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"Kanker adalah pertumbuhan sel baru yang tidak terkontrol, mampu menyebar danmenginvasi sehingga mengancam kehidupan. Insiden kanker dilaporkan daritahun ke tahun terjadi peningkatan. Berbagai upaya telah dilakukan untukmenurunkan morbiditas dan mortalitas kanker. Karya Ilmiah Akhir KIA iniadalah sebagai laporan praktik residensi keperawatan medikal bedah peminatanonkologi di RS Kanker Dharmais Jakarta. Karya ilmiah ini berisi tentang: 1 penerapan teori Konservasi Levine pada pasien kanker Tiroid, 2 IntervensiMenghirup Aromaterapi untuk mengurangi kerusakan kelenjar ludah selama dansetelah pemberian Terapi Radioactif Iodine 3 proyek inovasi manajemen edukasipre intra dan pasca ablasi pada pasien kanker tiroid yang menjalani terapiradioactive iodine I-131. Kesimpulan: bahwa teori Konservasi Levin tepatdigunakan untuk meningkatkan ketersediaan energy pada pasien kanker tiroid.Intervensi menghirup aromaterapi kombinasi citrus lemon dan jahe dapatdigunakan sebagai salah satu alternatif pilihan manajemen unuk mengurangikerusakan kelenjar ludah pada pasien kanker tiroid selama dan setelah pemberianterapi radioactive iodine. Edukasi berbasis multi median pre inra dan pasca ablasidiharapkan mampu memberikan pendidikan kesehatan yang bermanfaat bagipasien kanker tiroid yang akan menjalani terapi radiactif iodine.

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Cancer is the growth of new cells that are not controlled, capable of spreading andinvading so life threatening. The increase of incidence cancer is reported fromyear to year. Various attempts have been made to reduce cancer morbidity andmortality. This Final Scientific Work is a practice report of medical oncologymedical residency of oncology in Dharmais Jakarta Cancer Hospital.

This scientific work contains 1 the application of Levine Conservation theory inThyroid cancer patients, 2 Aromatherapy Inhalation Intervention to reducesalivary gland damage during and after the administration of Radioactive IodineTherapy 3 innovation project management of intra and post Ablation educationin patients Thyroid cancer through radioactive iodine I 131 therapy.

Conclusion Levin conservation theory is appropriately used to increase theavailability of energy in patients rsquo thyroid cancer. Interventions inhalingaromatherapy combinations of citrus lemon and ginger can be used as analternative management option to reduce salivary gland damage in patients withthyroid cancer during and after administration of radioactive iodine therapy. Preintraand post ablative multimedia based education is expected to provide a usefulhealth education for patients with thyroid cancer who will radiodic iodine therapy."

"Oksigenasi merupakan suatu proses pertukaran antara O2 dan CO2 sesuai dengan kebutuhan fisiologis tubuh untuk kelangsungan proses metabolisme sel tubuh dan aktivitas sel dan organ, dimana pemenuhan kebutuhan oksigen ini tidak terlepas dari sistem pernapasan. Kondisi kritis pada anak terjadi apabila mengalami kemunduran fungsi organ yang dapat mengganggu proses metabolisme tubuh yang dapat mengancam jiwa. Tujuan dari studi kasus ini untuk mengetahui pengaruh aplikasi teori konservasi Levine dalam asuhan pemenuhan kebutuhan oksigenasi pada anak kritis di ruang intensif. Studi kasus ini menggunakan desain deskriptif pada lima kasus anak kritis. Masalah yang terjadi: gangguan ventilasi spontan, penurunan kapasitas adaptif intrakranial, penurunan curah jantung, risiko perfusi serebral tidak efektif, risiko ketidakseimbangan elektrolit, risiko perdarahan, risiko infeksi dan ansietas. Asuhan keperawatan yang diberikan menggunakan pendekatan Levine dengan intervensi sesuai dengan masalah keperawatan menggunakan Standar Intervensi Keperawatan Indonesia. Hasilanalisis dari lima kasus terpilih di ruang intensif bahwa seluruh pasien memiliki gangguan pada konservasi energi terutama pada masalah oksigenasi dan terjadi penurunan kesadaran pada konservasi integritas struktural dengan respon organismik 2 (40%) pasien mengalami perburukan/meninggal dan 3(60%) pasien mengalami perbaikan yang secara menyeluruh (wholeness) ditandai dengan auskultasi ronchi berkurang, pola napas adekuat, hemodinamik stabil, kesadaran composmentis, pasien ekstubasi dan pindah ruangan/ rawat jalan.  Kesimpulan penerapan teori konservasi pada studi kasus melalui proses perawatan mulai dari pengkajian, trophicognosis, hipotesis intervensi serta evaluasi dengan melihat respon organismik secara satu kesatuan yang utuh (wholenes) sehingga teori ini dapat diterapkan pada anak kritis di ruang intensif.

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Oxygenation is an exchange process between O2 and CO2 in accordance with the body's physiological needs for the continuity of the body's cell metabolism processes and cell and organ activities, where the fulfillment of oxygen needs cannot be separated from the respiratory system. Critical conditions in children occur when there is a decline in organ function that can interfere with the body's metabolic processes which can be life-threatening.

The purpose of this case study is to determine the effect of Levine's conservation theory application in the care of oxygenation needs of critically ill children in intensive care. This case study uses a descriptive design in five cases of critically ill children. Problems that occur: impaired spontaneous ventilation, decreased intracranial adaptive capacity, decreased cardiac output, risk of ineffective cerebral perfusion, risk of electrolyte imbalance, risk of bleeding, risk of infection and anxiety. The nursing care provided uses the Levine approach with interventions according to nursing problems using the Indonesian Nursing Intervention Standards.

The results of the analysis of five selected cases in the intensive care unit showed that all patients had disturbances in energy conservation, especially in oxygenation problems and there was a decrease in awareness of the conservation of structural integrity with an organismic response. overall improvement (wholeness) is characterized by reduced auscultation crackles, adequate breathing pattern, stable hemodynamics, composmentis consciousness, extubated patients and moved rooms/outpatient.

The conclusion is the application of conservation theory to the case study through the treatment process starting from assessment, trophicognosis, intervention hypotheses and evaluation by looking at the organismic response as a whole so that this theory can be applied to critical children in the intensive room."

"ABSTRAKKetidakseimbangan termoregulasi berisiko terjadi pada Bayi Berat Lahir Rendah secarastruktur tubuh masih belum matang. Tujuan penulisan karya ilmiah akhir ini adalahmemberikan gambaran tentang bagaimana penerapan model konservasi Levine dalamproses asuhan keperawatan pada bayi berat lahir rendah untuk mencegahketidakseimbangan termoregulasi, juga memberikan gambaran langkah pencegahannyaselama transport BBLR intra hospital. Pada lima kasus kelolaan, masalah termoregulasiyang terjadi meliputi inefektif termoregulasi, risiko inefektif termoregulasi, hipotermiadan hipertermia. Pendekatan teori Konservasi Levine menggunakan prinsip konservasienergi, konservasi integritas struktural, konservasi integritas personal dan konservasiintegritas sosial dilakukan sebagai intervensi keperawatan dalam mengatasi masalahtermoregulasi. Evaluasi yang didapatkan, masalah ketidakseimbangan termoregulasidapat teratasi selama perawatan. Selanjutnya langkah pencegahan ketidakseimbangantermoregulasi pada BBLR yang baru lahir selama transportasi intra hospital dilakukandengan penyusunan Standar Prosedur Operasional Transportasi BBLR Intra hospitaldengan Kangaroo Care berdasarkan model konservasi Levine.

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Thermoregulatory imbalances are at risk for Low Birth Weight Infants, the bodystructure is still immature. The purpose of writing this final scientific paper is toprovide an overview of how the application of the Levine conservation model in thenursing care process in low birth weight infants to prevent thermoregulatoryimbalance, as well as provide an overview of its preventive measures during intrahospital LBW transport. In five cases of management, thermoregulation problemsthat occurred include ineffective thermoregulation, thermoregulatory ineffectiverisks, hypothermia and hyperthermia. The Levine Conservation theory approachuses the principles of energy conservation, conservation of structural integrity,conservation of personal integrity and conservation of social integrity carried out asnursing interventions in overcoming the problem of thermoregulation. Evaluationobtained, the problem of thermoregulation imbalance can be resolved duringtreatment. The next step is to prevent thermoregulation imbalance in newborn LBWduring intra-hospital transportation by preparing Standard Operating Proceduresfor LBW Intra-hospital Transportation with Kangaroo Care based on the Levineconservation model."

"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."

"ABSTRAK Dehidrasi dapat menyebabkan terjadinya hipovolemia, kegagalan organ, danbahkan berakhir dengan kematian. Asuhan keperawatan yang berkualitas sangatdiperlukan dalam mengatasi masalah gangguan cairan pada anak. Karya ilmiahakhir ini bertujuan untuk memberikan gambaran aplikasi Model KonservasiMyra E. Levine dalam memberikan asuhan keperawatan pada anak dengan kankeryang mengalami ketidakseimbangan cairan. Intervensi berdasarkan modelkonservasi Levine yaitu mengkaji tanda-tanda dehidrasi, memantau adanyamuntah, diare dan demam, mengukur tanda-tanda vital, mengukur intake outputcairan dan melakukan analisis terhadap balance cairan. Evaluasi setelahdilakukan intervensi keperawatan pada kasus 1, 2, dan 3 masalah risikokekurangan volume cairan tubuh tidak terjadi, sedangkan pada kasus 4 sampaidengan 5, masalah ketidakseimbangan cairan teratasi. Rekomendasi karya ilmiahini adalah dalam memberikan asuhan keperawatan pada anak dengan kasushemato-onkologi yang mengalami ketidakseimbangan cairan kepada pasien dapatmenerapkan teori keperawatan model konservasi Myra E. Levine.ABSTRACT Dehydration can lead to hypovolemia, organ failure, and even death. Qualitynursing care is of high importance in addressing the problem of fluid imbalancein children. This paper aimed to describe the application of Levine?sConservation Model in providing nursing care to children with cancer whoexperience fluid imbalance. Based on this model, the interventions includereviewing signs of dehydration, monitoring vomiting, diarrhea, and fever,measuring vital signs, measuring the fluid intake and output and analyzing thefluid balance. After the nursing intervention, the problem of risk of body fluidvolume deficiency did not occur in cases number 1, 2, and 3; while in the casesnumber 4 and 5 in which fluid imbalance already happened, this imbalanceproblem was resolved. It can be concluded that Levine?s model is an effectiveapproach to manage the fluid imbalance problem in children with hematooncologycases.;Dehydration can lead to hypovolemia, organ failure, and even death. Qualitynursing care is of high importance in addressing the problem of fluid imbalancein children. This paper aimed to describe the application of Levine?sConservation Model in providing nursing care to children with cancer whoexperience fluid imbalance. Based on this model, the interventions includereviewing signs of dehydration, monitoring vomiting, diarrhea, and fever,measuring vital signs, measuring the fluid intake and output and analyzing thefluid balance. After the nursing intervention, the problem of risk of body fluidvolume deficiency did not occur in cases number 1, 2, and 3; while in the casesnumber 4 and 5 in which fluid imbalance already happened, this imbalanceproblem was resolved. It can be concluded that Levine?s model is an effectiveapproach to manage the fluid imbalance problem in children with hematooncologycases.;Dehydration can lead to hypovolemia, organ failure, and even death. Qualitynursing care is of high importance in addressing the problem of fluid imbalancein children. This paper aimed to describe the application of Levine?sConservation Model in providing nursing care to children with cancer whoexperience fluid imbalance. Based on this model, the interventions includereviewing signs of dehydration, monitoring vomiting, diarrhea, and fever,measuring vital signs, measuring the fluid intake and output and analyzing thefluid balance. After the nursing intervention, the problem of risk of body fluidvolume deficiency did not occur in cases number 1, 2, and 3; while in the casesnumber 4 and 5 in which fluid imbalance already happened, this imbalanceproblem was resolved. It can be concluded that Levine?s model is an effectiveapproach to manage the fluid imbalance problem in children with hematooncologycases.;Dehydration can lead to hypovolemia, organ failure, and even death. Qualitynursing care is of high importance in addressing the problem of fluid imbalancein children. This paper aimed to describe the application of Levine?sConservation Model in providing nursing care to children with cancer whoexperience fluid imbalance. Based on this model, the interventions includereviewing signs of dehydration, monitoring vomiting, diarrhea, and fever,measuring vital signs, measuring the fluid intake and output and analyzing thefluid balance. After the nursing intervention, the problem of risk of body fluidvolume deficiency did not occur in cases number 1, 2, and 3; while in the casesnumber 4 and 5 in which fluid imbalance already happened, this imbalanceproblem was resolved. It can be concluded that Levine?s model is an effectiveapproach to manage the fluid imbalance problem in children with hematooncologycases.;Dehydration can lead to hypovolemia, organ failure, and even death. Qualitynursing care is of high importance in addressing the problem of fluid imbalancein children. This paper aimed to describe the application of Levine?sConservation Model in providing nursing care to children with cancer whoexperience fluid imbalance. Based on this model, the interventions includereviewing signs of dehydration, monitoring vomiting, diarrhea, and fever,measuring vital signs, measuring the fluid intake and output and analyzing thefluid balance. After the nursing intervention, the problem of risk of body fluidvolume deficiency did not occur in cases number 1, 2, and 3; while in the casesnumber 4 and 5 in which fluid imbalance already happened, this imbalanceproblem was resolved. It can be concluded that Levine?s model is an effectiveapproach to manage the fluid imbalance problem in children with hematooncologycases."

"ABSTRAK Ketidakseimbangan nutrisi dan penyakit infeksi merupakan faktor yang saling mempengaruhi. Ketidakseimbangan nutrisi akan menyebabkan penyakit infeksi, sebaliknya penyakit infeksi juga akan menyebabkan anak mengalami ketidakseimbangan nutrisi. Karya ilmiah akhir ini bertujuan untuk memberikan gambaran asuhan keperawatan pada anak yang mengalami ketidakseimbangan nutrisi melalui pendekatan model konservasi Levine serta mengetahui gambaran skrining malnutrisi menggunakan Paediatric Yorkhill Malnutrition Score PYMS . Model konservasi Levine diaplikasikan pada lima kasus kelolaan. Intervensi yang diberikan berdasarkan prinsip konservasi Levine untuk mengatasi masalah yang ditemukan. Hasil evaluasi akhir perawatan dari tropichognosis ketidakseimbangan nutrisi pada kelima kasus menunjukkan masalah dapat teratasi. Metode Evidence Based Nursing Practice menggunakan pendekaatan PICO. Hasil skrining PYMS menggambarkan nilai sensitivitas dan spesifisitas lebih tinggi yaitu 95,7 dan 66,7 . PYMS dapat disarankan untuk digunakan dalam melakukan skrining anak dengan ketidakseimbangan nutrisi.

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ABSTRACTNutrition imbalances and infectious diseases are mutually influencing factors. Nutritional imbalances will lead to infectious diseases, otherwise infectious diseases will also cause the child to experience nutritional imbalances. This final study was to provide an illustration of nursing care in children with nutritional imbalances through the Levine conservation model approach and know the malnutrition screening using Paediatric Yorkhill Malnutrition Score PYMS . Levine 39 s conservation model was applied to five cases of management. Interventions are given based on Levine 39 s conservation principles to address the problems found. The final evaluation result of treatment of tropichognosis nutritional imbalances in the five cases indicates the problem can be resolved. The Evidence Based Nursing Practice method used the PICO approach. PYMS screening results illustrated a higher sensitivity and specificity of 95.7 and 66.7 . PYMS may be recommended for use in screening children with nutritional imbalances."

"Pemenuhan kebutuhan nutrisi merupakan bagian penting dalam proses asuhan keperawatan pada anak dengan penyakit infeksi. Tujuan studi kasus ini adalah untuk memberikan gambaran pemenuhan kebutuhan nutrisi pada anak melalui penerapan intervensi oral hygiene menggunakan pendekatan model konservasi Levine. Pengkajian dilakukan berdasarkan konservasi Levine terhadap lima kasus terpilih yang menunjukkan gangguan pemenuhan nutrisi. Hipotesis, intervensi dan respon organismic ditujukan untuk mencapai adaptasi serta membuat klien mencapai keutuhan wholeness . Intervensi oral hygiene terbukti efektif menurunkan derajat kerusakam membrane mukosa oral dalam membantu optimalisasi pemenuhan kebutuhan nutrisi.

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Fulfillment of nutritional needs is an important part in the process of nursing care in children with infectious diseases. The purpose of this case study is to provide an overview of the fulfillment of nutritional needs in children through the application of oral hygiene interventions using the Levine conservation model approach. The assessment was conducted based on the Levine conservation of five selected cases demonstrating nutritional impairment. Hypotheses, interventions and organismic responses are aimed at achieving adaptation and making the client wholeness. Oral hygiene intervention has been shown to effectively lower the degree of oral mucous membrane damage in helping to optimize the fulfillment of nutritional needs."

"ABSTRAKAnak dan remaja yang menderita kanker sering mengalami gangguan tidur yang dapat menyebabkan penurunan daya tahan tubuh dan mempengaruhi kualitas hidup. Tujuan penulisan artikel ini adalah untuk memberikan gambaran penerapan Model Konservasi Levine dalam asuhan keperawatan pada anak dengan kanker yang mengalami gangguan tidur. Desain yang digunakan adalah studi kasus. Terdapat lima kasus yang menjadi pembahasan dalam artikel ini dan teridentifikasi bahwa masalah tidur merupakan masalah yang utama. Intervensi keperawatan yang diberikan didasarkan pada prinsip-prinsip konservasi yaitu konservasi energi, integritas struktural, integritas personal dan integritas sosial. Hasil evaluasi berdasarkan respon organismik menunjukkan sebagian besar masalah dapat teratasi dan menunjukkan perbaikan meskipun belum teratasi secara keseluruhan. Model Konservasi Levine direkomendasikan untuk dapat diterapkan dalam memberikan asuhan keperawatan pada anak dengan kanker yang mengalami gangguan tidur dengan intervensi sleep hygiene dan terapi komplementer pemberian madu sebelum anak tidur untuk mencapai hasil asuhan yang optimal."

"Karya Ilmiah Akhir ini memberikan gambaran tentang pelaksanaan Program Residensi Ners Spesialis Keperawatan Anak dalam bentuk kegiatan praktik Residensi I dan II. Karya Ilmiah Akhir ini bertujuan untuk memberikan gambaran aplikasi Model Konservasi Myra E. Levine pada asuhan keperawatan anak dengan penyakit infeksi dan pencapaian kompetensi baik sebagai pemberi asuhan, advocator, conselor, educator, colaborator, dan agen perubah selama praktik residensi. Menurut model konservasi Levin, trophicognosis peningkatan suhu tubuh (demam) merupakan gangguan pada integritas struktur. Intervensi keperwatan dilakukan untuk mengkonservasi integritas struktur tersebut, yang berdampak pada konservasi energi, integritas personal dan integritas sosial. Pada kondisi demam intervensi yang dilakukan adalah mempertahankan agar lingkungan tetap nyaman dan sejuk, mengurangi aktivitas yang melelahkan, meningkatkan istirahat, memberikan asupan nutrisi yang adekuat. Konsep lain yang diterapkan dalam asuhan keperawatan dengan demam ini adalah konsep family centered care (FCC), kemudian melaksanakan ners spesialis sebagai inovator, residen melaksanakan proyek inovasi berupa pembuatan format dischar planning dan optimalisasi ruang bermain.

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This final assignment provides an overview about the implementation residency practices of the specialist pediatric nurse program in the form practical activities residency I and II. The aim of this final assignment is provide overview application Conservation Model Myra E. Levine on nursing care of children with infectious diseases and the achievement of competencies such as a caregiver advocator, counselor, educator, collaborator, and change agents during practice residency. According to Levin conservation models, trophicognosis increase in body temperature (fever) is an interference with the integrity of the structure. Nursing interventions undertaken to conserve the integrity of these structures, which have an impact on energy conservation, personal integrity and social integrity. In the intervention condition of fever is to preserve the environment in order to stay comfortable and cool, reducing the exhausting activity, increased rest, providing adequate nutrition. Another concept that is applied in nursing care with a fever is the concept of family centered care (FCC), then carry out specialist nurses as an innovator, a resident carrying out innovation projects making planning and optimization dischar format playroom."

"Intoleransi minum merupakan masalah yang umum terjadi pada bayi prematur Tujuan penulisan Karya Ilmiah Akhir ini adalah memberikan gambaran penerapan Model Konservasi Levine pada bayi prematur dengan intoleransi minum dan gambaran pelaksanaan Praktik Residensi Keperawatan Anak Model Konservasi Levine berfokus pada peningkatan adaptasi melalui prinsip konservasi untuk mencapai integritas diri Penerapan Model Konservasi Levine tertuang dalam lima kasus terpilih Pada lima kasus terpilih tersebut ditemukan masalah gangguan pemenuhan kebutuhan nutrisi yang disebabkan oleh intoleransi minum Adapun masalah keperawatan lainnya adalah bersihan jalan napas tidak efektif gangguan pola napas gangguan termoregulasi risiko infeksi risiko gangguan perkembangan dan gangguan proses keluarga Masalah masalah tersebut dapat memperberat intoleransi minum dan menghambat proses pemulihan pada bayi prematur Asuhan keperawatan pada kasus terpilih diberikan oleh residen dengan melaksanakan perannya sebagai pemberi asuhan pendidik konsultan koordinator pengambil keputusan etik legal dan sebagai peneliti.

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Feeding intolerance is a common problem in premature infants The purpose of this Final Scientific Work is to describe the application of Levine Conservation Model in preterm infants with feeding intolerance and the implementation of Pediatric Nursing Residency Practice Levine Conservation Model focuses on the adaptation improvement through conservation principles to achieve wholeness Levine Conservation Model was implemented in five selected cases In the five selected cases there was a nutritional intake problem caused by feeding intolerance The other problems were ineffective airway clearance ineffective breathing pattern ineffective thermoregulation risk for infection risk for developmental disorder and altered family process These problems can aggravate the feeding intolerance and inhibit the healing process of premature infants The nursing care to selected cases was given by the resident by implementing the roles as a caregiver an educator a consultant a coordinator an ethical and legal decision maker and a researcher"