"Pemantauan terapi obat (PTO) adalah kegiatan apoteker dalam meningkatkan efektivitas obat dan meminimalkan risiko yang tidak diinginkan. PTO dilakukan dengan mengidentifikasi identitas, data, masalah terkait pengobatan, penyelesaian terhadap masalah, rencana, dan tidak lanjut pengobatan. PTO dilakukan terhadap pasien yang memenuhi kriteria, salah satunya adalah pada pasien geriatri dengan gangguan organ. Diagnosa klinis pasien adalah asites masif yang disebabkan gangguan hati kronis dengan ikterus obstruktif akibat choledocolelithiasis yang dirawat di ruang perawatan RSUP Persahabatan. PTO dilakukan untuk mengidentifikasi dan merekomendasi penyelesaian drug related problem (DRP). Pemantauan dilaksanakan dengan melakukan visite, meninjau data klinis, dan daftar pengobatan yang diterima pasien selama perawatan. Dari PTO yang dilaksanakan ditemukan DRP berupa ada obat tanpa indikasi, ada indikasi tanpa obat, dan pasien gagal menerima obat. Identifikasi masalah ada obat tanpa indikasi didasari atas penggunaan fitomenadion ketika parameter perdarahan pasien sudah mencapai nilai normal. Selama perawatan pasien merasakan keluhan dengan derajat nyeri 3 namun belum diberikan obat untuk mengatasinya. Pasien gagal menerima obat disebabkan karena ketidaktersediaannya Curcuma suplemen obat non formularium nasional di rumah sakit dan keluarga pasien belum membelinya namun pada akhir masa perawatannya nilai SGOT/SGPT pasien sudah mengalami perbaikan. Rekomendasi penyelesaian DRP adalah menghentikan obat yang tidak sesuai dengan kondisi klinis pasien, menambahkan obat untuk mengatasi keluhan pasien, dan memberikan salinan resep untuk mendapatkan obat di luar rumah sakit.

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Monitoring Drug Therapy (MDT) is a pharmacist's activity aimed at improving drug effectiveness and minimizing undesirable risks. MTM is carried out by identifying patient information, data, medication-related problems, resolving these issues, planning, and following up on the treatment. MDT is performed for patients who meet specific criteria, including geriatric patients with organ disorders. In this case, the patient's clinical diagnosis is massive ascites caused by chronic liver impairment with obstructive jaundice due to choledocholithiasis, and they are being treated in the inpatient ward of RSUP Persahabatan. MDT is conducted to identify and recommend solutions for drug-related problems (DRPs). The monitoring is done by visite, reviewing clinical data, and the patient's medication history during their treatment. From the MDT conducted, the following DRPs were identified the use of phytonadione (fitomenadion) without indication, indication without medication while the patient experienced a pain level of 3 but was not given medication to alleviate it, and failure of drug administration while the non-availability of Curcuma supplement, a non-formulary drug, at the hospital, which the patient's family had not purchased, although by the end of the treatment, the patient's SGOT/SGPT levels had improved. The recommended solutions for these DRPs are to discontinue inappropriate medications for the patient's clinical condition, add medication to address the patient's complaints of pain, and provide a prescription copy for obtaining medications outside the hospital."

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ABSTRAK

Nama               : Diah Widyastuti

Program Studi : Profesi Ilmu Keperawatan

Judul               : Analisis Asuhan Keperawatan pada Pasien Sirosis Hepatis dan

Penerapan Manajemen Cairan

Pembimbing    : Ns. Dikha Ayu Kurnia, M.Kep., Sp.Kep.MB

Sirosis hepatis merupakan penyakit kronik pada hati yang menyebabkan fungsi hati terganggu. Komplikasi dari penyakit ini salah satunya yaitu asites. Asites pada sirosis hepatis disebabkan oleh adanya kondisi hipoalbuminemia, hipertensi porta, dan retensi air dan garam. Kondisi ini menyebabkan klien mengalami ketidakseimbangan volume caira. Perawat memiliki peran penting dalam pemenuhan kebutuhan dasar, salah satunya adalah cairan. Manajemen cairan pada pasien sirosis bertujuan untuk memenuhi kebutuhan cairan, mengurangi asites, dan meningkatkan albumin. Intervensi yang dilakukan perawat yaitu monitoring status hidrasi, monitoring berat badan dan lingkar perut, mengukur balance cairan, mengatur intake cairan oral klien, dan memantau nilai elektrolit serta hematokrit. Sedangkan intervensi kolaboratif yaitu dengan terapi cairan yang mengandung asam amino rantai cabang, penggunaan obat diuretik, dan pemberian transfusi darah. Manajemen cairan yang optimal dapat menyelesaikan gangguan cairan pada pasien.

Kata kunci:

Sirosis hepatis, asites, manajemen cairan

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ABSTRACT

Name                   : Diah Widyastuti

Study Program    : Nursing

Title                     : Analysis of Nursing Care in Patients with Hepatic Cirrhosis and

Application of Fluid Management

Cousellor             : Ns. Dikha Ayu Kurnia, M.Kep., Sp.Kep.MB

Hepatic cirrhosis is a chronic disease of liver which causes distrubed liver function. One of the complications of the disease is ascites. Ascites in hepatic cirrhosis is caused by hypoalbuminemia, portal hypertension, and water and salt retention. This condition causes clients to experience fluid volume imbalances. Nurses have an important role in fulfilling basic needs, which include fluid needs. Fluid management in cirrhotic patients aims to meet fluid needs, reduce ascites, and improve albumin. Interventions conducted by nurses are monitoring hydration status, monitoring body weight and abdominal circumference, measuring fluid balance, regulating the client's oral fluid intake, and monitoring electrolyte and hematocrit values. While collaborative intervention is by treating fluids containing branched chain amino acids, using diuretic drugs, and administer blood transfusion. Optimal fluid management can resolve fluid disorders in patients.

Key words:

Hepatic cirrhosis, asicites, fluid management 

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"ABSTRAKManajemen cairan merupakan salah satu intervensi yang dilakukan pada pasien sirosis hepatis dengan komplikasi asites dan edema. Asites dan edema terjadi karena retensi natrium dan cairan akibat peningkatan sistem portal dan rusaknya fungsi hepatosit untuk produksi albumin. Tujuan penulisan ini adalah menggambarkan intervensi & analisis yang dilakukan pada pasien sirosis hepatis dengan metode studi kasus melalui pendekatan asuhan keperawatan. Pengaturan cairan, penggunaan diuretik, dan makanan yang tinggi asam amino diharapkan dapat mengurangi asites dan edema. Hasil yang ditemukan dalam studi kasus ini adalah asites dan edema pada klien selama dirawat di RSUP dr. Cipto Mangunkusumo berkurang yang ditandai dengan derajat edema berkurang dari derajat 4 menjadi 3 dan pengukuran asites dari lingkar perut tidak bertambah meskipun tidak terjadi penurunan yang signifikan. Oleh karena itu, peran perawat dalam memantau manajemen asites dan edema sangat penting untuk dilakukan agar lama perawatan tidak memanjang. Bekerja sama dengan keluarga dalam pengukuran minuman yang diminum pasien dan menimbang popok setiap diganti sebagai rekomendasi penelitian selanjutnya.

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ABSTRACT

Fluid management is one of the interventions carried out in patients with cirrhosis hepatic with complications of ascites and edema. Ascites and edema occur due to sodium and fluid retention due to an increase in the portal system and damage to hepatocyte function for albumin production. The purpose of this paper is to describe the intervention & analysis carried out in patients with hepatic cirrhosis with a case study method through a nursing care approach. Fluid management, use of diuretics, and foods high in amino acids are expected to reduce ascites and edema. The results found in this case study are ascites and edema in the client while being treated at RSUP dr. Cipto Mangunkusumo decreases which is characterized by the degree of edema decreasing from degree 4 to 3 and measurement of ascites from the abdominal circumference does not increase even though there is no significant decrease. Therefore, the role of nurses in monitoring management of ascites and edema is very important to do so that the length of treatment does not extend. Family involvement in drink measurement and weighing each diaper are recommended for further research."

"[Latar belakang : Angka ketahanan hidup dalam 5 tahun pasien penderitakeganasan kanker ovaeium rendah, karena > 70% kasus terlambat didiagnosis.CA125 asites merupakan metode untuk memprediksi kanker ovarium pra bedahsebelum dilakukan tindakan atau tatalaksanha selanjutnya. Tujuan : Penelitian ini bertujuan untuk menurunkan angka kematian akibatkanker ovarium stadium lanjut.Metode : Uji ini adalah uji diagnostik dengan desain potong lintang. Penelitianberlangsung dari Juli 2014 sampai Juni 2015 di Poli onkologi DepartemenObstetri dan Ginekologi RSUPN Dr Cipto Mangunkusumo sampel sebanyak 41kasus. Sampel diambil langsung dari pasien kanker ovarium dengan asites masif.Selanjutnya sampel di analisa nilai sensitivitas dan spesifitasnya. Hasil : Dari 41 orang subjek penelitian didapatkan nilai sensitivitas dan spesifitasyang cukup baik dalam mendiagnosis kanker ovarium, berturut ? turut nialisensitivitas dan spesifitasnya adalah 96% dan 100%. Pemeriksaan kadar CA125asites dapat dipertimbangkan untuk digunakan sebagai salah satu tumor markeruntuk mendiagnosis kanker ovarium dengan asites masif.Kesimpulan : Kadar CA125 asites memiliki nilai sensitivitas dan spesifitas 96% dan 100% untuk mendiagnosa kanker ovarium jenis sel epitel.;Background : Overall five-year survival rate of ovarian cancer is the lowest ofamongst gynecological malignancies, as it diagnosed in late stage diseases.Preoperative CA125 level in ascites fluid is one of the method to guide thesubsequent management. This research aimed to improve ovarian cancer survivalrate.Method :This study was a diagnostic study with cross-sectional review of CA125level in ascites fluid of 41 ovarian malignancy patients in Obstetrics andGynecology Department of RSUPN Dr. Cipto Mangunkusumo to analyze itssensitivity and specificity. Results :This research showed a good sensitivity and specificity of CA125 level,96 % and 100 % respectively. CA125 level in ascites fluid may consider as one ofthe tumour marker to diagnose ovarian malignancy with massive ascited fluid.Conclusion: CA125 level in ascites fluid had a good sensitivity and specificity to diagnose epithelial ovarian malignancy., Background : Overall five-year survival rate of ovarian cancer is the lowest ofamongst gynecological malignancies, as it diagnosed in late stage diseases.Preoperative CA125 level in ascites fluid is one of the method to guide thesubsequent management. This research aimed to improve ovarian cancer survivalrate.Method :This study was a diagnostic study with cross-sectional review of CA125level in ascites fluid of 41 ovarian malignancy patients in Obstetrics andGynecology Department of RSUPN Dr. Cipto Mangunkusumo to analyze itssensitivity and specificity. Results :This research showed a good sensitivity and specificity of CA125 level,96 % and 100 % respectively. CA125 level in ascites fluid may consider as one ofthe tumour marker to diagnose ovarian malignancy with massive ascited fluid.Conclusion: CA125 level in ascites fluid had a good sensitivity and specificity to diagnose epithelial ovarian malignancy.]"

"[ABSTRAKLatar Belakang: Penyakit Demam Berdarah Dengue (DBD) masih endemis dan merupakan masalah yang besar dan serius di Indonesia. Peningkatan kadar laktat dalam darah merupakan petanda hipoksia jaringan pada penyakit DBD, bila hipoksia jaringan tidak terdeteksi lebih awal/dini, dan tidak diberikan cairan lebih agresif dan sesuai, maka akan meningkatkan angka komplikasi dan kematian. Tujuan: Mengetahui perbedaan rerata kadar hematokrit dan albumin serum serta beda proporsi efusi pleura dan atau asites, pasien infeksi dengue dewasa pada berbagai derajat hiperlaktatemia untuk mengetahui secara dini adanya hipoksia jaringan Metode: Penelitian ini adalah Studi uji Potong Lintang. Penelitian dilakukan di RSUPN Cipto Mangunkusumo dan RSUP Persahabatan Jakarta, pada pasien yang dirawat periode waktu April 2014 sampai dengan Mei 2015. Menilai beda rerata kadar hematokrit darah dan albumin serum menggunakan uji statistik Uji T, sedangkan beda proporsi efusi pleura dan atau asites dengan Uji Kai Kuadrat. Hasil: Sebanyak 62 pasien infeksi demam dengue, dibagi kedalam 2 kelompok masing-masing 31 pasien berdasarkan kadar laktat darah. Kelompok I dengan kadar laktat darah > 2 sampai ≤ 2,4 mmol/L dan kelompok II > 2,4 mmol/L. Rerata kadar hematokrit darah pada kelompok I dan II masing-masing 40,06 (SB 4,54) dan 41,03 (SB 4,77). Tidak ada perbedaan rerata kadar hematokrit darah pada kedua kelompok dengan nilai p = 0,42. Rerata kadar albumin serum pada kelompok I dan II masing-masing 3,94 (SB 0,29) dan 3,89 (SB 0,30). Tidak ada perbedaan rerata kadar albumin serum pada kedua kelompok dengan nilai p = 0,49. Proporsi efusi pleura dan atau asites pada kelompok I dan II masing-masing 54,8% dan 58,1%. Tidak ada perbedaan proporsi adanya efusi pleura dan atau asites pada kedua kelompok dengan p = 1. Kesimpulan: Tidak ada perbedaan rerata kadar hematokrit darah dan albumin serum, serta beda proporsi efusi pleura dan atau asites pada kelompok kadar laktat darah > 2 sampai ≤ 2,4 mmol/L dibandingkan > 2,4 mmol/L.

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ABSTRACTBackground: Dengue Haemorrhagic Fever (DHF) is still endemic and is a big and serious problem in Indonesia. Increased levels of lactate in the blood is a marker for tissue hypoxia in DHF , when tissue hypoxia is not detected early and not given the more aggressive fluids and appropriate, it will increase the rate of complications and mortality. Objective: To determine differences in average levels of hematocrit and serum albumin as well as different proportions pleural effusion and/or ascites, adult patients with dengue infection in various degrees hyperlactatemia to know at an early stage for tissue hypoxia. Methods: This study is a test study Cross Sectional. The study was conducted at Cipto Mangunkusumo and at Persahabatan Hospital, Jakarta, in-patients admitted to the time period April 2014 through May 2015. Assessing the mean difference of blood hematocrit levels and serum albumin using statistical test T test, while the different proportion of pleural effusion and/or ascites with test Chi Square. Results: A total of 62 patients of dengue fever infections, distributed into 2 groups of each 31 patients based on blood lactate levels. Group I with a blood lactate levels > 2 to ≤ 2,4 mmol/L and Group II > 2.4 mmol/L. The mean blood hematocrit levels in group I and II, respectively 40.06 (SD 4.54) and 41.03 (SD 4.77). There is no difference in mean blood hematocrit levels in both groups with p = 0.42. The mean levels of serum albumin in group I and II respectively 3.94 (SD 0.29) and 3.89 (SD 0.30). There is no difference in the mean serum albumin levels in both groups with p = 0.49. The proportion of pleural effusion and/or ascites in groups I and II respectively 54.8% and 58.1%. There is no difference in the proportion of the pleural effusion and/or ascites in both groups with p = 1. Conclusion: There is no difference in mean blood hematocrit levels and serum albumin, as well as the different proportions of pleural effusion and/or ascites founds in the group of blood lactate levels > 2 to ≤ 2,4 mmol/L compared to > 2.4 mmol/L.;Background: Dengue Haemorrhagic Fever (DHF) is still endemic and is a big and serious problem in Indonesia. Increased levels of lactate in the blood is a marker for tissue hypoxia in DHF , when tissue hypoxia is not detected early and not given the more aggressive fluids and appropriate, it will increase the rate of complications and mortality. Objective: To determine differences in average levels of hematocrit and serum albumin as well as different proportions pleural effusion and/or ascites, adult patients with dengue infection in various degrees hyperlactatemia to know at an early stage for tissue hypoxia. Methods: This study is a test study Cross Sectional. The study was conducted at Cipto Mangunkusumo and at Persahabatan Hospital, Jakarta, in-patients admitted to the time period April 2014 through May 2015. Assessing the mean difference of blood hematocrit levels and serum albumin using statistical test T test, while the different proportion of pleural effusion and/or ascites with test Chi Square. Results: A total of 62 patients of dengue fever infections, distributed into 2 groups of each 31 patients based on blood lactate levels. Group I with a blood lactate levels > 2 to ≤ 2,4 mmol/L and Group II > 2.4 mmol/L. The mean blood hematocrit levels in group I and II, respectively 40.06 (SD 4.54) and 41.03 (SD 4.77). There is no difference in mean blood hematocrit levels in both groups with p = 0.42. The mean levels of serum albumin in group I and II respectively 3.94 (SD 0.29) and 3.89 (SD 0.30). There is no difference in the mean serum albumin levels in both groups with p = 0.49. The proportion of pleural effusion and/or ascites in groups I and II respectively 54.8% and 58.1%. There is no difference in the proportion of the pleural effusion and/or ascites in both groups with p = 1. Conclusion: There is no difference in mean blood hematocrit levels and serum albumin, as well as the different proportions of pleural effusion and/or ascites founds in the group of blood lactate levels > 2 to ≤ 2,4 mmol/L compared to > 2.4 mmol/L.;Background: Dengue Haemorrhagic Fever (DHF) is still endemic and is a big and serious problem in Indonesia. Increased levels of lactate in the blood is a marker for tissue hypoxia in DHF , when tissue hypoxia is not detected early and not given the more aggressive fluids and appropriate, it will increase the rate of complications and mortality. Objective: To determine differences in average levels of hematocrit and serum albumin as well as different proportions pleural effusion and/or ascites, adult patients with dengue infection in various degrees hyperlactatemia to know at an early stage for tissue hypoxia. Methods: This study is a test study Cross Sectional. The study was conducted at Cipto Mangunkusumo and at Persahabatan Hospital, Jakarta, in-patients admitted to the time period April 2014 through May 2015. Assessing the mean difference of blood hematocrit levels and serum albumin using statistical test T test, while the different proportion of pleural effusion and/or ascites with test Chi Square. Results: A total of 62 patients of dengue fever infections, distributed into 2 groups of each 31 patients based on blood lactate levels. Group I with a blood lactate levels > 2 to ≤ 2,4 mmol/L and Group II > 2.4 mmol/L. The mean blood hematocrit levels in group I and II, respectively 40.06 (SD 4.54) and 41.03 (SD 4.77). There is no difference in mean blood hematocrit levels in both groups with p = 0.42. The mean levels of serum albumin in group I and II respectively 3.94 (SD 0.29) and 3.89 (SD 0.30). There is no difference in the mean serum albumin levels in both groups with p = 0.49. The proportion of pleural effusion and/or ascites in groups I and II respectively 54.8% and 58.1%. There is no difference in the proportion of the pleural effusion and/or ascites in both groups with p = 1. Conclusion: There is no difference in mean blood hematocrit levels and serum albumin, as well as the different proportions of pleural effusion and/or ascites founds in the group of blood lactate levels > 2 to ≤ 2,4 mmol/L compared to > 2.4 mmol/L., Background: Dengue Haemorrhagic Fever (DHF) is still endemic and is a big and serious problem in Indonesia. Increased levels of lactate in the blood is a marker for tissue hypoxia in DHF , when tissue hypoxia is not detected early and not given the more aggressive fluids and appropriate, it will increase the rate of complications and mortality. Objective: To determine differences in average levels of hematocrit and serum albumin as well as different proportions pleural effusion and/or ascites, adult patients with dengue infection in various degrees hyperlactatemia to know at an early stage for tissue hypoxia. Methods: This study is a test study Cross Sectional. The study was conducted at Cipto Mangunkusumo and at Persahabatan Hospital, Jakarta, in-patients admitted to the time period April 2014 through May 2015. Assessing the mean difference of blood hematocrit levels and serum albumin using statistical test T test, while the different proportion of pleural effusion and/or ascites with test Chi Square. Results: A total of 62 patients of dengue fever infections, distributed into 2 groups of each 31 patients based on blood lactate levels. Group I with a blood lactate levels > 2 to ≤ 2,4 mmol/L and Group II > 2.4 mmol/L. The mean blood hematocrit levels in group I and II, respectively 40.06 (SD 4.54) and 41.03 (SD 4.77). There is no difference in mean blood hematocrit levels in both groups with p = 0.42. The mean levels of serum albumin in group I and II respectively 3.94 (SD 0.29) and 3.89 (SD 0.30). There is no difference in the mean serum albumin levels in both groups with p = 0.49. The proportion of pleural effusion and/or ascites in groups I and II respectively 54.8% and 58.1%. There is no difference in the proportion of the pleural effusion and/or ascites in both groups with p = 1. Conclusion: There is no difference in mean blood hematocrit levels and serum albumin, as well as the different proportions of pleural effusion and/or ascites founds in the group of blood lactate levels > 2 to ≤ 2,4 mmol/L compared to > 2.4 mmol/L.]"