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"Pendahuluan: Pasien fraktur akan berisiko mengalami konstipasi. Teknik pijat Swedish merupakan intervensi yang dapat mengurangi konstipasi, dimana pijat perut ini akan memberikan tekanan lembut pada permukaan jaringan sehingga dapat memperbaiki sirkulasi, melancarkan peredaran darah, menambah kenyamanan dan memperbaiki masalah sistem pencernaan. Air hangat dapat memberikan rangsangan pada sistem pencernaan sehingga feses menjadi lembek dan mudah untuk keluar. Dalam penelitian ini komsumsi air putih yang diberikan sebanyak 500 ml di pagi hari sesaat setelah bangun tidur.Tujuan: Tujuan penelitian ini untuk mengidentifikasi perbandingan efektivitas dari komsumsi air putih hangat dan pijat perut teknik Swedish terhadap skor konstipasi pada pasien post operasi fraktur ekstremitas bawah.Metode: Penelitian ini menggunakan desain Quasy eksperimental pre post test design dengan randomized control group pre post test design. Teknik pengambilan sampel menggunakan teknik simple random sampling. Perhitungan sampel dengan mengggunakan perhitungan komparatif numerik dengan total sampel minimal adalah 30 sampel dan instrumen pada penelitian ini menggunakan Constipation Assesment Scale (CAS).Hasil: Penelitian ini melaporkan bahwa konsumsi air putih maupun pijat perut teknik Swedish secara signifikan menurunkan skor konstipasi (p-value 0,00; α < 0,05). Namun, berdasarkan hasil uji statistik karakteristik responden jenis kelamin, usia dan jenis analgetik didapatkan hasil tidak signifikan terhadap skor konstipasi (p-value 0,71; 0,22; 0,57; α < 0,05). Terdapat perbedaan yang signifikan secara statistik antara skor konstipasi dengan rerata skor pada kelompok intervensi konsumsi air putih hangat 3,8 dan pada kelompok intervensi pijat perut teknik Swedish 6,5. Uji statistik menggunakan  pair t-test (p-value 0,00; α < 0,05).Kesimpulan: Penelitian ini menunjukkan bahwa intervensi konsumsi air putih hangat maupun pijat perut teknik Swedish secara signifikan dapat menurunkan skor konstipasi pada pasien fraktur ekstremitas bawah.

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Introduction: Fracture patients will be at risk of experiencing constipation. Swedish massage technique is an intervention that can reduce constipation, where this abdominal massage will apply gentle pressure to the surface of the tissue so that it can improve circulation, improve blood circulation, increase comfort and improve digestive system problems. Warm water can stimulate the digestive system so that the stool becomes soft and easy to pass. In this study, the consumption of water was given as much as 500 ml in the morning right after waking up.

Objective: The purpose of this study was to identify the comparative effectiveness of warm water consumption and Swedish abdominal massage technique on constipation scores in postoperative patients with lower extremity fractures.

Methods: This study used a Quasy experimental pre posttest design with randomized control group pre posttest design. The sampling technique used simple random sampling technique. Sample calculation using numerical comparative calculation with a total minimum sample of 30 samples and instruments in this study using the Constipation Assessment Scale (CAS).

Results: This study reported that both water consumption and Swedish abdominal massage significantly reduced constipation scores (p-value 0.00; α < 0.05). However, based on the results of statistical tests of respondent characteristics of gender, age and type of analgesic, the results were not significant on constipation scores (p-value 0.71; 0.22; 0.57; α < 0.05). There was a statistically significant difference between constipation scores with a mean score in the warm water consumption intervention group of 3.8 and in the Swedish abdominal massage intervention group of 6.5. Statistical test using pair t-test (p-value 0.00; α < 0.05).

Conclusion: This study shows that the intervention of warm water consumption and Swedish abdominal massage can significantly reduce constipation scores in lower limb fracture patients."

"Praktik residensi keperawatan medikal bedah adalah rangkaian dari program pendidikan magister keperawatan yang dilaksanakan dalam tatanan pelayanan keperawatan. Keperawatan medikal bedah berfokus pada konsep dan prinsip dasar medikal dan bedah dalam penerapan ilmu dan tehnologi keperawatan untuk memenuhi kebutuhan pasien dewasa yang mengalami perubahan fisik dengan atau tanpa gangguan struktural. Praktik residensi keperawatan dilaksanakan di RSPAD Gatot Soebroto dan RSUP Fatmawati. Kegiatan Residensi terdiri dari pemberian asuhan keperawatan pada pasien dengan gangguan muskuloskeletal menggunakan pendekatan teori Virginia Henderson. Asuhan keperawatan telah diberikan pada pasien dengan fraktur, osteoarthritis, SCI, osteosarcoma, spondylitis TB dan beberapa kasus lainnya. Pendekatan teori Henderson membantu pasien untuk memenuhi kebutuhannya selama mengalami gangguan muskuloskeletal. Penerapan evidence based nursing (EBN) melalui intervensi edukasi pada pasien yang akan menjalani operasi tulang belakang membantu pasien dalam menurunkan kecemasan dan nyeri. Intervensi edukasi membantu pemahaman pasien dalam menghadapi operasi sehingga mengurangi kecemasan dan dapat mengelola nyeri dengan lebih baik. Proyek inovasi melalui aplikasi peran perawat dalam program Enhace Recovery for Orthopedic Surgery (EROS) pada pasien operasi Total Hip Replacement (THR). Aplikasi peran perawat membantu pasien dalam persiapan operasi sampai dengan rehablitasi paska operasi.

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The residency program in medical medical nursing is a series of nursing master education programs carried out in the order of nursing services. Medical surgical nursing focuses on concepts and basic medical and surgical principles in the application of nursing science and technology to meet the needs of adult patients who experience physical changes with or without structural disorders. The practice of nursing residencies was carried out at Gatot Soebroto Army Hospital and Fatmawati General Hospital. Residency activities consist of giving nursing care to patients with musculoskeletal disorders using the Virginia Henderson theory approach. Nursing care has been given to patients with fractures, osteoarthritis, SCI, osteosarcoma, TB spondylitis and several other cases. Henderson's theoretical approach helps patients to meet their needs while experiencing musculoskeletal disorders. The application of evidence based nursing (EBN) through educational interventions in patients who will undergo spinal surgery helps patients reduce anxiety and pain. Educational interventions help understanding patients in the face of surgery so as to reduce anxiety and manage pain better. The innovation project through the application of the role of nurses in the Enhace Recovery for Orthopedic Surgery (EROS) program in patients operating Total Hip Replacement (THR). The application of the role of nurses helps patients in preparation for surgery until postoperative rehabilitation."

"Asuhan keperawatan yang diberikan oleh perawat sangat mempengaruhi kualitas pelayanan kesehatan yang akan diterima oleh pasien. Upaya yang dilakukan untuk meningkatkan kualitas asuhan keperawatan tersebut salah satunya dengan menerapkan peran ners spesialis. Tujuan penulisan Karya Ilmiah Akhir (KIA) ini adalah mampu menampilkan peran ners spesialis sebagai pemberi asuhan keperawatan lanjut, pembaharu dan peneliti. Metodologi dan pendekatan yang digunakan adalah dengan menggunakan studi literature. Karya Ilmiah Akhir berisi tentang : penerapan teori Virginia Henderson pada pasien dengan Neglected Fracture Left Shaft Femur, penerapan Progressive Muscle Relaxation (PMR) sebagai Evidance Based Nursing dan proyek inovasi yaitu Aplikasi Peran Perawat dalam Program Enhanced Recovery Orthopedic Surgery (EROS) pada Pasien Operasi Total Hip Replacement (THR). Hasil : Penerapan teori Virginia Henderson efektif diterapkan pada kasus muskuloskeletal. Intervensi Progressive Muscle Relaxation (PMR) juga efektif dalam menurunkan Anxiety pasien. Kesimpulan : bahwa teori Virginia Henderson dapat digunakan pada pasien dengan Neglected Fracture Left Shaft Femur untuk meningkatkan kemandirian akibat perubahan fisik dan psikologis. Intervensi Progressive Muscle Relaxation (PMR) dapat digunakan sebagai salah satu alternatif intervensi keperawatan mandiri dalam membantu mengurangi Anxiety pasien fraktur ekstremitas yang akan di lakukan tindakan operasi elektif.

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Nursing care provided by nurses greatly influences the quality of health services patients will receive. Efforts are being made to improve the quality of nursing care, either is applying the role of specialist nurses. The purpose of this Final Scientific Writing is able to show the role of specialist ners as nurse care nurse, change agent and researcher Methodology and approach used is by using literature study. The final work contains: the application of Virginia Hendersons theory to patients with Neglected Fracture Left Shaft Femur, and the Application Progressive Muscle Relaxation as Evidance Based Nursing and innovation projects Application of the Role of Nurses in Enhanced Recovery Orthopedic Surgery (EROS) in Patient Surgery Total Hip Replacement (THR). Results: The application of Virginia Hendersons theory was effectively applied to musculoskeletal cases. The intervention of Progressive Muscle Relaxation (PMR) is also effective in reducing patient anxiety. Conclusion: that Virginia Hendersons theory is appropriately used in patients with Neglected Fracture Left Shaft Femur to improve independence due to physical and psychological changes. The intervention of Progressive Muscle Relaxation (PMR) can be used as one of the alternative independent nursing interventions to help reduce Anxiety patients in limb fracture elective surgery."

"With the time available to surgeons-in-training ever dwindling, there is great emphasis placed on practical learning tools. Mirroring his earlier book on practical procedures in trauma surgery, Prof Giannoudis has produced a reference in more elective techniques. In most medical schools, most emphasis is placed on orthopaedic trauma surgery, with elective techniques often delayed until much later in a surgeon?s training."

"Latar Belakang: Nyeri pascaoperasi menyebabkan penglepasan sitokin proinflamasi yang secara resiprokal dapat memodulasi sensitifitas nyeri. Asetaminofen merupakan analgetik yang sering digunakan dan bekerja pada susunan saraf pusat, sedangkan ibuprofen menghambat siklooksigenase dan diyakini dapat mengurangi penglepasan sitokin. Penelitian ini membandingkan ibuprofen intravena 800 mg dan asetaminofen intravena 1000 mg dalam mengurangi respons inflamasi pascaoperasi ekstremitas bawah dengan parameter konsentrasi IL-6 dan CRP sebagai penanda nyeri.Metode: Uji klinis acak tersamar ganda dengan kontrol aktif di RSUPN dr. Cipto Mangunkusumo pada Juli - November 2017. Setelah mendapatkan izin dari Komite Etik, 62 subjek yang menjalani pembedahan elektif ortopedi ekstremitas bawah dialokasikan secara acak menjadi 2 kelompok. Kelompok A Asetaminofen mendapatkan asetaminofen intravena 1000 mg sedangkan Kelompok I Ibuprofen mendapatkan ibuprofen intravena 800 mg masing-masing setiap 6 jam. Sampel darah untuk pemeriksaan respons inflamasi IL-6 dan CRP diambil sesaat sebelum selesai pembedahan sebelum obat dimasukkan, 4, 6, dan 24 jam setelah pemberian obat pertama kali. Derajat nyeri VAS saat istirahat maupun bergerak diukur pada saat setelah pasien tersadar dari pembiusan, 4, 6, 8 dan 24 jam pascaoperasi. Hasil: Serum IL-6 dan CRP tidak berbeda bermakna antara kelompok A dan I pada semua waktu pengukuran. VAS saat bergerak dan istirahat lebih rendah pada kelompok I pada 24 jam pascabedah p

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Background Postoperative pain causes release of proinflammatory cytokines that reciprocally modulate pain sensitivity. Acetaminophen is a commonly used analgesic and acts on central nervous system, whereas ibuprofen inhibits cyclooxygenase and is believed to reduce cytokine release. This study compared intravenous ibuprofen 800 mg and intravenous acetaminophen 1000 mg in reducing postoperative inflammatory responses in lower extremity surgery with IL 6 and CRP as pain indicator.Methods Double blind randomized clinical trial with active control at RSUPN dr. Cipto Mangunkusumo in July November 2017. After obtaining approval from Ethics Committee, 62 subjects undergoing elective orthopedic surgery of lower extremities were randomly assigned to 2 groups. Group A Acetaminophen received 1000 mg intravenous acetaminophen while Group I ibuprofen received 800 mg intravenous ibuprofen every 6 hours respectively. Blood samples for inflammatory responses IL 6 and CRP were taken at the end of surgery prior to administration of study drug, 4, 6, and 24 hours afterward. Pain VAS at rest and with movement was assessed immediately after the surgery when patient recovered, 4, 6, 8 and 24 hours postoperative.Results There is no significant difference in serum IL 6 and CRP between group A and I at all time measurements. VAS at rest and with movement was lower in group I at 24 hours postoperative p."

"This highly illustrated text book will be an essential guide for surgeons in training, providing step by step approaches to performing Joint Aspiration/Injection, Bone Graft Harvesting and Lower Limb Amputations. Practical guidance will be given on Indications- Preoperative assessment, positioning and preparing the patient, approach required, tips and tricks, closure, postoperative complications, protocol of mobilization and follow-up procedure. All the procedures performed will include numerous intraoperative photographs and illustrations."