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"Demam merupakan respon tubuh terhadap infeksi, menyebabkan rasa tidak nyaman, gelisah, gangguan fisiologis pada anak. Tatalaksana demam dilakukan dengan metode farmakologi dan non farmakologi. Asuhan keperawatan menggunakan model konservasi Levine bertujuan untuk mempertahankan konservasi energi, konservasi integritas struktur, konservasi integritas personal dan konsevasi integritas sosial. Tepid water sponging (TWS) merupakan salah satu intervensi keperawatan mengatasi masalah demam, kombinasi TWS dengan terapi farmakologi lebih cepat menurunkan demam dibanding terapi farmakologi saja. Hasil pemberian asuhan keperawatan menggunakan model konservasi Levine dapat digunakan sebagai salah satu acuan dalam memberikan asuhan keperawatan pada anak dengan demam.

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Fever is the body's response to infection, causing discomfort, anxiety, physiological disorders in children. Management of fever performed with pharmacological and non-pharmacological methods. Nursing care using the model of conservation Levine aims to maintain energy conservation, structural integrity conservation, personal integrity conservation and social integrity conservation. Tepid Water sponging (TWS) is one of the nursing interventions to overcome the problem of fever, TWS combination with pharmacological treatment more quickly reduce fever than pharmacological treatment alone. The results of nursing care using Levine?s conservation model can be used as a reference in providing nursing care in children with fever."

"Demam merupakan respon tubuh terhadap adanya infeksi. Anak dengan demam dapat mengalami gangguan fisiologis, gelisah, dehidrasi, dan ketidaknyamanan. Penanganan demam dilakukan dengan menurunkan suhu tubuh secara perlahan dan memberikan kenyamanan pada anak. Salah satu penanganan demam nonfarmakologi berupa tepid water sponge yang menjadi rekomendasi jika dipadukan dengan terapi farmakologi. Pendekatan keperawatan untuk memberikan kenyamanan pada pasien didasarkan pada teori Comfort Kolcaba yang meliputi aspek kenyamanan fisik, psikospiritual, sosiokultural, dan lingkungan. Asuhan keperawatan menggunakan teori Comfort Kolcaba dapat digunakan sebagai salah satu acuan dalam pemberian asuhan keperawatan pada anak dengan demam.

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Fever is the body's response to infection. Children with fever may experience physiological disorders, anxiety, dehydration, and discomfort. Handling fever is done by slowly lowering the body temperature and provide comfort to the child. One of non pharmacological treatment to fever is tepid water sponge that recommended when it combined with pharmacological therapy. The nursing approach to comforting patient is based on Kolcaba Comfort theory which includes aspects of physical comfort, psychospiritual, sociocultural, and environment. Kolcaba comfort theory can be used as a reference in the provision of nursing care in children with fever."

"ABSTRAKSalah satu masalah kesehatan yang umum dialami oleh anak adalah demam. Penelitian ini bertujuan untuk mengetahui hubungan antara tingkat pengetahuan orang tua tentang demam dan manajemen demam anak di rumah. Penelitian ini menggunakan desain penelitian deskriptif korelasi dengan cross sectional di RSUD Cibinong pada bulan Mei-Juni 2014. Alat penelitian yang gunakan yaitu kuesioner.. Uji hipotesis dalam penelitian ini adalah menggunakan uji Fihser’s Exact. Jumlah responden yang terlibat dalam penelitian adalah 56 orang, 77% diantaranya jenis kelamin perempuan, 91% kategori dewasa awal, 57% memiliki tingkat pendidikan SMA/SMK dan 64%-nya tidak bekerja/Ibu Rumah Tangga (IRT). Tingkat pengetahuan tentang demam yang diperoleh pada penelitian ini adalah 0% kategori baik, 50% kategori cukup dan 50% kategori kurang. Sebanyak 86% tidak mampu melakukan manajemen demam di rumah. Hasil penelitian menunjukkan bahwa terdapat hubungan yang bermakna antara tingkat pengetahuan orang tua tentang demam dan manajemen demam anak di rumah (p=0,0022). Oleh sebab itu diperlukan usaha peningkatan tingkat pengetahuan orang tua mengenai demam, sehingga kemampuan manajemen demam juga akan ikut meningkat.

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ABSTRACTOne of the common diseases sufferred by children is fever. This research aims at finding out the relationship of the knowledge of parents about fever and children’s fever management at home. This research was conducted with the descriptive-coorelative research design with the cross sectional in RSUD Cibinong on May-June 2014. The tools of this research was questionnaire. The hypothesis examination done for this research was Fisher’s Exact test. The number of respondents involved in this research were 56 parents, with 77% female respondents, 91% were categorized as early adults, 57% with Senior High School/ Vocational School education, and 64% were unemployed/ housewives. The data for the knowledge of these parents about fever that was collected in this research were 0% for good category, 50% for sufficient category, and 50% for insufficient. There were 86% of parents could not do the fever management at home. This result showed that there was a meaningful relationship between the parents’ knowledge about fever and the children fever management at home (p=0,0022). Therefore efforts to improve the level of knowledge of parents about fever until fever management capability will also follow up."

"Demam merupakan salah satu permasalahan terbesar ketika anak dilarikan ke Instalasi Gawat Darurat. Keberlangsungan demam bergantung kepada waktu patogen berinvasi di dalam tubuh sehingga memicu proses inflamasi. Demam berkepanjangan merupakan demam yang terjadi lebih dari lima hari dengan salah satu penyebabnya adalah infeksi bakteri. Bakteri tuberkulosis, Mycobacterium tuberculosis kompleks, menjadi etiologi dari kejadian demam berkepanjangan, termasuk pada anak. Penanganan demam dapat dilakukan dengan melakukan kompres menggunakan metode tepid water sponge bersamaan dengan pemberian antipiretik, hal ini telah dibuktikan oleh berbagai penelitian yang ada. Maka dari itu, peneliti hendak membuktikan efektivitas tepid water sponge kepada anak dengan diagnosis medis prolonged fever suspect tuberculosis. Peneliti melakukan penelitian pada Anak AF dengan prolonged fever suspect tuberculosis dengan menimplementasikan asuhan keperawatan untuk mengatasi hipertermia, gangguan nutrisi, dan ketidakefektifan bersihan jalan napas pasien. Rangkaian asuhan keperawatan dimulai dari pengkajian secara holistik pada anak, penegakan diagnosis keperawatan dan menentukan prioritas diagnosis, perencanaan intervensi keperawatan, implementasi tindakan, serta evaluasi. Asuhan keperawatan yang dilakukan didokumentasikan ke dalam Catatan Perkembangan Pasien Terintegrasi. Tindakan utama yang diteliti adalah penerapan tepid water sponge terhadap penurunan suhu tubuh anak. Berdasarkan evaluasi yang dilakukan, tepid water sponge mampu menurunkan suhu tubuh anak hingga sebesar 1°C. Peneliti menarik kesimpulan bahwa penerapan tindakan tepid water sponge pada anak dengan prolonged fever efektif dalam menurunkan demam yang dialami oleh anak.

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Fever is one of the biggest problems when a child is taken to the Emergency Room. The persistence of fever depends on the time when pathogen invades the body then trigger the inflammatory process. Prolonged fever is a fever that lasts more than five days with one of the causes is bacterial infection. The bacteria of tuberculosis, Mycobacterium tuberculosis complex, is an etiology of prolonged fever, even in pediatrics. Fever treatment can be done by applying warm compress using the warm water sponge method along with administering antipyretics, and the effectivity has been proven by various existing studies. Therefore, the researcher would like to prove the effectiveness of warm water sponges for a child with prolonged fever, suspected of being tuberculosis. The writer did the research on AF, a toddler with suspected prolonged tuberculosis fever by implementing nursing care to overcome hyperthermia, nutritional disorders, and ineffectiveness in clearing the patient's airway. The preparation started with a holistic assessment, establishing a diagnosis and determine the nursing diagnosis priorities, planning the interventions, implementing the interventions, and evaluate the nursing care. The nursing care is documented with Integrated Patient Progress Note format. The main intervention to be studied was an application of tepid water sponge to reduce the child's body temperature. Based on the evaluation, tepid water sponge can reduce a child's body temperature by up to 1°C. The writer conclude that applying tepid water sponges to pediatrics with prolonged fever was effective in reducing their fever."

"Bayi prematur mempunyai banyak risiko gangguan kesehatan yang dapat dialami akibat fungsi dan sistem tubuh yang belum sempurna. Mandi merupakan tindakan non invasif yang dilakukan setiap hari dan dapat mengakibatkan stres pada bayi. Respon stres yang ditunjukkan oleh bayi prematur selama prosedur memandikan dapat berupa menangis, tremor, kehilangan suhu tubuh, dan perubahan tanda-tanda vital. Tujuan penelitian ini adalah memberikan gambaran penerapan Model Konservasi Levine pada asuhan keperawatan bayi prematur dengan risiko gangguan termoregulasi melalui teknik memandikan swaddled bath. Penelitian ini menggunakan metode studi kasus terhadap lima bayi prematur yang berisiko mengalami gangguan termoregulasi melalui pendekatan proses keperawatan. Gangguan termoregulasi dapat menghambat proses adaptasi bayi prematur dalam mencapai keutuhannya, sehingga diperlakukan intervensi berbasis Model Konservasi Levine melalui empat prinsip konservasi. Hasil penelitian menunjukkan bahwa Model Konservasi Levine dapat digunakan dalam asuhan keperawatan bayi prematur dengan masalah termoregulasi melalui penggunaan teknik memandikan swaddled bath.

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Premature babies have many risks of health problems that can be experienced due to immature body functions and systems. Bathing is a non-invasive action that is performed every day and can cause stress to the baby. The stress respone shown by premature babies during the bathing procedure can be in the form of crying, tremors, loss of body temperature, and changes in vital signs. The purpose of this study was to provide an overview of the application of the Levine Conservation Model in nursing care of premature infants with a risk of thermoregulation disorders through the swaddled bath technique. This research used a case study method of five premature babies who were at risk of experiencing thermoregulation disorders through the nursing process approach. Disorders of thermoregulation can hinder the adaptation process of premature babies in achieving their wholeness, so interventions based on the Levine Conservation Model are treated through four principles of conservation. The results of this study indicate that the Levine Conservation Model can be used in nursing care of premature infants with thermoregulation problems through the use of the swaddled bath technique."

"Masalah nutrisi merupakan permasalahan yang sering dihadapi oleh anak kanker. Tujuan penulisan Karya Ilmiah Akhir ini adalah memberikan gambaran pelaksanaan Praktik Residensi Keperawatan Anak kanker yang mengalami masalah nutrisi dengan mengaplikasikan Model Konservasi Levine. Dalam pencapaian kompetensi sebagai Ners Spesialis Keperawatan Anak residen telah menjalankan peran sebagai pemberi asuhan keperawatan, peran koordinasi dan kolaborasi, pembuatan keputusan etik, advocator, dan innovator. Aplikasi Model Konservasi Levine tertuang dalam lima kasus terpilih, dimana trophicognosis yang umum ditemukan adalah ketidakseimbangan nutrisi kurang atau lebih dari kebutuhan tubuh. Intervensi diberikan berdasarkan empat prinsip konservasi. Hasil evaluasi terhadap trophicognosis ketidakseimbangan nutrisi menunjukkan adanya peningkatan terhadap kemampuan konservasi energi. Model Konservasi Levine dapat diterapkan pada klien anak dengan kanker yang mengalami masalah nutrisi. Pencapaian kompetensi dalam praktik residensi keperawatan anak telah memperkaya dan meningkatkan pengetahuan serta keterampilan klinis residen.

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Nutritional problem is commonly faced by children with cancer. The aim of this final assignment was to provide Nursing Practice Residency implementation of children with cancer which have nutritional problems by applying Levine Conservation Model. Competencies that had been made included providing nursing care, coordination and collaboration, ethical decision making, advocator and innovator. Levine Conservation Model was applied in five selected cases and the trophicognosis commonly found was imbalanced nutrition supply of the body needs. Interventions were given based on the four principles of conservation, that are conservation of energy, conservation of structural integrity, conservation of personal integrity, and conservation of social integrity. Evaluation of nutritional imbalance trophicognosis showed an increase in energy conservation ability. Levine Conservation Model can be applied to children with cancer who have a nutrition problem. Achievement of competence in the practice residency of nursing children have enriching and improving knowledge and clinical skills of resident."

"ABSTRAKKanker merupakan penyakit yang dapat menyebabkan gangguan nutrisi pada anak. Tujuan dari karya ilmiah akhir adalah menggambarkan aplikasi model konservasi Levine dalam melakukan asuhan keperawatan pada anak dengan kanker yang mengalami masalah ketidakseimbangan nutrisi kurang dari kebutuhan tubuh dan pencapaian kompetensi praktik spesialis keperawatan anak. Peran perawat yang dilakukan selama praktik residensi adalah sebagai pemberi asuhan, advokat, edukator, dan peneliti yang dilaksanakan dengan memperhatikan etik dan legal. Pendekatan model konservasi Levine menggunakan empat prinsip konservasi yaitu konservasi energi, integritas struktural, integritas personal, dan sosial. Empat prinsip konservasi tersebut diaplikasikan ke dalam proses keperawatan yang dimulai dengan pengkajian, trophicognosis, hipotesis, intervensi, dan evaluasi pada lima kasus kelolaan. Evaluasi yang didapat untuk masalah ketidakseimbangan nutrisi kurang dari kebutuhan tubuh adalah masalah teratasi sebagian ditandai dengan mual berkurang dan asupan makan meningkat. Model konservasi Levine dapat diaplikasikan pada anak dengan kanker dalam upaya konservasi energi dan peningkatan kualitas hidup anak.

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ABSTRACT

Children with cancer were potentially experienced nutritional imbalance. The purpose of the final report was to described the application of Levine Conservation Model in performing nursing care for children with cancer whom experienced problems nutritional imbalance, and achievement of residency competency for pediatric nursing. The role of the nurse performed during residency were conducted as direct nursing care, advocate, educator, and researcher based on professional, ethical and legal. Levine's model approach using four principles were conservation of energy, structural integrity, personal integrity, and social integrity. These conservation principles were applied to the nursing care since assessment, trophicognosis, hypothesis, intervention, and evaluation phases in five selected cases of patients. Organismic evaluation obtained for all nutritional imbalance problems were solved partially that can be measured from the lower level of nausea and the higher food intake. Levine conservation model may apply to nursing care in children with cancer who experienced nutritional problems to increase quality of life."

"Penumonia menjadi penyebab utama kematian balita. Penulisan Karya Ilmiah Akhir Ners ini bertujuan memberi gambaran asuhan keperawatan pada balita dengan pneumonia. Berdasarkan hasil pengkajian pada klien dengan pneumonia didapatkan tanda dan gejala demam, batuk, pilek, sesak, pernafasan cuping hidung, frekuensi pernafasan meningkat, hasil laboratorium leukositosis, serta gambaran foto thorak terkesan gambaran pneumonia. Intervensi tepid water sponge adalah salah satu tindakan mandiri perawat untuk menurunkan gejala demam. Evaluasi menunjukan bahwa tindakan tepid water sponge yang disertai dengan pemberian antipiretik adalah tindakan efektif untuk menurunkan demam pada anak. Karya ilmiah ini memberikan saran bagi perawat rumah sakit agar mengoptimalkan tindakan tepid water sponge untuk menurunkan demam pada anak dan penerapanya dapat melibatkan keluarga.

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Pneumonia is to be the main cause of infant death. Final Scientific Writing nurses aims to give an overview of nursing care in children with pneumonia. Based on the results of the assessment on a client with pneumonia found the signs and symptoms of fever, cough, cold, breathless, nostril breathing, increased respiratory rate, leukocytosis laboratory results, as well as an overview of photos thoracic impressed pneumonia. Intervention tepid water sponge is one nurse independent action to reduce fever. Evaluation shown that tepid water sponge action coupled with antipyretic treatment is effective measures to reduce fever in children. This paper provided advice to nurses in order to optimize tepid water sponge action to reduce fever on children and their applicability can involve the family."

"Latar belakang: Pengukuran suhu tubuh sebenarnya (core body temperature) tidak lazim dilakukan pada anak karena invasif dan sulit, sehingga pengukuran suhu aksila dan membran timpani lebih disukai. Namun sampai saat ini ketepatan hasil pengukuran suhu membran timpani dan aksila masih diperdebatkan.Tujuan: Membandingkan ketepatan hasil pengukuran suhu membran timpani dan aksila dengan rektal, mengetahui metode terbaik pengukuran suhu tubuh, dan cut off demam pada anak berdasarkan masing-masing metode pengukuran suhu.Metode: Penelitian diagnostik potong lintang pada anak demam berusia 6 bulan ? 5 tahun yang dipilih secara konsekutif di Poliklinik Anak, IGD Anak, dan Ruang Perawatan Anak Gedung A RSCM antara bulan Desember 2014 ? Januari 2015.Hasil: Dengan cut off demam suhu aksila 37,4oC dan membran timpani 37,6oC didapatkan sensitivitas 96% (IK 95% 0,88-0,98) dan 93% (IK 95% 0,84-0,97), spesifisitas 50% (IK 95% 0,47-0,84) dan 50% (IK 95% 0,31-0,69), NDP 90% (IK 95% 0,81-0,95) dan 85% (IK 95% 0,75-0,91), NDN 83% (IK 95% 0,61-0,94) dan 69% (IK 95% 0,44-0,86). Cut off optimal demam suhu membran timpani dan aksila pada penelitian ini adalah 37,8oC (AUC 0,903 dan 0,903).Simpulan: Hasil pengukuran suhu aksila sama baik dengan membran timpani dalam mendeteksi demam dan dapat digunakan dalam praktik klinis sehari-hari maupun di rumah. Dengan cut off demam 37,8oC didapatkan sensitivitas 81% dan 88%, spesifisitas 86% dan 73%, NDP 95% dan 91%.

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Background: Core body temperature measurement is not common in pediatric population because it is invasive and difficult. Therefore tympanic and axillary temperature measurement are prefereble but their accuracy still debated.Objective: To compare the accuracy of axillary and tympanic temperature to rectal temperature in children with fever and measure the cut off point for fever based on each temperature measurement method.Methods: A cross-sectional diagnostic study was conducted among children age 6 months ? 5 years which was selected consecutively at Pediatric Out-patient clinic, Pediatric emergency unit, and the in-patient wards in building A RSCM from December 2014 to January 2015.Results: With the cut off for fever on axilla 37,4oC and tympanic membrane 37,6oC the sensitivity was 96% (95% CI 0,88-0,98) and 93% (95% CI 0,84-0,97), specificity 50% (95% CI 0,47-0,84) and 50% (95% CI 0,31-0,69), NDP 90% (95% CI 0,81-0,95) and 85% (95% CI 0,75-0,91), NDN 83% (95% CI 0,61-0,94) and 69% (95% CI 0,44-0,86). Optimal cut off of tympanic membrane and axilla temperature was 37,8oC (AUC 0,903 dan 0,903).Conclusions: Axillary temperature measurement is as good as the tympanic membrane temperature measurement and can be used at the daily clinical practice or at home. By increasing the optimum fever cut off point for axilla temperature and tympanic membrane to 37,8oC, we found sensitivity 81% and 88%, specificity 86% and 73%, NDP 95% and 91%."