Skala Koma GlasgowTheGlasgow Coma ScaleorGCSis
aneurologicalscalethat aims to give a reliable, objective way of
recording the conscious state of a person for initial as well as
subsequent assessment. A patient is assessed against the criteria
of the scale, and the resulting points give a patient score between
3 (indicating deep unconsciousness) and either 14 (original scale)
or 15 (the more widely used modified or revised scale).GCS was
initially used to assesslevel of consciousnessafterhead injury, and
the scale is now used byfirst aid,EMS,nursesanddoctorsas being
applicable to all acute medical and trauma patients. In hospitals
it is also used in monitoring chronic patients inintensive
care.Unsur Skala Koma Glasgow
123456
EyeDoes not open eyesOpens eyes in response topainful
stimuliOpens eyes in response to voiceOpens eyes
spontaneouslyN/AN/A
VerbalMakes no soundsIncomprehensible soundsUtters inappropriate
wordsConfused, disorientedOriented, converses normallyN/A
MotorMakes no movementsExtension to painful stimuli (decerebrate
response)Abnormal flexion to painful stimuli (decorticate
response)Flexion / Withdrawal to painful stimuliLocalizes painful
stimuliObeys commands
Eye response (E)There are four grades starting with the most
severe:1. No eye opening2. Eye opening in response topain stimulus.
(a peripheral pain stimulus, such as squeezing thelunulaarea of the
patient'sfingernailis more effective than a central stimulus such
as a trapezius squeeze, due to a grimacing effect).[3]3. Eye
opening to speech. (Not to be confused with the awakening of a
sleeping person; such patients receive a score of 4, not 3.)4. Eyes
opening spontaneouslyVerbal response (V)There are five grades
starting with the most severe:1. No verbal response2.
Incomprehensible sounds. (Moaning but no words.)3. Inappropriate
words. (Random or exclamatory articulated speech, but no
conversational exchange. Speaks words but no sentences.)4.
Confused. (The patient responds to questions coherently but there
is some disorientation and confusion.)5. Oriented. (Patient
responds coherently and appropriately to questions such as the
patients name and age, where they are and why, the year, month,
etc.)Motor response (M)There are six grades:1. No motor response2.
Decerebrate posturingaccentuated by pain (extensor
response:adductionof arm, internal rotation of shoulder,pronationof
forearm and extension at elbow,flexionof wrist and fingers, leg
extension,plantarflexionof foot)3. Decorticate posturingaccentuated
by pain (flexor response: internal rotation of shoulder,flexionof
forearm and wrist with clenched fist, leg
extension,plantarflexionof foot)4. Withdrawal from pain (Absence of
abnormal posturing; unable to lift hand past chin with
supra-orbital pain but does pull away when nailbed is pinched)5.
Localizes to pain (Purposeful movements towards painful stimuli;
e.g., brings hand up beyond chin when supra-orbital pressure
applied.)6. Obeys commands (The patient does simple things as
asked.)
Nasal cannulaThenasal cannula(NC) is a device used to deliver
supplementaloxygenor airflow to a patient or person in need of
respiratory help. This device consists of a light weight tube which
on one end splits into two prongs which are placed in
thenostrilsand from which a mixture of air and oxygen flows. The
other end of the tube is connected to an oxygen supply such as a
portable oxygen generator, or a wall connection in a hospital via
aflow meter. The cannula is generally attached to the patient by
way of the tube hooking around the patient's ears or by elastic
head band. The earliest, and most widely used form of adult nasal
cannula carries 15 litres of oxygen per minute. Cannulae with
smaller prongs intended for infant or neonatal use can carry less
than one litre per minute. Flow rates of up to 60 litres of
air/oxygen per minute can be delivered through wider bore
humidified nasal cannula.The nasal cannula was invented by Wilfred
Jones and patented in 1949 by his employer,BOC.
Supplemental oxygenA nasal cannula is generally used wherever
small amounts of supplemental oxygen are required, without rigid
control of respiration, such as in oxygen therapy. Most cannulas
can only provide oxygen at low flow ratesup to 5 liters per minute
(L/min)delivering an oxygen concentration of 2844%. Rates above 5
L/min can result in discomfort to the patient, drying of the nasal
passages, and possibly nose bleeds (epistaxis). Also with flow
rates above 6 L/min, the laminar flow becomes turbulent and the
oxygen therapy being delivered is only as effective as delivering
5-6 L/min.
FACE MASK
1. Simple face maskThesimple face mask(SFM) is a basic
disposable mask, made of clear plastic, to provideoxygen therapyfor
patients who are experiencing conditions such aschest pain(possible
heart attacks),dizziness, and minorhemorrhages. It is often set to
deliveroxygenbetween 6-10 litres per minute. This mask is only
meant for patients who are able to breathe on their own, but who
may require a higher oxygen concentration than the 21%
concentration found in ambient air. Patients who are unable to
breathe on their own are placed on amedical ventilatorinstead.
The final oxygen concentration delivered by a simple face mask
is dependent upon the amount of room air that mixes with the oxygen
the patient breathes. The air mixing is determined by how much air
any individual is breathing at the moment, combined with the fit of
the mask. Because of the variability in these factors, the final
oxygen concentration is uncontrolled. Aventuridevice attached to
the mask can be used to control to some degree the concentration of
oxygen delivered, usually this is used to prevent respiratory
depression inemphysemapatients who have lost the ability to
fullyinhale. The effectiveness of the therapy can be continuously
monitored using apulse oximeter, though more clinically useful data
can only by obtained by drawingarterial blood gas.
2. Rebreather mask A rebreather mask has a soft plastic
reservoir bag attached at the end that saves one-third of a persons
exhaled air, while the rest of the air gets out via side ports
covered with a one-way valve. This allows the person to rebreathe
some of the carbon dioxide, which acts as a way to stimulate
breathing.
3. Non-rebreather maskAnon-rebreather mask, orNRB, is a device
used inmedical emergenciesthat requiresoxygen therapy. An NRB
requires that the patient can breathe unassisted, but unlike low
flownasal cannula, the NRB allows for the delivery of higher
concentrations ofoxygen.
DesignThe non-rebreather mask covers both the nose and mouth of
the patient and attaches with the use of an elastic cord around the
patient's head. The NRB has an attached reservoir bag, typically 1
liter, that connects to an externaloxygen tankor Bulk Oxygen Supply
system. Before an NRB is placed on the patient, the reservoir bag
is inflated to greater than two-thirds full of oxygen, at a rate of
15 liters per minute (lpm).Approximately of the air from the
reservoir is depleted as the patient inhales, and it is then
replaced by the flow from the O2supply. If the bag becomes
completely deflated, the patient will no longer have a source of
air to breathe.Exhaled air is directed through aone-way valvein the
mask, which prevents the inhalation of room air and the
re-inhalation of exhaled air. The valve, along with a sufficient
seal around the patient's nose and mouth, allows for the
administration of high concentrations of oxygen, approximately
60%-80% O2.Many textbooks report higher oxygen concentrations,
however formal studies reporting these levels are not referenced to
research. The patient must partially deflate the reservoir bag
during inspiration or the high oxygen concentration will not be
achieved, and the mask will provide only the liter flow rate
setting on the flowmeter.
4. Venturi maskTheventuri mask, also known as an air-entrainment
mask (and sometimes by the brand name Ventimask), is amedical
deviceto deliver a knownoxygenconcentration to patients on
controlledoxygen therapy. The mask was invented byMoran Campbellas
a replacement for intermittent oxygen treatment, a practice he
described as "bringing a drowning man to the surface-
occasionally".
Venturi masks are considered high-flow oxygen therapy devices.
This is because venturi masks are able to provide total inspiratory
flow at a specifiedFiO2to patients therapy. The kits usually
include multiple jets in order to set the desiredFiO2which are
usually color-coded.Other brands of masks have a rotating
attachment that controls the air entrainment window, affecting the
concentration of oxygen. This system is often used with
air-entrainment nebulizers to provide humidification and oxygen
therapy.MechanismThe mechanism of action is usually incorrectly
quoted as depending on theventuri effect. Despite there being no
evidence for this, many textbooks and journal articles cite this as
the mechanism. However, a fixed performance oxygen delivery system,
despite often being called a venturi mask works on the principle
ofjet mixing.[1][2]UseDelivering supplemental oxygen at a precise
concentration.Flow problemsAir entrainment masks, although
considered high flow systems, are not always able to guarantee the
total flow with oxygen percentages above 35% in patients with high
inspiratory flow demands. The problem with air entrainment systems
is that as theFiO2is increased, the air to oxygen ratio decreases.
For example, for 30% the ratio is 8 parts air to 1 part oxygen.For
40% the ratio decreases to 3 to 1. Since the jets in venturi masks
generally limit oxygen flow at 12 to 15 liters per minute the total
flow decreases as the ratio decreases.At an oxygen flow rate of 12
liters per minute and a 30%FiO2setting, the total flow would be 108
L/min. At a 40%FiO2setting, the total flow would decrease to 48
L/min.As a rule of thumb, 60 L/min is considered the minimum flow
rate to qualify as a high flow device.
Medical ventilatorAmedical ventilator(or simplyventilatorin
context) is a machine designed to mechanically move breathable air
into and out of the lungs, to provide the mechanism of breathing
for a patient who is physically unable to breathe, or breathing
insufficiently.While modern ventilators are computerized machines,
patients can be ventilated with abag valve mask, a simple
hand-operated bag-valve mask.Ventilators are chiefly used
inintensive care medicine,home care, andemergency medicine(as
standalone units) and inanesthesia(as a component of ananesthesia
machine).Medical ventilators are sometimes colloquially called
"respirators," a term which stems from commonly used devices in the
1950s (particularly the "Bird Respirator"). However, in modern
hospital and medical terminology, these machines are never referred
to as respirators, and use of "respirator" in this context is now a
deprecated anachronism which signals technical unfamiliarity.
FunctionIn its simplest form, a modernpositive pressure
ventilatorconsists of a compressibleairreservoir or turbine, air
andoxygensupplies, a set of valves and tubes, and a disposable or
reusable "patient circuit". The air reservoir is pneumatically
compressed several times a minute to deliver room-air, or in most
cases, an air/oxygen mixture to the patient. If a turbine is used,
the turbine pushes air through the ventilator, with a flow valve
adjusting pressure to meet patient-specific parameters. When
overpressure is released, the patient will exhale passively due to
thelungs' elasticity, the exhaled air being released usually
through a one-way valve within the patient circuit called the
patient manifold. The oxygen content of the inspired gas can be set
from 21 percent (ambient air) to 100 percent (pure oxygen).
Pressure and flow characteristics can be set mechanically or
electronically.
Life-critical systemBecause the failure of a mechanical
ventilation system may result in death, it is classed as
alife-critical system, and precautions must be taken to ensure that
mechanical ventilation systems are highly reliable. This includes
theirpower-supplyprovision.
Endotracheal Tubes
Atracheal tubeis acatheterthat is inserted into thetracheafor
the primary purpose of establishing and maintaining a patent airway
and to ensure the adequateexchangeof oxygen and carbon dioxide.Many
different types of tracheal tubes are available, suited for
different specific applications: Anendotracheal tubeis a specific
type of tracheal tube that is nearly always inserted through the
mouth (orotracheal) or nose (nasotracheal). Atracheostomy tubeis
another type of tracheal tube; this 23-inch-long (5176mm) curved
metal or plastic tube may be inserted into a tracheostomy stoma
(following atracheotomy) to maintain a patent lumen. Atracheal
buttonis a rigid plastic cannula about 1inch in length that can be
placed into the tracheostomy after removal of a tracheostomy tube
to maintain patency of the lumen.ApplicationsTracheal tubes can
also be used to deliver oxygen in higher concentrations than found
in air, or to administer other gases such ashelium,nitric
oxide,nitrous oxide,xenon, or certain volatile anesthetic agents
such asdesflurane,isoflurane, orsevoflurane. Tracheal tubes may
also be used as a route for administration of certain medications
such assalbutamol,atropine,epinephrine,ipratropium, andlidocaine.
Tracheal tubes are commonly used forairway managementin the
settings ofgeneral anesthesia, critical care,mechanical
ventilation, and emergency medicine.
Radial artery punctureRadial artery punctureis a medical
procedure performed to obtain a sample of arterialbloodforgas
analysis. A needle is inserted into theradial arteryand
spontaneously fills with blood. The syringe is either prepacked
with a small amount ofheparinto prevent coagulation, or must
beheparinised, by drawing up a small amount of heparin and
squirting it out again.Most commonly, radial artery puncture is
performed to obtain arterial blood sampling for gas analysis. The
partial pressures of oxygen (PaO2) and carbon dioxide (PaCO2), and
the pH of arterial blood are important in assessing pulmonary
function. These data indicate the status of gas exchange between
lungs and blood.Allen testIt is important to perform an Allen Test
to confirm thepatencyof the ulnar arterybecause, with no collateral
flow through the ulnar artery, radial artery puncture can result in
a gangrenous finger or loss of the hand from spasm or clotting of
the radial artery. The Allen Test is performed with the patient
sitting with hands resting on knees. A medical professional stands
at the patient's side with fingers around the patient's wrist and
compresses the tissue over both radial and ulnar arteries for a few
minuteswaiting for the blood to drain from the hand while the
patient opens and closes the hand several times. Releasing pressure
on the ulnar artery while keeping the radial artery occluded should
return normal skin color to the ulnar side of the palm in one to
two seconds, followed by quick restoration of normal color to the
entire palm. A hand that remains white indicates either absence or
occlusion of the ulnar artery, and radial artery puncture is
contraindicated.
VenipunctureIn medicine, venipuncture, venipuncture or
venipuncture is the process of obtaining intravenous access for the
purpose ofintravenous therapyor forblood sampling of venous blood.
This procedure is performed bymedical laboratory scientists,medical
practitioners, someEMTs,paramedics, phlebotomists, dialysis
technicians, and other nursing staff. In veterinary medicine, the
procedure is performed byveterinariansand veterinary technicians.
Venipuncture is one of the most routinely performed invasive
procedures and is carried out for any of five reasons: (1) to
obtain blood for diagnostic purposes; (2) to monitor levels of
blood components (Lavery & Ingram 2005); (3) to administer
therapeutic treatments including medications, nutrition, or
chemotherapy; (4) to remove blood due to excess levels of iron or
erythrocytes (red blood cells); or (5) to collect blood for later
uses, mainlytranfusioneitherin the donororin another person.
Venipuncture in childrenUse of lidocaineiontophoresisis an
effective method for reducing pain and alleviating distress during
venipuncture in pediatric patients. Rapid dermal anesthesia can be
achieved by local anesthetic infiltration, but it may evoke anxiety
in children frightened by needles or distort the skin, making
vascular access more difficult and increasing the risk of needle
exposure to health care workers. Dermal anesthesia can also be
achieved without needles by the topical application of local
anesthetics or by lidocaine iontophoresis. By contrast, noninvasive
dermal anesthesia can be established in 515 min without distorting
underlying tissues by lidocaine iontophoresis, where a direct
electrical current facilitates dermal penetration of positively
charged lidocaine molecules when placed under the positive
electrode.
One study concluded that the iontophoretic administration
oflidocainewas safe and effective in providing dermal anesthesia
for venipuncture in children 617 years old. This technique may not
be applicable to all children. Future studies may provide
information on the minimum effective iontophoretic dose for dermal
anesthesia in children and the comparison of the anesthetic
efficacy and satisfaction of lidocaine iontophoresis with topical
anesthetic creams and subcutaneous infiltration.[2]
Subcutaneous injectionAsubcutaneous injectionis administered as
abolusinto thesubcutis,[1]the layer of skin directly below
thedermisandepidermis, collectively referred to as thecutis.
Subcutaneous injections are highly effective in administering
vaccines and medications such
asinsulin,morphine,diacetylmorphineandgoserelin. Subcutaneous, as
opposed to intravenous, injection ofrecreational drugsis referred
to as "skin popping". Subcutaneous administration may
beabbreviatedasSC,SQ,sub-cu,sub-Q,SubQ, orsubcut.Subcutis the
preferred abbreviation for patient safety.[2]Subcutaneous tissue
has few blood vessals and so drugs injected here are for slow,
sustained rates of absorption.[3]It is slower thanIntramuscular
injectionsbut still faster thanintradermal
injections.[3]Procedure[edit]Subcutaneous injections are inserted
at 45 to 90 degree angles, depending on amount of subcutaneous
tissue present and length of needle- a shorter, 3/8" needle is
usually inserted 90 degrees and a 5/8" needle is usually inserted
at 45 degrees. Medication is administered slowly, about 10
seconds/milliliter.SUARA NAFAS NORMALSuara nafas normal dihasilkan
dari getaran udara ketika melalui jalan nafas dari laring ke
alveoli, dengan sifat bersih. Suara nafas normal :a) Bronchial :
sering juga disebut dengan Tubular sound karena suara ini
dihasilkan oleh udara yang melalui suatu tube (pipa), suaranya
terdengar keras, nyaring, dengan hembusan yang lembut. Fase
ekspirasinya lebih panjang daripada inspirasi, dan tidak ada henti
diantara kedua fase tersebut. Normal terdengar di atas trachea atau
daerah suprasternal notch.b) Bronchovesikular : merupakan gabungan
dari suara nafas bronchial dan vesikular. Suaranya terdengar
nyaring dan dengan intensitas yang sedang. Inspirasi sama panjang
dengan ekspirasi. Suara ini terdengar di daerah thoraks dimana
bronchi tertutup oleh dinding dada.c) Vesikular : terdengar lembut,
halus, seperti angin sepoi-sepoi. Inspirasi lebih panjang dari
ekspirasi, ekspirasi terdengar seperti tiupan.
SUARA NAFAS TAMBAHAN/ABNORMAL1. CracklesAdalah bunyi yang
berlainan, non kontinu akibat penundaan pembukaan kembali jalan
napas yang menutup. Terdengar selama : inspirasi. Fine
crackles/krekels halusTerdengar selama : akhir inspirasi. Karakter
suara : meletup, terpatah-patah.Penyebab : udara melewati daerah
yang lembab di alveoli atau bronchioles/penutupan jalan napas
kecil. Suara seperti rambut yang digesekkan. Krekels kasarTerdengar
selama : ekspirasi. Karakter suara : parau, basah, lemah, kasar,
suara gesekan terpotong.Penyebab : terdapatnya cairan atau sekresi
pada jalan nafas yang besar. Mungkin akan berubah ketika klien
batuk.
2. Wheezing (mengi)Adalah bunyi seperti bersiul, kontinu, yang
durasinya lebih lama dari krekels. Terdengar selama :
Ekspirasi.Penyebab : akibat udara melewati jalan napas yang
menyempit/tersumbat sebagian. Dapat dihilangkan dengan batuk.Dengan
karakter suara nyaring, suara terus menerus yang berhubungan dengan
aliran udara melalui jalan nafas yang menyempit (seperti pada asma
dan bronchitis kronik). Wheezing dapat terjadi oleh karena
perubahan temperature, allergen, latihan jasmani, dan bahan iritan
terhadap bronkus.3. RonchiAdalah bunyi gaduh yang dalam. Terdengar
selama : ekspirasi.Penyebab : gerakan udara melewati jalan napas
yang menyempit akibat obstruksi napas. Obstruksi : sumbatan akibat
sekresi, odema, atau tumor.Contoh : suara ngorok. Ronchi kering :
suatu bunyi tambahan yang terdengar kontinyu terutama waktu
ekspirasi disertai adanya mucus/secret pada bronkus. Ada yanghigh
pitch(menciut) misalnya pada asma danlow pitcholeh karena secret
yang meningkat pada bronkus yang besar yang dapat juga terdengar
waktu inspirasi. Ronchi basah (krepitasi) : bunyi tambahan yang
terdengar tidak kontinyu pada waktu inspirasi seperti bunyi ranting
kering yang terbakar, disebabkan oleh secret di dalam alveoli atau
bronkiolus. Ronki basah dapat halus, sedang, dan kasar. Ronki halus
dan sedang dapat disebabkan cairan di alveoli misalnya pada
pneumonia dan edema paru, sedangkan ronki kasar misalnya pada
bronkiekstatis.Perbedaan ronchi dan mengi.Mengi berasal dari bronki
dan bronkiolus yang lebih kecil salurannya, terdengar bersuara
tinggi dan bersiul. Biasanya terdengar jelas pada pasien
asma.Ronchi berasal dari bronki dan bronkiolus yang lebih besar
salurannya, mempunyai suara yang rendah, sonor. Biasanya terdengar
jelas pada orang ngorok.4. Pleural friction rubAdalah suara
tambahan yang timbul akibat terjadinya peradangan pada pleura
sehingga permukaan pleura menjadi kasar.Karakter suara : kasar,
berciut, disertai keluhan nyeri pleura. Terdengar selama : akhir
inspirasi dan permulaan ekspirasi. Tidak dapat dihilangkan dengan
dibatukkan. Terdengar sangat baik pada permukaan anterior lateral
bawah toraks.Terdengar seperti bunyi gesekan jari tangan dengan
kuat di dekat telinga, jelas terdengar pada akhir inspirasi dan
permulaan ekspirasi, dan biasanya disertai juga dengan keluhan
nyeri pleura. Bunyi ini dapat menghilang ketika nafas ditahan.
Sering didapatkan pada pneumonia, infark paru, dan
tuberculosis.
NyeriKarakteristik nyeri (Metode P, Q, R, S, T).1. Faktor
Pencetus (P:Provocate),Perawat mengkaji tentang penyebab atau
stimulus-stimulus nyeri pada klien, dalam hal ini perawat juga
dapat melakukan observasi bagian-bagian tubuh yang mengalami
cedera.2. Kualitas (Q:Quality),Kualitas nyeri merupakan seseuatu
yang subjektif yang diungkapkan oleh klien. Misal kalimat-kalimat:
tajam, tumpul, berdenyut, berpindah-pindah, seperti tertindih,
perih, dan tertusuk.3. Lokasi (R:Region),Untuk mengkaji lokasi
nyeri maka perawat meminta klien untuk menunjukkan semua bagian
atau daerah yang dirasakan tidak nyaman oleh klien.4. Keparahan
(S:Severe),Tingkat keparahan pasien tentang nyeri merupakan
karakteristik yang paling subjektif. Pada pengkajian ini klien
diminta untuk menggambarkan nyeri yang ia rasakan sebagai nyeri
ringan, nyeri sedang atau berat.5. Durasi (T:Time).Perawat
menanyakan pada pasien untuk menentukan awitan, durasi, dan
rangkaian nyeri
Untuk mengukur skala intensitas nyeri pada anak-anak
dikembangkan alat yang dinamakan Oucher, yang terdiri dari dua
skala yang terpisah dengan nilai 0-100 pada sisi sebelah kiri untuk
anak-anak yang berusia lebih besar dan skala fotografik enam gambar
pada sisi sebelah kanan yang digunakan pada anak-anak yang lebih
kecil.
Gambar 5 Skala Nyeri Wajah yang Dikembangkan Wong &
BakerAnarterial blood gas(ABG) is ablood testthat is performed
usingbloodfrom anartery. It involves puncturing an artery with a
thin needle and syringe and drawing a small volume of blood. The
most common puncture site is theradial arteryat thewrist,[1]but
sometimes thefemoral arteryin thegroinor other sites are used. The
blood can also be drawn from anarterial catheter.Pulse oximetryplus
transcutaneous carbon dioxide measurement is an alternative method
of obtaining similar information as well. An ABG is a test that
measures thearterial oxygen tension(PaO2),carbon dioxide
tension(PaCO2), and acidity (pH). In addition, arterial
oxyhemoglobin saturation (SaO2) can be determined. Such information
is vital when caring for patients with critical illness or
respiratory disease. As a result, the ABG is one of the most common
tests performed on patients in intensive care units
(ICUs).Parameters and reference rangesThese are typicalreference
ranges, although various analysers and laboratories may employ
different ranges.AnalyteRangeInterpretation
pH7.34[8]-7.44[8]ThepHor H+indicates if a patient is acidemic
(pH < 7.35; H+>45) or alkalemic (pH > 7.45; H+<
35).
H+3545 nmol/L(nM)See above.
Arterialoxygen partial pressure(PaO2)11[9]-13[9]kPaor
75[8]-100[8]mmHgA low PaO2indicates that the patient is not
oxygenating properly, and is hypoxemic. (Note that a low PaO2is not
required for the patient to havehypoxia.) At a PaO2of less than
60mm Hg, supplemental oxygen should be administered. At a PaO2of
less than 26 mmHg, the patient is at risk of death and must be
oxygenated immediately.[citation needed]
Arterialcarbon dioxide partial pressure(PaCO2)4.7[9]-6.0[9]kPa
or 35[8]-45[8]mmHgThe carbon dioxide partial pressure (PaCO2) is an
indicator of CO2production and elimination: for a constant
metabolic rate, the PaCO2is determined entirely by its elimination
throughventilation.[10]A high PaCO2(respiratory acidosis,
alternativelyhypercapnia) indicates underventilation (or, more
rarely, ahypermetabolic disorder), a low PaCO2(respiratory
alkalosis, alternativelyhypocapnia) hyper- or overventilation.
HCO32226mEq/LTheHCO3ion indicates whether ametabolicproblem is
present (such asketoacidosis). A low HCO3indicatesmetabolic
acidosis, a high HCO3indicatesmetabolic alkalosis. As this value
when given with blood gas results is often calculated by the
analyzer, correlation should be checked withtotal CO2levelsas
directly measured (see below).
SBCe21 to 27mmol/Lthe bicarbonate concentration in the blood at
aCO2of 5.33 kPa, full oxygen saturation and 37 Celsius.[11]
Base excess2 to +2mmol/LThe base excess is used for the
assessment of the metabolic component of acid-base disorders, and
indicates whether the patient has metabolic acidosis or metabolic
alkalosis. Contrasted with the bicarbonate levels, the base excess
is a calculated value intended to completely isolate the
non-respiratory portion of the pH change.[12]There are two
calculations for base excess (extra cellular fluid - BE(ecf); blood
- BE(b)). The calculation used for the BE(ecf) = cHCO3 - 24.8 +16.2
X (pH-7.4). The calculation used for BE(b) = (1-0.014 x hgb) x
(cHCO3 - 24.8 + (1.43 x hgb + 7.7) x (pH -7.4).
totalCO2(tCO2(P)c)23[13]-30[13]mmol/L or
100[14]-132[14]mg/dLThis is the total amount of CO2, and is the sum
of HCO3andPCO2by the formula:tCO2= [HCO3] + *PCO2, where =0.226
mM/kPa, HCO3is expressed inmillimolar concentration(mM) (mmol/l)
and PCO2is expressed in kPa[15]
O2Content (CaO2, CvO2, CcO2)vol% (mL oxygen/dL blood)This is the
sum of oxygen dissolved in plasma and chemically bound
tohemoglobinas determined by the calculation: CaO2= (PaO2* 0.003) +
(SaO2* 1.34 * Hgb) where hemoglobin concentration is expressed in
g/dL.[16]
Menghitung Dosis ObatKebanyakan intruksi dan label obat ditulis
dalam sitem pengukuran metrik. Jika jumlah obat spesifik yang
dibutuhkan sama dengan jumlah obat yang tertera dalamlabel obat,
tidak diperlukan perhitungan dosis obat, dan obat dapat disiapkan
dengan cara yang sederhana. Sebagai contoh, jika kebutuhan dosis
ibuprofen 400 mg PO dan di kemasan obat tertulis ibuprofen 400 mg
pertablet ini jelas berarti 1 tablet yang akan diberi. Tetapi
bagaimana jika obat yang dibutuhkan dengan dosis 400 mg, dan obat
yang tersedia tablet dengan dosis 200 mg ? pertanyaannya adalah
berapa banyak 200 mg tablet yang diberikan untuk memenuhi dosis 400
mg? Pada kasus ini dapat dihitung mudah yaitu 2 tablet. Contoh
tersebut merupakan contoh sedrhana untuk mengilustrasikan
perhitungan matematika pada obat. Masalah tersebut dapat dipecahkan
oleh beberapa metode.Rumus:
D = desired dose dosis yang dinginkan (dosis yang dipesan,
biasanya dalam milligrams)H = on-hand dosis ditangan atau available
dose dosis yang tersedia (dosis yang tercantum dalam label kemasan
biasanya ditulis dalam tablet, kapsul, atau mililiter)X = unknown
(jumlah obat yang belum diketahui)V = unit atau satuan (bisa dalam
tablet,per mililiter atau cc, dll)
Apa yang terjadi jika permintaan obat dan label obat ditulis
dalam unit (satuan) berbeda? Sebagai contoh, intruksi pemberian
obat Amoxicillin 0.5 g dan pada label kemasan tertulis amoxcilin
500 mg/ kapsul untuk menghitung jumlah kapsul yang sesuai dengan
kebutuhan dosis, langkah pertama adalah merubah 0.5 g ke satuan
miligram. Atau merubah 500 mg ke satuan gram. Dosis yang dinginkan
(yang diperintahkan) dan dosis yang tersedia (atau yang tertulis
dalam kemasan) harus dalam satuan ukur yang sama.Langkah 1: kita
rubah dari gram (g) ke miligram (mg)
Langkah 2: kita hitung menggunakan rumus.
Cara dan rumus yang sama dapat digunakan untuk menghitung dosis
obat dalam bentuk kapsul atau cair. Contohnya sebagai berikut.
Seorang laki-laki usia 23 tahun mengalami kecelakaan bagian
frontal membentur jalan, Saat kejadian sampai saat pengkajian (2
jam post kecelakaan). Pengkajian ditemukan data: tidak sadarkan
diri, pernapasan grugling, nilai GCS: E2M3V2, saturasi oksigen
87%Apakah tindakan yang dilakukan perawat pertama kali
?a.Suctionb.Ventilatorc.Pemasangan OPAd.Intubasi (pasang
ETT)e.Pasang Laringeal Mask Airway
Seorang perempuan berusia 50 tahun dirawat di ruang dewasa
mengeluh nyeri kepala, tidak dapat menelan,tidak merasakan rasa
asam, manis dan pahit di lidah bagian
depan,terlihatiritable/gelisah dan ingin tidur terus.NilaiGCS
E3V4M5Apakah prioritas masalah keperawatan pada pasien?a.Gangguan
persepsi sensorib.Gangguan perfusi serebralc.Gangguan
nutrisid.Resiko jatuhe.Nyeri
Seorang perempuan umur 25 tahun dirawat di ruang dewasa karena
meningitis. Hasil pengkajian didapatkan penurunan kesadaran,
pernapasan snoring, sesak napas, napas cepat dan dangkal. Saat anda
melakukan hisap lender, perawat menaikan tekanan oksigen,
menghidupkan mesin, mengecek tekanan dan botol penampung,
memasukkan kanul hisap lender ke dalam mulut. Tiba-tiba pasien
terbatukApakah tindakan pertama perawat ?a.Menghentikan hisap
lendirb.Menghisap lendir dengan menutup kanulc.Mengobservasi
keadaan umum dan pernapasan pasiend.Mengeluarkan kanul hisap
lendire.Mematikan mesin
Seorang laki-laki berusia 46 tahun dirawat di ruang bedah
mengeluh sakit pada daerah punggung setinggi lumbal kebawah setelah
mengalami jatuh 2 minggu lalu dari ketinggian kurang lebih 3 meter
dengan posisi jatuh terduduk. Hasil pengkajian sudah 1 minggu
pasien tidak dapat mengontrol buang air besar dan buang kecil,
lumpuh pada kedua kaki dan baal/kebas pada daerah kaki bawah kanan
dan kiri.Apakah masalah keperawatan utama pada pasien
diatas?a.Gangguan pemenuhan aktifitas sehari-harib.Gangguan
eleminasi BAB dan BAKc.Gangguan persepsi sensorid.Gangguan
mobilitas fisike.Ganguan integritas kulit
Seorang perempuan berusia 35 tahun, dirawat di ruang penyakit
dalam, mengeluh badanya panas, lemes, tak ada nafsu makan, lidah
terasa pahit, konstipasi, perut nyeri. Hasil pemeriksaan lidah
pasien kotor, tepi lidah merah, TD 100/60 mmHg, Nadi100kali
permenit,pernapasan 20 kali permenit,Suhu axilla 390C.Apakah
tindakan keperawatan yang akan saudara lakukan pada pasien
tersebut?a.Pemberian kompres hangatb.AnjurkanBed rest
totalc.Pemberian diitlunakd.Pemasangan infuse.Huknah rendah
Seorang laki-laki berusia 30 th dirawat di RS dengan diagnose
medis hepatitis viral akut. Hasil pengkajian pasien mengeluh
pusing, mual, muntah, tampak lemah, sklera tampak ikterik, suhu 395
0C.Apakah diet yang tepat untuk pasien di di atas ?a.Diet lembek
rendah lemakb.Diet lembek rendah garamc.Diet lembek rendah
kalorid.Diet lembek tinggi kalorie.Diet biasa tinggi protein
Seorang perempuan 17 tahun status belum menikah ditunggui oleh
kedua orang tuanya dan pacarnya. Pasien dilakukan apendiktomi
dengan general anestesi. Pada saat di lakukan palpasi abdomen
ditemukan pembesaran uterus, setelah dilakukan test urine positif
hamil.Apakah yang harus dilakukan perawat terkait dengan informasi
kehamilanya tersebut ?a.Mengimformasikan segera kepada pacarnya
sajab.Mengimformasikan kepada orang tua &
pacarnyac.Mengimformasikan kepada pasien setelah pasien
sadard.Mengimformasikan segera kepada kedua orang tuanya
sajae.Tidak memberikan informasi kehamilan pasien karena menjaga
privasi pasien
Seorang pasien perempuan berusia 16 tahun diantar oleh orang
tuanya masuk IGD dengan riwayat deman sejak 3 hari yang lalu. Saat
ini pasien mengeluh mual, mutah dan nyeri ulu hati. Hasil
pemeriksaan ditemukan data: Tekanan darah 100/70 mmHg, Nadi 90 kali
permenit, pernapasan 20 kali permenit, suhu 390C, Haemoglobin
plasma 13 gr/dL, trombosit 100.000mm3, Hematokrit 36 vol %Apakah
masalah keperawatan utama pada pasien di atas ?a.Nyeri
akutb.Hipertermiac.Gangguan rasa nyaman muald.Gangguan nutrisi
kurang dari kebutuhan tubuhe.Resiko gangguan keseimbangan cairan
elektrolit
