j!&i $,( &e e%(e %y! "ik,,'!%is"e y!%' &!$!( "e%'i%2eksi luk!0
A0 PERSIAPAN 30 Me%#u#i (!%'!% 40 Me%yi!$k!% !l!()!l!( &!l!" /!ki1(,lley Al!( S(eil &!l!" /!k i%s(u"e% uku!% se&!%' (e(u(u$: 30 Pi%se( !%!(,"is 4 /u!h 2.Pi%se( #hiu'is 4 /u!h 3. H!%&s#,,% s(eil 4. K," s(eil 4 /u!h 5. K!ss! &!% k!$!s s(eil se#uku$%y!
;
6.
Gu%(i%' j!i%'!%1 Gu%(i%' U$ He#(i%' jik! &i$eluk!% Al!( L!i%: 1. Gu%(i%' Ve/!%&1$les(e 2. Ples(e 3. Nie/ekke% Be%'k,k 4. Li&i k!$!s 5. W!s /e%si% 6. Al!s 1 Pel!k 7. Seli"u( M!%&i 8. K!$!s Alk,h,l &!l!" (e"$!(%y! 9. Be(!&i%e &!l!" (e"$!(%y! 10. L!u(!% &!l!" /,(,l%y! N!=L 5* 11. Le"/! #!(!(!% klie%
90 Se(el!h le%'k!$ /!-! $e!l!(!% ke &ek!( klie%
B0 MELAKUKAN PERAWATAN LUKA 30 90 0 ;0 60 <0 >0 0 350
330
Me%#u#i (!%'!% 40 L!kuk!% i%2," #,%se%( lis!% $!&! klie%1kelu!'! &!% i%(uksik!% klie% Me%j!'! $i?!#y &!% ke%y!"!%!% klie% &!% "e%'!(u ke%y!"!%!% klie% A(u $,sisi y!%' %y!"!% /!'i klie% &!% (u(u$i /!'i!% (u/uh sel!i% /!'i!% luk! Si!$k!% $les(e u%(uk 2iks!si /il! $elu P!s!%' !l!s1$el!k Dek!(k!% %ie/ekke% P!ke( s(eil &i/uk! &e%'!% /e%! Ke%!k!% s!u%' (!%'!% sek!li $!k!i Me"/uk! /!lu(!% l!"! 1. B!s!hi $les(e y!%' "elek!( &e%'!% -!s /e%si% &e%'!% li&i k!$!s0 2. Le$!sk!% $les(e "e%''u%!k!% $i%se( !%!(,"is ke 3 &e%'!% "ele$!sk!% uju%'%y! &!% "e%!ik se#!! $el!h!%* sej!j! &e%'!% kuli( ke !!h /!lu(!%0 3. Ke"u&i!% /u!%' /!lu(!% ke %ie/ekke%0 4. Si"$!% $i%se( ,% s(eil ke %ie/ekke% y!%' su&!h (eisi l!u(!% #hl,i% 5*; K!ji Luk!: Ce%is* (i$e luk!* lu!s1ke&!l!"!% luk!* '!&e luk!* -!%! &!s! luk!* 2!se $,ses $e%ye"/uh!%* (!%&!)(!%&! i%2eksi $eh!(ik!% k,%&isi%y!* le(!k &!i%* k,%&isi j!hi(!%* /il! $elu $!l$!si luk! &e%'! (!%'!% %,% &,"i%!% u%(uk "e%'k!ji !&! (i&!k%y! $uss0
6
340
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BAB III PENUTUP *.1.
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!0 /0
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DAFTAR PUSTAKA As"!&i0 455>0 Teknik Prosedural eperawatan! onsep dan "plikasi ebutuhan Dasar lien 0 C!k!(!: S!le"/! Me&ik! B,/!k* K0 Ce%se%0 455;0 Perawatan #aternitas0 C!k!(!: EG=0 Du&ley HA8* E#kesley CRT* P!(es,%)B,-% S0 45550 Pedoman Tindakan #edik dan $edah0 C!k!(!: EG=0 E22e%&y* =his(!%(ie &!% A'0 Si Ok(i H!s(u(i0 455;0 iat %ukses menghadapi &perasi0 Y,'y!k!(!: S!h!/!( Se(i!0 P,((e Pey0 455;0 $uku "'ar undamental eperawatan0 C!k!(!: EG=
