tag:blogger.com,1999:blog-25726539437917894762024-03-05T00:50:36.530-08:00SISTEM ENDOKRINita_2A_SISTEM_ENDOKRINhttp://www.blogger.com/profile/01283161728267260485noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-2572653943791789476.post-3315915371668518052011-07-06T00:40:00.000-07:002011-07-06T00:45:37.539-07:00ASKEP PADA KLIEN DENGAN GANGGUAN KELENJAR TYROID<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-outline-level: 3; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Penyakit akibat gangguan kelenjar tiroid umum terjadi,namun untungnya dapat di diagnosa dengan cepat dan di obati dengan hasil yang sangat baik. </span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><br />
Penyakit tiroid timbul sebagai gangguan fungsi (hipofungsi atau hiperfungsi) atau sebagai lesi masa (perbesaran neoplasma atau nonneoplastik,yang di kenal sebagai goiter).<br />
<br />
A. Tinjauan Gangguan Kelenjar Tiroid</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><br />
<br />
<b style="mso-bidi-font-weight: normal;"><u>I. Hipertiroidisme</u></b></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><br />
<br />
Hipertiroidisme digambarkan sebagai suatu kondisi dimana terjadi kelebihan sekresi hormon tiroid. Tirotoksikosis mengacu pada manivestasi klinis yang terjadi bila jaringan tubuh di stimulasi oleh peningkatan hormon ini. Hipertiroidisme merupakan kelainan endokrin yang dapat di cegah. Seperti kebanyakan kondisi tiroid, kelainan ini merupakan kelainan yang sangat menonjol pada wanita. Kelainan ini menyerang wanita empat kali lebih banyak daripada para pria, terutama wanita muda yang berusia antara 20 dan 40 tahun.<br />
<br />
<b style="mso-bidi-font-weight: normal;">PATOFISIOLOGI<br />
</b><br />
Hipertiroidisme mungkin karena overfungsi keseluruhan kelenjar, atau kondisi yang kurang umum, mungkin disebabkan oleh fungsi tunggal atau multiple adenoma kanker tiroid. Juga pengobatan miksedema dengan hormon tiroid yang berlebihan dapat menyebabkan hipertiroidisme. Bentuk hipertiroidisme yang paling umum adalah penyakit Graves (goiter difustoksik)yang mempuyai tiga tanda penting yaitu :</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><br />
(1). Hipertiroidisme<br />
(2) Perbesaan kelenjar tiroid (goiter)<br />
(3) Eksoptalmos (protrusi mata abnormal)<br />
Penyebab lain hipertiroidisme dapat mencakup goiter nodular toksik, adenoma toksik (jinak), karsinoma tiroid, tiroiditis subakut dan kronis, dan ingesti TH.<br />
<br />
Dampak hipertiroidisme terhadap berbagai sistem tubuh adalah sebagai beikut :<br />
1. Sistem integument seperti diaphoresis, rambut halus, jarang dan kulit lembab.<br />
2. Sistem pencernaan seperti berat badan menurun, nafsu makan meningkat dan diare.<br />
3. Sistem muskuloskeletal seperti kelemahan.<br />
4. Sistem pernapasan seperti dispnea dan takipnea.<br />
5. Sistem kardiovaskular seperti palpitasi, nyeri dada.<br />
6. Metabolik seperti peningkatan laju metabolisme tubuh, intoleran terhadap panas dan suhu sub febris.<br />
7. Sistem neurologi seperti mata kabur, mata lelah, insomnia.<br />
8. Sistem reproduksi seperti amenore, volume menstruasi berkurang dan libido meningkat.<br />
9. Psikologis/Emosi seperti gelisah, iritabilitas, gugup/nervous.<br />
<br />
<b style="mso-bidi-font-weight: normal;"><u>II. Hipotiroidisme</u></b><br />
<br />
Penurunan sekresi hormon kelenjar tiroid sebagai akibat kegagalan mekanisme kompensasi kelenjar tiroid dalam memenuhi kebutuhan jaringan tubuh akan hormon-hormon tiroid.<br />
<br />
<br />
<b style="mso-bidi-font-weight: normal;">PATOFISIOLOGI</b><br />
<br />
Hipotiroidisme dapat terjadi akibat pengangkatan kelenjar tiroid dan pada pengobatan tirotoksikosis dengan RAI. Juga terjadi akibat infeksi kronis kelenjar tiroid dan atropi kelenjar tiroid yang bersifat idiopatik.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><br />
Prevalensi penderita hipotiroidisme meningkat pada usia 30 sampai 60 tahun, empat kali lipat angka kejadiannya pada wanita di bandingkan pria. Hipotiroidisme kongenital di jumpai satu orang pada empat ribu kelahiran hidup.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><br />
Jika produksi hormon tiroid tidak adekuat maka kelenjar tiroid akan berkompensasi untuk meningkatkan sekresinya sebagai respons terhadap rangsangan hormon TSH. Penurunan sekresi hormon kelenjar tiroid akan menurunkan laju metabolisme basal yang akan mempengaruhi semua sistem tubuh. Proses metabolik yang di pengaruhi antara lain :</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><br />
a. Penurunan produksi asam lambung (aclorhidia)<br />
b. Penurunan motilitas usus<br />
c. Penurunan detak jantung<br />
d. Gangguan fungsi neurologik<br />
e. Penurunan produksi panas<br />
<br />
Penurunan hormon tiroid juga akan mengganggu metabolisme lemak dimana akan terjadi peningkatan kadar kolesterol dan trigliserida sehingga klien berpotensi mengalami atherosklerosis Akumulasi proteoglicans hidrophilik di rongga intertisial seperti rongga pleura, cardiak dan abdominal sebagai tanda dari mixedema. Pembentukan eritrosit yang tidak optimal sebagai dampak dari menurunnya hormon tiroid memungkinkan klien mengalami anemi.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><br />
Dampak hipotiroidisme terhadap berbagai sistem tubuh adalah sebagai berikut :<br />
1. Sistem integument seperti kulit dingin, pucat, kering, bersisik<br />
2. Sistem pulmonari seperti hipoventilasi, pleural efusi, dispnea<br />
3. Sistem kardiovaskular seperti brakikardi¸disritmia,pembesaran jantung.<br />
4. Metabolik seperti penurunan meabolisme basal, penurunan suhu tubuh.<br />
5. Sistem muskuloskeletal seperti nyeri otot, kontraksi dan relaksasi otot yang melambat.<br />
6. Sistem neurologi seperti fungsi intelektual yang lambat, berbicara lambat dan terbata-bata.<br />
<br />
<b style="mso-bidi-font-weight: normal;"><u>III. Hipertrofi Kelenjar Tiroid</u></b><br />
<br />
Kelenjar tiroid mengalami pembesaran akibat pertambahan ukuran sel/jaringan tanpa di sertai peningkatan atau penurunan sekresi hormon-hormon kelenjar tiroid. Disebut juga sebagai goiter nontosik atau simple goiter atau struma Endemik. Pada kondisi ini dimana pembesaran kelenjar tidak disertai penurunan atau peningkatan sekresi hormon-hormonnya maka dampak yang di timbulkannya hanya bersifat lokal yaitu sejauh mana pembesaran tersebut mempengaruhi organ di sekitarnya seperti pengaruhnya pada trakhea dan esophagus.<br />
<br />
<b style="mso-bidi-font-weight: normal;">PATOFISIOLOGI</b><br />
<br />
Berbagai faktor di identifikasi sebagai penyebab terjadinya hipertropi kelenjar tiroid termasuk di dalamnya defisiensi jodium, goitrogenik glikosida agent (zat atau bahan ini dapat menekan sekresi hormon tiroid) seperti ubi kayu, jagung lobak,<br />
kangkung, kubis bila di konsumsi secara berlebihan, obat-obatan anti tiroid, anomali, peradangan dan tumor/neoplasma.<br />
Sedangkan secara fisiologis, menurut Benhard (1991) kelenjar tiroid dapat membesar sebagai akibat peningkatan aktifitas kelenjar tiroid sebagai upaya mengimbangi kebutuhan tubuh yang meningkat pada masa pertumbuhan dan masa kehamilan<br />
Berdasarkan kejadiannya atau penyebarannya ada yang di sebut Struma Endemis dan Sporadis. Secara sporadis dimana kasus-kasus struma ini di jumpai menyebar diberbagai tempat atau daerah. Bila di hubungkan dengan penyebab maka struma sporadis banyak disebabkan oleh faktor goitrogenik, anomali dan penggunaan obat-obatan anti tiroid, peradangan dan neoplasma. Secara endemis, dimana kasus-kasus struma ini dijumpai pada sekelompok orang di suatu daerah tertentu, dihubungkan dengan penyebab defisiensi jodium.<br />
<br />
<b style="mso-bidi-font-weight: normal;">B. Penatalaksanaan Klien dengan Hipertiroidisme</b><br />
<br />
I. Pengkajian<br />
<br />
1. Pengumpulan biodata seperti umur, jenis kelamin dan tempat tinggal.<br />
2. Riwayat penyakit dalam keluarga.<br />
3. Kebiasaan hidup sehari-hari mencakup aktifitas dan mobilitas, pola makan, penggunaan obat-obat tertentu, istirahat dan tidur.<br />
4. Keluhan klien seperti berat badan turun meskipun napsu makan meningkat, diare, tidak tahan terhadap panas, berkeringat banyak<br />
5. Pemeriksaan fisik :<br />
a. Amati penampilan umum klien, amati wajah klien khususnya kelainan pada mata seperti :<br />
• Opthalmopati yang di tandai :<br />
- eksoftalmus : bulbus okuli menonjol keluar<br />
- tanda Stellwag s : mata arang berkedip<br />
- tanda Von Graefes : jika klien melihat kebawah maka palpebra superior sukar atau sama sekali tidak dapat mengikuti bola mata<br />
- tanda mobieve : sukar mengadakan atau menahan konvergensi<br />
- tanda joffroy : tidak dapat mengerutkan dahi jika melihat ke atas<br />
- tanda rosenbagh : tremor palpebra jika mata menutup<br />
• Edema palpebra dikarenakan akumulasi cairan di periorbita dan penumpukan lemak di retro orbita<br />
• Juga akan di jumpai penurunan visus akibat penekanan saraf optikus dan adanya tanda-tanda radang atau infeksi pada konjunktiva dan atau kornea<br />
• Fotopobia dan pengeluaran air mata yang berlebihan merupakan tanda yang lazim<br />
b. Amati manifestasi klinis hipertiroidisme pada berbagai sistem tubuh seperti yang sudah dijelaskan sebelumnya<br />
c. Palpasi kelenjar tiroid, kaji adanya pembesaran, bagaimana konsistensinya, apakah dapat digerakkan serta apakah nodul soliter atau multipel<br />
d. Auskultasi adanya “bruit”<br />
6. Pengkajian psikososial<br />
7. Pemeriksaan diagnostik<br />
<br />
II. Diagnosa Keperawatan<br />
<br />
Diagnosa keperawatan yang utama dijumpai pada klien dengan hipertiroidisme adalah :<br />
1. Penurunan curah jantung yang berhubungan dengan penurunan waktu pengisian diastolik sebagai akibat peningkatan frekwensi jantung<br />
2. Perubahan nutrisi : kurang dari kebutuhan tubuh yang berhubungan dengan efek hiperkatabolisme<br />
3. Perubahan persepsi sensoris (penglihatan) yang berhubungan dengan gangguan perpindahan impuls sensoris akibat ofthalmopati<br />
<br />
Diagnosa keperawatan tambahan antara lain :<br />
1. Diare yang berhubungan dengan peningkatan aktivitas metabolik<br />
2. Koping individu tak efektif yang berhubungan dengan emosi yang labil<br />
3. Intoleransi terhadap aktifitas yang berhubungan dengan kelemahan akibat metabolisme yang meningkat<br />
4. Gangguan pola tidur sehubungan dengan suhu tubuh yang meningkat akibat peningkatan metablisme<br />
5. Gangguan proses berpikir yang berhubungan dengan emosi yang labil dan perhatian yang menyempit<br />
<br />
III. Rencana Tindakan Keperawatan<br />
<br />
Diagnosa Keperawatan :<br />
Penurunan curah jantung yang berhubungan dengan menurunnya waktu pengisian diastolik sebagai akibat dari peningkatan frekuensi jantung<br />
<br />
Tujuan :<br />
Fungsi kardiovaskular kembali normal<br />
<br />
Intervensi Keperawatan :<br />
1. Observasi setiap 4 jam nadi apikal, tekanan darah dan suhu tubuh<br />
2. Anjurkan kepada klien agar segera melaporkan pada perawat bila mengalami nyeri dada, palpitasi, dispnea dan vertigo.<br />
3. Upayakan agar klien dapat istirahat<br />
4. Bantu klien memenuhi kebutuhan sehari-hari sesuai kebutuhan<br />
5. Batasi aktivitas yang melelahkan klien<br />
6. Kolaborasi pemberian obat-obat antitiroid.<br />
7. Kolaborasi tindakan pembedahan bila dengan tindakan konservatif<br />
<br />
Diagnosa Keperawatan :<br />
Perubahan nutrisi kurang dari kebutuhan tubuh yang berhubungan dengan efek hiperkatabolisme<br />
<br />
Tujuan :<br />
Setelah perawatan di rumah sakit, klien akan mempertahankan status nutrisi yang optimal<br />
Intervensi Keperawatan :<br />
1. Berikan makanan tinggi kalori tinggi protein<br />
2. Beri makanan tambahan diantara waktu makan<br />
3. Timbang berat badan secara teratur setiap 2 hari sekali<br />
4. Bila perlu, konsultasikan klien dengan ahli gizi<br />
<br />
Diagnosa Keperawatan :<br />
Gangguan persepsi sensoris (penglihatan) yang berhubungan dengan gangguan transmisi impuls sensorik sebagai akibat oftalmopati<br />
<br />
Tujuan :<br />
Klien tidak mengalami penurunan visus yang lebih buruk dan tidak terjadi trauma / cidera pada mata<br />
<br />
Intervensi Keperawatan :<br />
1. Anjurkan pada klien bila tidur dengan posisi elevasi kepala<br />
2. Basahi mata dengan borwater sterill<br />
3. Jika ada photopobia, anjurkan klien menggunakan kacamata rayben<br />
4. Jika klien tidak dapat menutup mata rapat pada saat tidur, gunakan plester non alergi<br />
5. Berikan obat-obat steroid sesuai program<br />
<br />
C. Penatalaksanaan Klien dengan Hipotiroidisme<br />
<br />
I. Pengkajian<br />
<br />
Dampak penurunan kadar hormon dalam tubuh sangat bervariasi, oleh karena itu lakukanlah pengkajian terhadap hal-hal penting yang dapat menggali sebanyak mungkin informasi antara lain :<br />
<br />
1. Riwayat kesehatan klien dan keluarga<br />
2. Kebiasaan hidup sehari-hari seperti :<br />
a. Pola makan<br />
b. Pola tidur (klien menghabiskan banyak waktu untuk tidura)<br />
c. Pola aktivitas<br />
3. Tempat tinggal klien sekarang dan pada waktu balita<br />
4. Keluhan utama klien, mencakup gangguan pada berbagai sistem tubuh :<br />
a. Sistem pulmonari<br />
b. Sistem pencernaan<br />
c. Sistem kardiovaskular<br />
d. Sistem muskuloskeletal<br />
e. Sistem neurologik<br />
f. Sistem reproduk<br />
g. Metabolik<br />
h. Emosi/psikologis<br />
5. Pemeriksaan fisik mencakup :<br />
a. Penampilan secara umum<br />
b. Nadi lambat dan suhu tubuh menurun<br />
c. Perbesaran jantung<br />
d. Disritmia dan hipotensi<br />
e. Parastesia dan reflek tendon menurun<br />
6. Pengkajian psikososial<br />
7. Pemeriksaan penunjang<br />
<br />
II. Diagnosa Keperawatan<br />
<br />
Diagnosa keperawatan utama yang dapat dijumpai pada klien dengan hipotiroidisme antara lain :<br />
<br />
1. Penurunan curah jantung yang berhubungan dengan penurunan volume sekuncup sebagai akibat dari bradikardi : arteriosklerosis arteri koronaria<br />
2. Pola nafas yang tidak efektif yang berhubungan dengan penurunan tenaga / kelelahan : ekspansi paru yang menurun, obesitas dan inaktivitas<br />
3. Gangguan proses pikir yang berhubungan dengan edema jaringan serebral dan retensi air<br />
<br />
Diagnosa keperawatan tambahan antara lain :<br />
1. Perubahan nutrisi<br />
2. Hipotermi<br />
3. Konstipasi<br />
4. Gangguan integritas kulit<br />
5. Disfungsi seksual<br />
<br />
II. Rencana Tindakan Keperawatan<br />
<br />
Diagnosa Keperawatan :<br />
Penurunan curah jantung yang berhubungan dengan penurunan volume sekuncup akibat bradikardi dan arteriosklerosis arteri koronaria<br />
<br />
Tujuan :<br />
Fungsi kardiovaskular tetap optimal yang ditandai dengan tekanan darah irama jantung dalam batas normal<br />
<br />
Intervensi Keperawatan :<br />
1. Pantau tekanan darah, denyut dan irama jantung setiap 2 jam untuk mengidentifikasi kemungkinan terjadinya gangguan hemodinamik jantung seperti hipotensi, penurunan haluaran urine dan perubahan status mental<br />
<br />
2. Anjurkan klien untuk memberitahu perawat segera bila klien mengalami nyeri dada<br />
3. Kolaborasi pemberian obat-obatan untuk mengurangi gejala-gejala<br />
<br />
Diagnosa Keperawatan :<br />
Pola napas tidak efektif yang berhubungan dengan kelelahan, obesitas dan inaktivitas<br />
<br />
Tujuan :<br />
Agar dapat mempertahankan pola napas yang efektif<br />
<br />
Intervensi Keperawatan :<br />
1. Amati dan catat irama serta kedalaman pernafasan<br />
2. Auskultasi bunyi pernapasan dan catat dengan seksama<br />
3. Bila klien mengalami kesulitan pernapasan yang berat, kolaborasikan dengan dokter<br />
4. Hindarkan penggunaan obat sedatif karena dapat menekan pusat pernapasan<br />
5. Bantu klien beraktivitas<br />
6. Penuhi kebutuhan sehari-hari klien sesuai kebutuhan<br />
<br />
Diagnosa Keperawatan :<br />
Gangguan proses berpikir yang berhubungan dengan edema jaringan otak dan retensi air<br />
<br />
Tujuan :<br />
Proses berpikir klien kembali ketingkat yang optimal<br />
<br />
Intervensi Keperawatan :<br />
1. Observasi dan catat tanda gangguan proses berpikir yang berat seperti :<br />
a. Letargi<br />
b. Gangguan memori<br />
c. Tidak ada perhatian<br />
d. Kesulitan berkomunikasi<br />
e. Mengantuk<br />
2. Orientasikan klien kembali dengan lingkungannya baik terhadap orang, tempat dan waktu<br />
3. Beri dorongan pada keluarga agar dapat menerima perubahan prilaku klien dan mengadaptasinya<br />
<br />
Penyuluhan Kesehatan :<br />
Penyuluhan kesehatan sangat penting bagi klien dan keluarga. Berikanlah kepada mereka hal-hal yang harus di perhatikan dalam penggunaan obat di rumah dan perawatan klien pada umumnya. Berikan penjelasan tentang :<br />
1. Cara penggunaan obat, dosis dan waktunya. Tidak meminum obat bersama dengan obat yang lain<br />
2. Tanda dan gejala bila kelebihan obat atau sebaliknya<br />
3. Menggunakan selimut tambahan pada waktu tidur, penggunaan baju hangat dan pakaian tebal bila suhu udara dingin<br />
4. Meningkatkan pemasukan makanan yang bergizi, cairan yang cukup dan makanan tinggi serat<br />
5. Memeriksakan diri secara teratur ke tempat pelayanan kesehatan terdekat<br />
<br />
D. Penatalaksanaan Klien dengan Hipertrofi Kelenjar Tiroid<br />
<br />
I. Pengkajian<br />
<br />
1. Kaji riwayat penyakit :<br />
- sudah sejak kapan keluhan dirasakan klien<br />
- apakah ada anggota keluarga yang berpenyakit sama<br />
2. Tempat tinggal sekarang dan pada masa balita<br />
3. Usia dan jenis kelamin<br />
4. Kebiasaan makan<br />
5. Penggunaan obat-obatan<br />
- Kaji jenis obat-obat yang sedang digunakan dalam 3 bulan terakhir<br />
- Sudah berapa lama digunakan<br />
- Tujuan pemberian obat<br />
6. Keluhan klien :<br />
- Sesak napas, apakah bertambah sesak bila beraktivitas<br />
- Sulit menelan<br />
- Leher bertambah besar<br />
- Suara serak/parau<br />
- Merasa malu dengan bentuk leher yang besar dan tidak simetris<br />
7. Pemeriksaan fisik :<br />
- Palpasi kelenjar tiroid, nodul tunggal atau ganda, konsistensi dan simetris tidaknya, apakah terasa nyeri pada saat di palpasi<br />
- Inspeksi bentuk leher, simetris tidaknya<br />
- Auskultasi bruit pada arteri tyroidea<br />
- Nilai kualitas suara<br />
- Palpasi apakah terjadi deviasi trakhea<br />
8. Pemeriksaan diagnostik<br />
- Pemeriksaan kadar T3 dan T4 serum<br />
- Pemeriksaan RAI<br />
- Test TSH serum<br />
9. Lakukan pengkajian lengkap dampak perubahan patologis diatas terhadap kemungkinan adanya gangguan pemenuhan oksigen, nutrisi, cairan dan elektrolit serta gangguan rasa aman dan perubahan konsep diri seperti :<br />
- Status pernapasan<br />
- Warna kulit<br />
- Suhu kulit (daerah akral)<br />
- Keadaan / kesadaran umum<br />
- Berat badan dan tinggi badan<br />
- Kadar hemoglobin<br />
- Kelembaban kulit dan teksturnya<br />
- Porsi makan yang dihabiskan<br />
- Turgor<br />
- Jumlah dan jenis cairan per oral yang dikonsumsi<br />
- Kondisi mukosa mulut<br />
- Kualitas suara<br />
- Bagaimana ekspresi wajah, cara berkomunikasi dan gaya interaksi klien dengan orang di sekitarnya<br />
- Bagaimana klien memandang dirinya sebagai seorang pribadi<br />
<br />
II. Diagnosa Keperawatan<br />
<br />
Diagnosa keperawatan utama yang dijumpai pada klien dengan goiter nontoksik antara lain :<br />
1. Pola napas yang tidak efektif yang berhubungan dengan penekanan kelenjar tiroid terhadap trakhea<br />
2. Perubahan nutrisi : kurang dari kebutuhan tubuh yang berhubungan dengan asupan yang kurang akibat disfagia<br />
3. Perubahan citra diri yang berhubungan dengan perubahan bentuk leher<br />
4. Gangguan rasa aman : ansietas yang berhubungan dengan kurang informasi tentang penyakit dan pengobatannya, atau persepsi yang salah tentang penyakit yang diderita<br />
<br />
III. Rencana Tindakan Keperawatan<br />
<br />
Diagnosa Keperawatan :<br />
Pola napas yang tidak efektif yang berhubungan dengan penekanan kelenjar tiroid terhadap trakhea<br />
<br />
Tujuan :<br />
Selama dalam perawatan, pola napas klien efektif kembali (sambil menunggu tindakan pembedahan bila diperlukan) dengan kriteria sebagai berikut :<br />
- Frekuensi pernapasan 16-20 x/menit dan pola teratur<br />
- Akral hangat<br />
- Kulit tidak pucat atau cianosis<br />
- Keadaan klien tenang/tidak gelisah<br />
<br />
Intervensi Keperawatan :<br />
1. Batasi aktivitas, hindarkan aktivitas yang melelahkan<br />
2. Posisi tidur setengah duduk dengan kepala ekstensi bila diperlukan<br />
3. Kolaborasi pemberian obat-obatan<br />
4. Bila dengan konservatif gejala tidak hilang, kolaborasi tindakan operatif<br />
5. Bantu aktivitas klien di tempat tidur<br />
6. Observasi keadaan klien secara teratur<br />
7. Hindarkan klien dari kondisi-kondisi yang menuntut penggunaan oksigen lebih banyak seperti ketegangan, lingkungan yang panas atau yang terlalu dingin<br />
<br />
Diagnosa Keperawatan :<br />
Perubahan nutrisi : kurang dari kebutuhan yang berhubungan dengan asupan nutrien kurang akibat disfagia<br />
<br />
Tujuan :<br />
Nutrisi klien dapat terpenuhi kembali dalam waktu 1-2 minggu dengan kriteria sebagai berikut :<br />
- Berat badan bertambah<br />
- Hemoglobin : 12-14 gr% (wanita) dan 14-16 gr% (pria)<br />
- Tekstur kulit baik<br />
<br />
Intervensi Keperawatan :<br />
1. Berikan makanan lunak atau cair sesuai kondisi klien<br />
2. Porsi makanan kecil tetapi sering<br />
3. Beri makanan tambahan diantara jam makan<br />
4. Timbang berat badan dua hari sekali<br />
5. Kolaborasi pemberian ruborantia bila diperlukan<br />
6. Ciptakan lingkungan yang menyenangkan menjelang jam makan<br />
<br />
Diagnosa Keperawatan :<br />
Perubahan citra diri yang berhubungan dengan perubahan bentuk leher<br />
<br />
Tujuan :<br />
Setelah menjalani perawatan, klien memiliki gambaran diri yang positif kembali dengan kriteria :<br />
- Klien menyenangi kembali tubuhnya<br />
- Klien dapat melakukan upaya-upaya untuk mengurangi dampak negatif pembesaran pada leher<br />
- Klien dapat melakukan aktivitas fisik dan sosial sehari-hari<br />
<br />
Intervensi Keperawatan :<br />
1. Dorong klien mengungkapkan perasaan dan pikirannya tentang bentuk leher yang berubah<br />
2. Diskusikan upaya-upaya yang dapat dilakukan klien untuk mengurangi perasaan malu seperti menggunakan baju yang berkerah tertutup<br />
3. Beri pujian bila klien dapat melakukan upaya-upaya positif untuk meningkatkan penampilan diri<br />
4. Jelaskan penyebab terjadinya perubahan bentuk leher dan jalan keluar yang dapat dilakukan seperti tindakan operasi<br />
5. Jelaskan pula setiap risiko yang perlu di antisipasi dari setiap tindakan yang dapat dilakukan<br />
6. Ikut sertakan klien dalam kegiatan keperawatan sesuai kondisi klien<br />
7. Fasilitasi klien untuk bertemu teman-teman sebayanya<br />
<br />
Diagnosa Keperawatan :<br />
Ansietas yang berhubungan dengan kurang pengetahuan klien tentang penyakit dan pengobatannya atau persepsi yang salah tentang penyakit yang diderita<br />
<br />
Tujuan :<br />
Setelah diberikan pendidikan kesehatan sebanyak 2 kali, ansietas klien akan hilang dengan kriteria sebagai berikut :<br />
- Ekspresi wajah tampak rileks<br />
- Klien dapat melakukan aktivitas sehari-hari dengan baik<br />
- Klien mengetahui penyakit dan upaya pengobatan<br />
<br />
Intervensi Keperawatan :<br />
1. Kaji pengetahuan klien tentang penyakit dan pengobatannya<br />
2. Identifikasi harapan-harapan klien terhadap pelayanan yang diberikan<br />
3. Buat rancangan pembelajaran yang mencakup :<br />
- Jenis penyakit dan penyebabnya<br />
- Upaya penanggulangan seperti pemberian obat-obatan, tindakan operasi bila ada indikasi<br />
- Prognosa dan prevalensi penyakit<br />
- Kondisi-kondisi yang dapat menyebabkan keadaan yang lebih buruk dan kondisi yang mempercepat penyembuhan<br />
4. Laksanakan pembelajaran bersama dengan anggota keluarga, perhatikan kondisi klien dan lingkungannya.</span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="text-align: justify;">Dipostingkan oleh : ita nurmalitasari</div><div class="MsoNormal" style="text-align: justify;"> 05200ID09017</div>ita_2A_SISTEM_ENDOKRINhttp://www.blogger.com/profile/01283161728267260485noreply@blogger.com0tag:blogger.com,1999:blog-2572653943791789476.post-22875436705596946172011-06-09T21:12:00.000-07:002011-06-09T21:20:33.656-07:00TUGAS KE IV (5penyakit pada pankreas, SOP perawatan Luka Gangren, Teknik Pemberian Insulin)<div align="center" class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 1; text-align: center;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif";">KANKER PANKREAS</span></b><b><span style="font-family: "Times New Roman","serif";"></span></b></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 1; text-align: justify;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">A.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif";">DEFINISI</span></div><div style="line-height: 150%; text-align: justify;"><b>Kanker pankreas</b> adalah <a href="http://id.wikipedia.org/w/index.php?title=Neoplasma&action=edit&redlink=1" title="Neoplasma (halaman belum tersedia)"><span style="color: windowtext; text-decoration: none;">neoplasma</span></a> yang terjadi pada <a href="http://id.wikipedia.org/wiki/Kelenjar" title="Kelenjar"><span style="color: windowtext; text-decoration: none;">kelenjar</span></a> <a href="http://id.wikipedia.org/wiki/Pankreas" title="Pankreas"><span style="color: windowtext; text-decoration: none;">pankreas</span></a>. Klasifikasi terbagi menjadi kanker endokrin dan kanker eksokrin seperti <a href="http://id.wikipedia.org/w/index.php?title=Adenokarsinoma&action=edit&redlink=1" title="Adenokarsinoma (halaman belum tersedia)"><span style="color: windowtext; text-decoration: none;">adenokarsinoma</span></a>, <a href="http://id.wikipedia.org/w/index.php?title=Karsinoma_adenoskuamus&action=edit&redlink=1" title="Karsinoma adenoskuamus (halaman belum tersedia)"><span style="color: windowtext; text-decoration: none;">karsinoma adenoskuamus</span></a>, <a href="http://id.wikipedia.org/w/index.php?title=Karsinoma_SRC&action=edit&redlink=1" title="Karsinoma SRC (halaman belum tersedia)"><span style="color: windowtext; text-decoration: none;">karsinoma SRC</span></a>, <a href="http://id.wikipedia.org/w/index.php?title=Karsinoma_hepatoid&action=edit&redlink=1" title="Karsinoma hepatoid (halaman belum tersedia)"><span style="color: windowtext; text-decoration: none;">karsinoma hepatoid</span></a>, <a href="http://id.wikipedia.org/w/index.php?title=Karsinoma_koloid&action=edit&redlink=1" title="Karsinoma koloid (halaman belum tersedia)"><span style="color: windowtext; text-decoration: none;">karsinoma koloid</span></a>, <a href="http://id.wikipedia.org/w/index.php?title=Karsinoma_tidak_terdiferensiasi&action=edit&redlink=1" title="Karsinoma tidak terdiferensiasi (halaman belum tersedia)"><span style="color: windowtext; text-decoration: none;">karsinoma tidak terdiferensiasi</span></a>, <a href="http://id.wikipedia.org/w/index.php?title=Karsinoma_UOGC&action=edit&redlink=1" title="Karsinoma UOGC (halaman belum tersedia)"><span style="color: windowtext; text-decoration: none;">karsinoma UOGC</span></a>. Pada umumnya, <a href="http://id.wikipedia.org/wiki/Kanker" title="Kanker"><span style="color: windowtext; text-decoration: none;">kanker</span></a> pada pankreas akan meningkatkan <a href="http://id.wikipedia.org/wiki/Plasma_darah" title="Plasma darah"><span style="color: windowtext; text-decoration: none;">plasma</span></a> <a href="http://id.wikipedia.org/w/index.php?title=Sitokeratin-7&action=edit&redlink=1" title="Sitokeratin-7 (halaman belum tersedia)"><span style="color: windowtext; text-decoration: none;">sitokeratin-7</span></a>, <a href="http://id.wikipedia.org/w/index.php?title=Sitokeratin-8&action=edit&redlink=1" title="Sitokeratin-8 (halaman belum tersedia)"><span style="color: windowtext; text-decoration: none;">8</span></a>, <a href="http://id.wikipedia.org/w/index.php?title=Sitokeratin-13&action=edit&redlink=1" title="Sitokeratin-13 (halaman belum tersedia)"><span style="color: windowtext; text-decoration: none;">13</span></a>, <a href="http://id.wikipedia.org/w/index.php?title=Sitokeratin-18&action=edit&redlink=1" title="Sitokeratin-18 (halaman belum tersedia)"><span style="color: windowtext; text-decoration: none;">18</span></a>, <a href="http://id.wikipedia.org/w/index.php?title=Sitokeratin-19&action=edit&redlink=1" title="Sitokeratin-19 (halaman belum tersedia)"><span style="color: windowtext; text-decoration: none;">19</span></a>, <a href="http://id.wikipedia.org/wiki/Antigen_karsinoembrionik" title="Antigen karsinoembrionik"><span style="color: windowtext; text-decoration: none;">CEA</span></a>, <a href="http://id.wikipedia.org/w/index.php?title=Antigen_karbohidrat-19.9&action=edit&redlink=1" title="Antigen karbohidrat-19.9 (halaman belum tersedia)"><span style="color: windowtext; text-decoration: none;">CA-19.9</span></a>, <a href="http://id.wikipedia.org/w/index.php?title=Antigen_karbohidrat-125&action=edit&redlink=1" title="Antigen karbohidrat-125 (halaman belum tersedia)"><span style="color: windowtext; text-decoration: none;">125</span></a>, B-72.3, <a href="http://id.wikipedia.org/w/index.php?title=DUPAN-2&action=edit&redlink=1" title="DUPAN-2 (halaman belum tersedia)"><span style="color: windowtext; text-decoration: none;">DUPAN-2</span></a> dan <a href="http://id.wikipedia.org/w/index.php?title=Musin-1&action=edit&redlink=1" title="Musin-1 (halaman belum tersedia)"><span style="color: windowtext; text-decoration: none;">musin-1</span></a>, <a href="http://id.wikipedia.org/w/index.php?title=Musin-3&action=edit&redlink=1" title="Musin-3 (halaman belum tersedia)"><span style="color: windowtext; text-decoration: none;">3</span></a>, <a href="http://id.wikipedia.org/w/index.php?title=Musin-4&action=edit&redlink=1" title="Musin-4 (halaman belum tersedia)"><span style="color: windowtext; text-decoration: none;">4</span></a>, <a href="http://id.wikipedia.org/w/index.php?title=Musin-5AC&action=edit&redlink=1" title="Musin-5AC (halaman belum tersedia)"><span style="color: windowtext; text-decoration: none;">5AC</span></a>, dan <a href="http://id.wikipedia.org/w/index.php?title=Klaudin-4&action=edit&redlink=1" title="Klaudin-4 (halaman belum tersedia)"><span style="color: windowtext; text-decoration: none;">klaudin-4</span></a>, <a href="http://id.wikipedia.org/w/index.php?title=Klaudin-18&action=edit&redlink=1" title="Klaudin-18 (halaman belum tersedia)"><span style="color: windowtext; text-decoration: none;">18</span></a>, <a href="http://id.wikipedia.org/wiki/Protein" title="Protein"><span style="color: windowtext; text-decoration: none;">protein</span></a> <a href="http://id.wikipedia.org/w/index.php?title=Protein_S-100&action=edit&redlink=1" title="Protein S-100 (halaman belum tersedia)"><span style="color: windowtext; text-decoration: none;">S-100</span></a>, dan <a href="http://id.wikipedia.org/w/index.php?title=Mesotelin&action=edit&redlink=1" title="Mesotelin (halaman belum tersedia)"><span style="color: windowtext; text-decoration: none;">mesotelin</span></a> yang terikat <i>glycosylphosphatidyl-inositol</i>; dengan ekspresi <a href="http://id.wikipedia.org/wiki/Kompleks_histokompatibilitas_utama" title="Kompleks histokompatibilitas utama"><span style="color: windowtext; text-decoration: none;">HLA</span></a> <a href="http://id.wikipedia.org/w/index.php?title=CD44&action=edit&redlink=1" title="CD44 (halaman belum tersedia)"><span style="color: windowtext; text-decoration: none;">CD44</span></a><sup+, <a href="http://id.wikipedia.org/w/index.php?title=CD24&action=edit&redlink=1" title="CD24 (halaman belum tersedia)"><span style="color: windowtext; text-decoration: none;">CD24<sup>+</sup> ESA<sup>+</sup></span></a>.<sup id="cite_ref-0"><a href="http://id.wikipedia.org/wiki/Kanker_pankreas#cite_note-0"><span style="color: windowtext; text-decoration: none;">[1]</span></a></sup></div><div style="line-height: 150%; text-align: justify;">Pada <a href="http://id.wikipedia.org/w/index.php?title=Panc-1&action=edit&redlink=1" title="Panc-1 (halaman belum tersedia)"><span style="color: windowtext; text-decoration: none;">Panc-1</span></a>, <a href="http://id.wikipedia.org/w/index.php?title=Protein_BM-4&action=edit&redlink=1" title="Protein BM-4 (halaman belum tersedia)"><span style="color: windowtext; text-decoration: none;">BMP-4</span></a> menginduksi <a href="http://id.wikipedia.org/wiki/Transisi_epitelial-mesenkimal" title="Transisi epitelial-mesenkimal"><span style="color: windowtext; text-decoration: none;">EMT</span></a> dan peningkatan aktivitas lesi duktular pankreatik serta adenokarsinoma duktular pankreatik.<sup id="cite_ref-1"><a href="http://id.wikipedia.org/wiki/Kanker_pankreas#cite_note-1"><span style="color: windowtext; text-decoration: none;">[2]</span></a></sup> BMP-2, BMP-4 menginduksi <a href="http://id.wikipedia.org/wiki/Metaloproteinase_matriks-2" title="Metaloproteinase matriks-2"><span style="color: windowtext; text-decoration: none;">MMP-2</span></a> dan aktivitas Panc-1, BMP-7 meningkatkan aktivitas tersebut. Pada kasus adenokarsinoma pankreatik, ekspresi BMP-2, BMPR-2 dan ALK3 mRNA menentukan daya tahan paska bedah. Penelitian terakhir menunjukkan peran <a href="http://id.wikipedia.org/wiki/Asam_retinoat" title="Asam retinoat"><span style="color: windowtext; text-decoration: none;">asam retinoat</span></a> untuk meredakan simtoma adenokarsinoma tersebut</div><ul type="disc"><li class="MsoNormal" style="line-height: 150%; mso-list: l1 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Merokok, penyakit pankreas kronis, dan kemungkinan diabetes yang berlangsung lama adalah faktor resiko untuk kanker pankreas </span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l1 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Rasa sakit, kehilangan berat badan, penyakit kuning, dan muntah adalah beberapa ciri khas gejalanya. </span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l1 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify;"><i><span lang="EN-US" style="font-family: "Times New Roman","serif";">Computed tomography</span></i><span lang="EN-US" style="font-family: "Times New Roman","serif";"> adalah cara diagnosa yang paling tepat. </span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l1 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Kanker pankreas biasanya fatal. </span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l1 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Operasi bisa menyembuhkan mereka yang kankernya tidak menyebar.</span></li>
</ul><div class="MsoNormal" style="line-height: 150%; margin-bottom: 12.0pt; mso-margin-top-alt: auto; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Sekitar 95% tumor yang bersifat kanker (<i>malignant</i>) pada pankreas adalah <i>adenocarcinoma</i>. <i>Adenocarcinoma</i> biasanya berasal dari sel kelenjar yang melapisi saluran pankreas. Kebanyakan <i>adenocarcinoma</i> terjadi di dalam kepala pankreas, bagian yang paling dekat bagian pertama usus kecil (<i>duodenum</i>).</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 12.0pt; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif";"> <i><span lang="EN-US">Adenocarcinoma</span></i><span lang="EN-US"> pada pankreas telah meningkat kemungkinannya di Amerika Serikat, terjadi dalam perkiraan 37.000 orang setiap tahun. <i>Adenocarcinoma</i> biasanya tidak terjadi sebelum usia 50. Usia rata-rata pada diagnosa adalah 55. Tumor ini hampir dua kali terjadinya diantara para lelaki. <i>Adenocarcinoma</i> pada pankreas 2 sampai 3 kali lebih sering terjadi diantara para perokok dibandingkan orang yang tidak merokok. Konsumsi alkohol dan kafein tidak tampak menjadi faktor resiko. Orang yang menderita penyakit pankreas kronis dan mereka yang kemungkinan menderita diabetes yang berlangsung lama (terutama sekali para wanita) berada dalam resiko yang lebih besar juga. </span></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjq4Bq8zRhu2IkOMEaUL4Qz_bGGSdTQiNVUgzZ4am-i4a83E6tetgjJ8gdF5dQQzu2IkNj5QjiCMe-UzQZgbOUFIBuWbwZ1YIByCJ0PSSbo-oVZR14XF6IHULuind-PMl2-1g44jeTQOwWC/s1600/gambar-pankreas.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="280" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjq4Bq8zRhu2IkOMEaUL4Qz_bGGSdTQiNVUgzZ4am-i4a83E6tetgjJ8gdF5dQQzu2IkNj5QjiCMe-UzQZgbOUFIBuWbwZ1YIByCJ0PSSbo-oVZR14XF6IHULuind-PMl2-1g44jeTQOwWC/s320/gambar-pankreas.jpg" width="320" /></a></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 12pt; text-align: justify;"><br />
</div><div style="margin-left: 36.0pt; mso-list: l0 level1 lfo2; text-indent: -18.0pt;">B.<span style="font: 7pt "Times New Roman";"> </span>PENYEBAB</div><div style="line-height: 150%; text-align: justify;">Penyebab Seperti kasus kanker pada umumnya, karsinogen tercetus oleh sinergis banyak faktor antara lain</div><ul type="disc"><li class="MsoNormal" style="line-height: 150%; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kebiasaan merokok</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kurangnya asupan <a href="http://id.wikipedia.org/wiki/Sayur" title="Sayur"><span style="color: windowtext; text-decoration: none;">sayur</span></a> dan <a href="http://id.wikipedia.org/wiki/Buah" title="Buah"><span style="color: windowtext; text-decoration: none;">buah</span></a></span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tingginya asupan <a href="http://id.wikipedia.org/wiki/Daging" title="Daging"><span style="color: windowtext; text-decoration: none;">daging</span></a> merah</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><a href="http://id.wikipedia.org/wiki/Gemuk" title="Gemuk"><span style="color: windowtext; text-decoration: none;">Gemuk</span></a></span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><a href="http://id.wikipedia.org/wiki/Diabetes_mellitus" title="Diabetes mellitus"><span style="color: windowtext; text-decoration: none;">Diabetes mellitus</span></a></span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><a href="http://id.wikipedia.org/wiki/Pankreatitis" title="Pankreatitis"><span style="color: windowtext; text-decoration: none;">Pankreatitis</span></a> kronis</span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Infeksi <a href="http://id.wikipedia.org/w/index.php?title=Helicobacter_pylori&action=edit&redlink=1" title="Helicobacter pylori (halaman belum tersedia)"><span style="color: windowtext; text-decoration: none;">Helicobacter pylori</span></a></span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><a href="http://id.wikipedia.org/w/index.php?title=Gingivitis&action=edit&redlink=1" title="Gingivitis (halaman belum tersedia)"><span style="color: windowtext; text-decoration: none;">Gingivitis</span></a></span></li>
</ul><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 12.0pt; mso-add-space: auto; mso-margin-top-alt: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif";">C.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif";">GEJALA</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Tumor di kepala pankreas bisa berhubungan dengan pembuangan pada empedu (cairan penncernaan yang dihasilkan oleh hati) ke dalam usus kecil. Oleh karena itu, <i>jaundice</i> (perubahan warna kuning pada kulit dan warna putih pada mata) disebabkan oleh penyumbatan pada aliran empedu biasanya adalah gejala awal. <i>Jaundice</i> tersebut disertai oleh rasa gatal di seluruh tubuh diakibatkan dari penyimpanan kristal garam empedu di bawah kulit. Muntah bisa diakibatkan dari hal-hal ketika kanker di kepala pankreas menyumbat aliran pada isi perut ke dalam usus kecil (penyumbatan pada saluran lambung) atau penyumbatan usus kecil itu sendiri.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif";"> <span lang="EN-US">Komplikasi : <i>adenocarcinoma</i> pada tubuh atau ujung pankreas (bagian tengah pada pankreas dan bagian terjauh dari <i>duodenum</i>) biasanya tidak menyebabkan gejala-gejala sampai tumor tersebut berkembang luas. Dengan begitu, gejala pertama adalah rasa sakit dan kehilangan berat badan. Pada waktu diagnosa, 90% orang mengalami rasa sakit pada perut-biasanya rasa sakit hebat di perut bagian atas yang tembus ke bagian belakang-dan kehilangan berat badan yang signifikan. <br />
<i>Adenocarcinoma</i> pada tubuh atau ujung pankreas bisa menghalangi pembuluh mengeringkan limpa (organ yang menghasilkan, memantau, menyimpan, dan menghancurkan sel darah), mengakibatkan pembesaran limpa (<i>splenomegaly</i>). Penyumbatan bisa menyebabkan pembuluh menjadi bengkak dan terpuntir (<i>varicose</i>) di sekitar kerongkongan (varises kerongkongan) dan perut. Pendarahan hebat bisa terjadi, terutama berasal dari kerongkongan, jika varises vena pecah.</span></span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraph" style="line-height: 150%; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif";">D.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Jenis Langka Kanker Pankreas</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><i><span lang="EN-US">Cystadenocarcinoma </span></i><span lang="EN-US" style="font-family: "Times New Roman","serif";">pada pankreas adalah jenis yang langka pada kanker pankreas yang terbentuk dari tumor berisi cairan yang tidak bersifat kanker (<i>benign</i>) disebut <i>cystadenoma</i>. Hal itu seringkali menimbulkan rasa sakit perut sebelah atas dan bisa berkembang cukup besar untuk seorang dokter merasakan hal itu melalui dinding perut. Diagnosa biasanya dibuat dengan ultrasonografi atau pemindai <i>computed tomography</i> (CT)pada pankreas. Hanya 20% pada kanker ini telah menyebar pada saat operasi dilakukan. Oleh karena itu, cystadenocarcinoma memiliki dugaan yang lebih baik dibandingkan adenocarcinoma. Jika kanker tidak menyebar dan seluruh pankreas diangkat dengan cara operasi, orang tersebut memiliki 65% kesempatan untuk bertahan hidup setidaknya 5 tahun. <br />
<br />
Tumor <i>intraductal papillary-mucinous</i> adalah jenis tumor pankreas langka yang ditandai dengan pembesaran (<i>dilation</i>) pada saluran utama pankreas, memproduksi lendir secara berlebihan, dan kadangkala sakit. Lebih dari 30% tumor ini bersifat kanker (<i>malignant</i>), tetapi karena tes diagnosa tidak dapat membedakan antara bentuk yang bersifat kanker dan bukan pada tumor ini, operasi adalah diagnosa terbaik dan pilihan pengobatan untuk setiap orang yang terduga memiliki tumor <i>intraductal papillary-mucinous</i>.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif";">E.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif";">DIAGNOSA</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 12.0pt; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Diagnosa awal pada tumor di dalam tubuh atau ujung pankreas adalah sulit karena gejala-gejala lambat terjadi dan pengamatan fisik dan hasil tes darah seringkali normal. Ketika <i>adenocarcinoma</i> pada pankreas diduga, pemeriksaan diagnosa yang paling tepat adalah <i>computed tomography</i> (CT). Pemeriksaan lain yang umumnya digunakan adalah pemindai ‘ultrasonik’, <i>endoscopic retrograde cholangiopancreatography</i> dan <i>magnetic resonance imaging</i> (MRI). </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 12.0pt; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Untuk memastikan diagnosa, seorang dokter bisa memeperoleh contoh pankreas untuk diteliti di bawah mikroskop (biopsi) dengan memasukkan jarum melalui kulit menggunakan CT atau pemindai ‘ultrasonik’ sebagai panduan. Meskipun begitu, pendekatan ini seringkali tidak terlihat tumor tersebut dan bisa menyebarkan sel kanker ke luar daerah lokal sepanjang lintasan jarum. Pendekatan yang sama kemungkinan digunakan untuk memperoleh contoh biopsi dari hati untuk melihat kanker yang telah menyebar ke pankreas, jika hasil dari pemeriksaan ini adalah normal tetapi dokter masih menduga keras <i>adenocarcinoma</i>, pankreas kemungkinan diteliti dengan cara operasi. </span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif";">F.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif";">PENGOBATAN</span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Karena <i>adenocarcinoma</i> pada pankreas biasanya menyebar ke bagian yang lain pada tubuh sebelum ditemukan, prognosisinya sangat rendah. Kurang dari 2 % orang yang menderita <i>adenocarcinoma</i> pada pankreas bertahan hidup untuk 5 tahun setelah diagnosa. Harapan satu-satunya kesembuhan adalah operasi, yang dilakukan pada 10 sampai 20 % orang yang percaya bahwa kanker tersebut tidak menyebar. Salah satu dari pankreas tunggal atau pankreas dan duodenum diangkat. Setelah beberapa operasi, hanya 15 sampai 20 % orang hidup sampai 5 tahun. Kemoterapi tambahan dan terapi radiasi biasanya diberikan tetapi tidak mungkin memperbaiki waktu atau tingkat bertahan hidup secara mendasar. </span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Rasa sakit ringan kemungkinan dihilangkan dengan aspirin atau asetaminofen. Seringkali, pembunuh rasa sakit yang kuat sekali, seperti codeine atau morphine digunakan lewat mulut, diperlukan. Untuk 70 sampai 80% orang dengan rasa sakit yang hebat, suntikan ke dalam saraf untuk menghambat rasa sakit bisa menghasilkan keringanan. Kebocoran pada enzim pencernaan pankreas bisa diobati dengan persiapan enzim oral. Jika diabetes terbentuk, pengobatan insulin kemungkinan diperlukan.</span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif";"> Penyumbatan pada aliran empedu kemungkinan hilang sementara dengan menempatkan pipa (<i>stent</i>) di bagian bawah perut pada saluran yang mengeringkan empedu dari hati dan kantung empedu. Pada kebanyakan kasus, meskipun begitu, tumor tersebut kadangkala menyumbat saluran di sebelah atas dan bawah stent. Metode pengobatan alternatif adalah menciptakan pembedahan pada saluran yang dipotong melalui saluran yang menghubungkan perut dengan bagian usus kecil yang melebihi sumbatan. </span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Karena <i>adenocarcinoma</i> pada pankreas adalah fatal pada kebanyakan kasus, seorang dokter biasanya membicarakan perawatan sampai akhir hidup dengan orang tersebut, anggota keluarga, dan praktisi pemerhati kesehatan lainnya. </span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Referensi</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif";">http://medicastore.com/penyakit/3124/Kanker_Pankreas.html</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif";">http://wikipedia.com </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: center; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PANKREATITIS AKUT</span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 25.1pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">A.<span style="font: 7pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Pengertian</span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 25.1pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Pankreatitis akut merupakan keadaan inflamasi pankreas yang bersifat reversibel.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Pankreatitis akut adalah inflamasi pankreas yang biasanya terjadi akibat alkoholisme dan penyakit saluran empedu seperti kolelitiasis dan kolesistisis. (Sandra M. Nettina, 2001) </span><span style="font-family: "Times New Roman","serif";">. </span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Pankreatitis akut atau inflamasi pada pankreas terjadi akibat tercernanya organ ini oleh enzim-enzimnya sendiri, khususnya oleh tripsin. (Brunner & Suddart, 2001:1339)</span><span style="font-family: "Times New Roman","serif";">. </span><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pankreatitis Akut</span></b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> merupakan reaksi peradangan pankreas, secara klinis ditandai nyeri perut akut dengan kenaikan enzim dalam darah dan urin. Perjalanan penyakit dari ringan self limited sampai berat yang disertai renjatan gangguan ginjal dan paru-paru yang bisa berakibat fatal.<b> Pankreatitis Akut</b>. Ditandai gagal organ dengan adanya renjatan, insufisiensi paru (PaO</span><span lang="EN-US" style="font-family: "Cambria Math","serif"; font-size: 12pt; line-height: 150%;">₂</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> ≤60 mmHg), gangguan ginjal (kreatinin >2 mg/dL) dan perdarahan saluran cerna atas (>500 mL/hari). Adanya nekrosis, pseudokista atau abses juga berperan dalam beratnya pankreatitis</span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7xCNEMLu-Q1zVcOVBoN02bHtcCvGJZkS6ywQe_SI6RhcW9rUj57csDZT9YPa28dk7DPfomeDFBIt_i3bG3Z6f2KJ5s1ALKEnGTLUnTk2S0-oaQoDSPfBwES_AMJ_68ZAcaMjDRPx-5vRh/s1600/Januvia3.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7xCNEMLu-Q1zVcOVBoN02bHtcCvGJZkS6ywQe_SI6RhcW9rUj57csDZT9YPa28dk7DPfomeDFBIt_i3bG3Z6f2KJ5s1ALKEnGTLUnTk2S0-oaQoDSPfBwES_AMJ_68ZAcaMjDRPx-5vRh/s1600/Januvia3.jpg" /></a></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 25.1pt;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 25.1pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo2; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif";">B.<span style="font: 7pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif";">Klasifikasi</span></b></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pankreatitis Akut Interstisial</span></b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">. Terdapat nekrosis lemak di tepi pankreas dan edema interstisial; biasanya ringan dan self limited</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Secara makroskopik pankreas membengkak secara difus dan pucat. Tidak terdapat nekrosis atau perdarahan, bila ada, minimal sekali. Secara mikroskopik, daerah interstisial melebar karena adanya edema ekstrasel, disertai sebaran sel leukosit PMN. Saluran pankreas diisi bahan purulen. Tidak didapatkan destruksi asinus.</span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pankreatits Akut Nekrosis</span></b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">. Bisa setempat atau difus; terdapat korelasi antara derajat nekrosis pankreas dan beratnya serangan serta manifestasi sistemik. Secara makroskopik, tampak nekrosis jaringan pankreas (lemak di tepi pankreas, parenkim) disertai perdarahan dan inflamasi yang dapat mengisi ruang retroperitoneal. Bila penyakit berlanjut, tampak abses dan timbulnya bakteri di jaringan nekrosis yang berdinding (abses purulen). Secara mikroskopik, adanya nekrosis lemak dan jaringan pankreas, kantong infiltrat yang meradang dan berdarah. Pembuluh darah di dalam dan di sekitar daerah nekrotik menunjukkan kerusakan mulai dari inflamasi perivaskular, vaskulitis, dan trombosis pembuluh darah. Bentuk pankreatitis ini lebih fatal dibanding pankreatitis akut interstisial</span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Faktor yang menentukan beratnya <b>pankreatitis akut</b> sebagian masih belum diketahui. Pada 80% kasus pankreatitis akut, jaringan yang meradang masih hidup (<b>pankreatitis interstisial</b>), sisanya 20% mengalami <b>nekrosis pankreas atau nekrosis peripankreas</b> yang merupakan komplikasi berat dan mengancam jiwa. Nekrosis peripankreas diduga akibat aktivitas lipase pankreas pada jaringan lemak peripankreas; sedang penyebab nekrosis pankreas adalah multifaktor (kerusakan mikrosirkulasi dan efek langsung enzim pankreas pada parenkim pankreas)</span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 25.1pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada <b>pankreatitis interstisial</b> dapat menunjukkan toksisitas sistemik yang jelas (gagal napas), umumnya self limited bila tidak terdapat nekrosis pankreas. Bila terdapat nekrosis pankreas, kerusakan bersifat permanen, karena adanya enzim pankreas, toksin, dan timbulnya infeksi sekunder</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 25.1pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">C.<span style="font: 7pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";"> Etiologi</span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Faktor-faktor etiologik pada pankreatitis akut yaitu:</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 32.2pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l4 level1 lfo3; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">a.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Metabolik</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 46.4pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo4; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">1.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Alkoholisme</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 46.4pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo4; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">2.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Hiperlipoproteinemia</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 46.4pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo4; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">3.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif";"> Hiperkalsemia</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 46.4pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo4; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">4.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Obat-obatan (misalnya, diuretik tiazid)</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 46.4pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo4; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">5.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Genetik <a href="http://www.blogger.com/post-edit.g?blogID=2572653943791789476&postID=2287543670559694617" name="more"></a></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 32.2pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l4 level1 lfo3; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">b.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Mekanis</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 46.4pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l6 level1 lfo5; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">1.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Trauma</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 46.4pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l6 level1 lfo5; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">2.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Batu empedu</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 46.4pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l6 level1 lfo5; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">3.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Jejas iatrogenic</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 46.4pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l6 level1 lfo5; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">4.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Jejas perioperatif</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 46.4pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l6 level1 lfo5; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">5.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Prosedur endoskopik dengan penyuntikan zat warna</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 32.2pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l4 level1 lfo3; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">c.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Vaskuler</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 46.4pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l9 level1 lfo6; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">1.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Syok</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 46.4pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l9 level1 lfo6; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">2.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Atheroembolisme</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 46.4pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l9 level1 lfo6; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">3.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Poliarteritis nodosa</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 32.2pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l4 level1 lfo3; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">d.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Infeksi </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 46.4pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l11 level1 lfo7; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">1.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Parotitis (<i>mumps</i>)</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 46.4pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l11 level1 lfo7; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">2.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Coxsackievirus</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 46.4pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l11 level1 lfo7; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">3.<span style="font: 7pt "Times New Roman";"> </span></span><i><span lang="EN-US" style="font-family: "Times New Roman","serif";">Mycoplsma pneumoniae</span></i><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 25.1pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">D.<span style="font: 7pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Manifestasi Klinik</span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Nyeri abdomen yang hebat merupakan gejala utama pankreatitis. Rasa sakit dan nyeri tekan pada abdomen yang disertai nyeri pada punggung, terjadi akibat iritasi dan edema pada pankreas yang mengalami inflamasi tersebut sehingga timbul rangsangan pada ujung-ujung saraf. Peningkatan tegangan pada kapsul pankreas dan obstruksi duktus pankreatikus juga turut manimbulkan rasa sakit. Secara khas rasa sakit terjadi pada bagian tengah ulu hati (midepigastrium). Awitannya sering bersifat akut dan terjadi 24 hingga 48 jam setelah makan atau setelah mengkonsumsi minuman keras; rasa sakit ini dapat bersifat menyebar dan sulit ditentukan lokasinya. Umumnya rasa sakit semakin parah setelah makan dan tidak dapat diredakan dengan pemberian antasid. Rasa sakit dapat disertai dengan distensi abdomen, adanya massa abdominal yang dapat diraba tetapi batasnya tidak jelas, dan dengan penurunan peristaltis. </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Perut yang kaku atau mirip papan dapat terjadi dan merupakan tanda yang fatal. Namun demikian, abdomen dapat tetap lunak jika tidak terjadi peritonitis. Ekimosis (memar) di daerah pinggang dan di sekitar umbilikus merupakan tanda yang menunjukkan adanya pankreatitis hemoragik yang berat.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Mual dan muntah umumnya dijumpai pada pankreatitis akut. Muntahan biasanya berasal dari isi lambung tetapi juga dapat mengandung getah empedu. Gejala panas, ikterus, konfusi dan agitasi dapat terjadi. </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Hipotensi yang terjadi bersifat khas dan mencerminkan keadaan hipovolemia serta syok yang disebabkan oleh kehilangan sejumlah besar cairan yang kaya protein karna cairan ini mengalir ke dalam jaringan dan rongga peritoneum. Pasien dapat mengalami takikardi, sianosis dan kulit yang dingin serta basah disamping gejala hipotensi. Gangguan pernapsan serta hipoksia lazim terjadi, dan pasien dapat memperlihatkan gejala infiltrasi paru yang difus, dispnu, takipnu dan hasil pemeriksaan gas darah abnormal. </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 25.1pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">E.<span style="font: 7pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";"> Patofisiologi </span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 25.1pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Pankreas menyekresikan sejumlah enzim; amilase dan lipase disekresikan dalam bentuk aktif sementara protease, elastase dan fosfolipase disekresikan sebagai proenzim yang dalam keadaan normal harus diaktifkan oleh tripsin di dalam duodenum. Tripsin sendiri normalnya diaktifkan oleh enteropeptidase duodenal. Patogenesis pankreatitis akut berpusat pada aktivitas tripsin yang tidak tepat di dalam pankreas; tripsin yang sudah diaktifkan tersebut akan mengubah (i) berbagai proenzim menjadi aktif (ii) prekalikrein menjadi kalikrein yang akan mengaktifkan sistem kinin serta pembekuan. Hasil nettonya berupa inflamasi pankreas dan trombosis. Ciri-ciri pankreatitis meliputi <i>proteolisis jaringan, lipolisis dan perdarahan</i>, terjadi karna efek destruktif enzim-enzim pankreas yang dilepas dari sel-sel asiner. </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Mekanisme yang dikemukakan untuk aktivitas enzim pankreas meliputi hal-hal berikut ini:</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 25.1pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l13 level1 lfo8; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">a)<span style="font: 7pt "Times New Roman";"> </span></span><i><span lang="EN-US" style="font-family: "Times New Roman","serif";">Obstruksi duktus penkreatikus</span></i><span lang="EN-US" style="font-family: "Times New Roman","serif";">. Batu empedu dapat terjepit di dalam ampula Vateri; di sebelah proksimal obstruksi, cairan kaya enzim menumpuk dan menimbulkan jejas parenkim pankreas. Leukosit dalam jaringan parenkim akan melepaskan sitokin proinflamatorik yang menggalakkan inflamasi local dan edema.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 25.1pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l13 level1 lfo8; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">b)<span style="font: 7pt "Times New Roman";"> </span></span><i><span lang="EN-US" style="font-family: "Times New Roman","serif";">Jejas primer sel asiner</span></i><span lang="EN-US" style="font-family: "Times New Roman","serif";">. Keadaan ini dapat disebabkan oleh kerusakan karna virus (<i>parotitis</i>), obat-obatan, trauma atau iskemia.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 25.1pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l13 level1 lfo8; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">c)<span style="font: 7pt "Times New Roman";"> </span></span><i><span lang="EN-US" style="font-family: "Times New Roman","serif";">Defek transportasi-intraseluler proenzim</span></i><span lang="EN-US" style="font-family: "Times New Roman","serif";">. Enzim-enzim eksokrin pankreas mengalami kesalahan arah dalam perjalanannya, yaitu menuju lisosom dan bukan menuju sekresi; hidrolisis proenzim di dalam lisosom akan menyebabkan aktivitas dan pelepasan enzim.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 25.1pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l13 level1 lfo8; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">d)<span style="font: 7pt "Times New Roman";"> </span></span><i><span lang="EN-US" style="font-family: "Times New Roman","serif";">Alkohol</span></i><span lang="EN-US" style="font-family: "Times New Roman","serif";"> dapat meningkatkan jejas sel asiner lewat perjalanan proenzim intraseluler yang salah arah dan pengendapan sumbatan protein yang mengental serta bertambah banyak di dalam duktud pankreatikus sehingga terjadi inflamasi dan obstruksi lokal.</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 25.1pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l13 level1 lfo8; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">e)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Pankreatitis herediter ditandai oleh serangan rekuren pankreatitis yang hebat dan sudah di mulai sejak usia kanak-kanak. Kelainan ini disebabkan oleh mutasi <i>germ line</i> (garis-turunan sel tunas) pada:</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo9; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">1)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Gen <i>tripsinogen kationik</i> (<i>PRSS1</i>), menimbulkan kehilangan suatu tempat pada tripsin yang esensial untuk inaktivasi enzim itu sendiri (mekanisme pengaman yang penting untuk mengatur aktivitas enzim tripsin).</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo9; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">2)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Gen <i>inhibitor protease serin, Kazal tipe I</i> (<i>SPINK1</i>), yang menimbulkan protein yang cacat sehingga tidak lagi mampu memperlihatkan aktivitas tripsin. </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 25.1pt; mso-add-space: auto; mso-list: l12 level1 lfo2; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">F.<span style="font: 7pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif";">Tanda Dan Gejala </span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 25.1pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Nyeri abdomen yang hebat merupakan gejala utama pankreatitis yang menyebabkan pasien datang ke rumah sakit. Rasa sakit dan nyeri tekan abdomen yang disertai nyeri pada punggung, terjadi akibat iritasi dan edema pada pankreas yang mengalami inflamasi tersebut sehingga timbul rangsangan pada ujung-ujung saraf. Peningkatan tekanan pada kapsul pankreas dan obstruksi duktus pankreatikus juga turut menimbulkan rasa sakit.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Secara khas rasa sakit yang terjadi pada bagian tengah ulu hati (midepigastrium). Awitannya sering bersifat akut dan terjdi 24-48 jam setelah makan atau setelah mengkonsumsi minuman keras; rasa sakit ini dapat bersifat menyebar dan sulit ditentukan lokasinya. Umumnya rasa sakit menjadi semakin parah setelah makan dan tidak dapat diredakan dengan pemberian antasid. Rasa sakit ini dapat disertai dengan distensi abdomen, adanya massa pada abdomen yang dapat diraba tetapi batasnya tidak jelas dan dengan penurunan peristatis. Rasa sakit yang disebabkan oleh pankreatitis sering disertai dengn muntah.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Pasien tampak berada dalam keadaan sakit berat defens muskuler teraba pada abdomen. Perut yang kaku atau mirip papan dapat terjadi dan merupakan tanda yang fatal. Namun demikian abdomen dapat tetap lunak jika tidak terjadi peritonitis. Ekimosis (memar) didaerah pinggang dan disekitar umbilikus merupakan tanda yang menunjukkan adanya pankreatitis haemoragik yang berat.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Mual dan muntah umumnya dijumpai pada pankreatitis akut. Muntahan biasanya berasal dari isi lambung tetapi juga dapat mengandung getah empedu. Gejala panas, ikterus, konfusidan agitasi dapat terjadi.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Hipotensi yang terjadi bersifat khas dan mencerminkan keadaan hipovolemia serta syok yang disebabkan oleh kehilangan sejumlah besar cairan yang kaya protein, karena cairan ini mengalir kedalam jaringan dan rongga peritoneum. Pasien dapat mengalami takikardia, sianosis dan kulit yang dingin serta basah disamping gejala hipotensi. Gagal ginjal akut sering dijumpai pada keadaan ini.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Gangguan pernafasan serta hipoksia lazim terjadi, dan pasien dapat memperlihatkan gejala infiltrasi paru yang difus, dispnoe, tachipnoe dan hasil pemeriksaan gas darah abnormal. Depresi miokard, hipokalsemia, hiperglikemia dan koagulopati intravaskuler diseminata dapat pula terjadi pada pankreatitis akut (Brunner & Suddart, 2001:1339)</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 25.1pt; mso-add-space: auto; mso-list: l12 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif";">G.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span lang="EN-US" style="font-family: "Times New Roman","serif";">Pemeriksaan Penunjang</span></b><span style="font-family: "Times New Roman","serif";"></span></div><ol start="1" style="margin-top: 0cm;" type="1"><li class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l2 level1 lfo1; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Scan-CT : menentukan luasnya edema dan nekrosis</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l2 level1 lfo1; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Ultrasound abdomen: dapat digunakan untuk mengidentifikasi inflamasi pankreas, abses, pseudositis, karsinoma dan obstruksi traktus bilier.</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l2 level1 lfo1; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Endoskopi : penggambaran duktus pankreas berguna untuk diagnosa fistula, penyakit obstruksi bilier dan striktur/anomali duktus pankreas. Catatan : prosedur ini dikontra indikasikan pada fase akut.</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l2 level1 lfo1; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Aspirasi jarum penunjuk CT : dilakukan untuk menentukan adanya infeksi.</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l2 level1 lfo1; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Foto abdomen : dapat menunjukkan dilatasi lubang usus besar berbatasan dengan pankreas atau faktor pencetus intra abdomen yang lain, adanya udara bebas intra peritoneal disebabkan oleh perforasi atau pembekuan abses, kalsifikasi pankreas.</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l2 level1 lfo1; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Pemeriksaan seri GI atas : sering menunjukkan bukti pembesaran pankreas/inflamasi.</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l2 level1 lfo1; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Amilase serum : meningkat karena obstruksi aliran normal enzim pankreas (kadar normal tidak menyingkirkan penyakit).</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l2 level1 lfo1; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Amilase urine : meningkat dalam 2-3 hari setelah serangan.</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l2 level1 lfo1; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Lipase serum : biasanya meningkat bersama amilase, tetapi tetap tinggi lebih lama.</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l2 level1 lfo1; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Bilirubin serum : terjadi pengikatan umum (mungkin disebabkan oleh penyakit hati alkoholik atau penekanan duktus koledokus).</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l2 level1 lfo1; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Fosfatase Alkaline : biasanya meningkat bila pankreatitis disertai oleh penyakit bilier.</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l2 level1 lfo1; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Albumin dan protein serum dapat meningkat (meningkatkan permeabilitas kapiler dan transudasi cairan kearea ekstrasel).</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l2 level1 lfo1; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Kalsium serum : hipokalsemi dapat terlihat dalam 2-3 hari setelah timbul penyakit (biasanya menunjukkan nekrosis lemak dan dapat disertai nekrosis pankreas).</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l2 level1 lfo1; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Kalium : hipokalemia dapat terjadi karena kehilangan dari gaster; hiperkalemia dapat terjadi sekunder terhadap nekrosis jaringan, asidosis, insufisiensi ginjal.</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l2 level1 lfo1; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Trigliserida : kadar dapat melebihi 1700 mg/dl dan mungkin agen penyebab pankreatitis akut.</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l2 level1 lfo1; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">LDH/AST (SGOT) : mungkin meningkat lebih dari 15x normal karena gangguan bilier dalam hati.</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l2 level1 lfo1; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Darah lengkap : SDM 10.000-25.000 terjadi pada 80% pasien. Hb mungkin menurun karena perdarahan. Ht biasanya meningkat (hemokonsentrasi) sehubungan dengan muntah atau dari efusi cairan kedalam pankreas atau area retroperitoneal.</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l2 level1 lfo1; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Glukosa serum : meningkat sementara umum terjadi khususnya selama serangan awal atau akut. Hiperglikemi lanjut menunjukkan adanya kerusakan sel beta dan nekrosis pankreas dan tanda aprognosis buruk. Urine analisa; amilase, mioglobin, hematuria dan proteinuria mungkin ada (kerusakan glomerolus).</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l2 level1 lfo1; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Feses : peningkatan kandungan lemak (seatoreal) menunjukkan gagal pencernaan lemak dan protein (Dongoes, 2000).</span></li>
</ol><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 25.1pt; mso-add-space: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 25.1pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">H.<span style="font: 7pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Penatalaksanaan </span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 25.1pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Penatalaksanaan pasien pankreatitis akut bersifat asimtomatik dan ditujukan untuk mencegah atau mengatasi komplikasi. Semua asupan peroral harus dihentikan untuk menghambat stimulasi dan sekresi pankreas. Pelaksanaan TPN (<i>total parenteral nutrition</i>) pada pankreatitis akut biasanya menjadi bagian terapi yang penting. Pemasangan NGT dengan pengisapan (<i>suction</i>) isi lambung dapat dilakukan untuk meredakan gejala mual dan muntah, mengurangi distensi abdomen yang nyeri dan ileus paralitik, serta untuk mengeluarkan asam hidroklorida agar asam ini tidak kembali mengalir kedalam duodenum serta menstimulasi pankreas. Preparat simetidin (Tagamet) juga digunakan untuk menurunkan sekresi asam hidroklorida.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><b><i><span lang="EN-US" style="font-family: "Times New Roman","serif";">Penanganan Nyeri</span></i></b><span lang="EN-US" style="font-family: "Times New Roman","serif";">. Pemberian obat pereda nyeri yang adekuat merupakan tindakan yang esensial dalam perjalanan penyakit pankreatitis akut karna akan mengurangi rasa nyeri dan kegelisahan yang dapat menstimulasi sekresi pankreas. Penggunaan morfin dan turunannya harus dihindari karna preparat ini dapat menyebabkan spasme sfingter Oddi. Antiemetik dapat diberikan untuk mencegah muntah.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><b><i><span lang="EN-US" style="font-family: "Times New Roman","serif";">Perawatan Intensif</span></i></b><span lang="EN-US" style="font-family: "Times New Roman","serif";">. Koreksi terhadap kehilangan cairan serta darah dan kadar albumin yang rendah diperlukan untuk mempertahankan volume cairan dan mencegah gagal ginjal akut. </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><b><i><span lang="EN-US" style="font-family: "Times New Roman","serif";">Perawatan Respiratorius</span></i></b><span lang="EN-US" style="font-family: "Times New Roman","serif";">. Perawatan respiratorius yang agresif diperlukan karna resiko untuk terjadinya elevasi diafragma, infiltrasi serta efusi dalam paru, dan atelektasis cenderung tinggi. Hipoksemia terjadi dengan frekuensi yang bermakna pada penderita pankreatitis akut sekalipun pada pemeriksaan sinar-X tidak tampak adanya kelainan. Perawatan respiratorius dapat berkisar dari pemantauan gas darah arteri yang ketat, pemberian oksigen hingga intubasi dan ventilasi mekanis.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><b><i><span lang="EN-US" style="font-family: "Times New Roman","serif";">Drainase Bilier</span></i></b><span lang="EN-US" style="font-family: "Times New Roman","serif";">. Pemasangan drain bilier (untuk drainase eksternal) dan <i>stent</i> (selang indwelling) dalam duktus pankreatikus melalui endoskoppi telah dilakukan dengan keberhasilan yang terbatas. Terapi ini akan membentuk kembali aliran pankreas dan akibatnya, akan mengurangi rasa sakit serta menaikkan berat badan.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><b><i><span lang="EN-US" style="font-family: "Times New Roman","serif";">Intervensi Bedah</span></i></b><span lang="EN-US" style="font-family: "Times New Roman","serif";">. Meskipun pasien yang berada dalam keadaan sakit berat mempunyai resiko bedah yang buruk, namun pembedahan dapat dilakukan untuk membantu menegakkan diagnosa pankreatitis (laparatomi diagnostik), untuk membentuk kembali drainase pankreas atau untuk melakukan reseksi atau pengangkatan jaringan pankreas yang nekrotik. Pasien yang menjalani operasi pankreas dapat memiliki lebih dari satu drain yang terpasang pada tempat pascaoperatif dan luka insisi terbuka, yang dirigasi dan diganti balutannya setiap 2 sampai 3 hari sekali untuk menghilangkan debris nekrotik.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><b><i><span lang="EN-US" style="font-family: "Times New Roman","serif";">Penatalaksanaan Pasca-akut</span></i></b><span lang="EN-US" style="font-family: "Times New Roman","serif";">. Antasid dapat diberikan ketika gejala akut pankreatitis mulai menghilang. Pemberian makanan yang rendah lemak dan protein dimulai secara bertahap. </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 25.1pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">I.<span style="font: 7pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Diagnosa Keperawatan</span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Diagnosa keperawatan yang lazim muncul pada klien dengan Pankreatitis</span><span style="color: black; font-family: "Times New Roman","serif";"> akut</span><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";"> adalah:</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 25.1pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l8 level1 lfo10; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">1.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";"> Nyeri berhubungan dengan obstruksi pankreas, duktus bilier, kontaminasi kimia pada permukaan peritoneal oleh eksudat pankreas/autodigestif oleh pankreas.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Ditandai dengan: keluhan nyeri, focus pada diri sendiri, wajah meringis, perilaku distraksi/tegang.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 25.1pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l8 level1 lfo10; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">2.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Resiko tinggi terhadap kekurangan volume cairan berhubungan dengan kebilangan berlebihan, peningkatan ukuran dasar vaskuler, gangguan proses pembekuan, perdarahan.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Ditandai dengan: </span><span lang="EN-US" style="font-family: "Times New Roman","serif";">tidak dapat diterapkan adanya tanda dan gejala.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 25.1pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l8 level1 lfo10; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">3.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";"> Perubahan nutrisi kurang dari kebutuhan tubuh berhubungan dengan muntah, penurunan pemasukan oral, pembatasan diet, kehilangan enzim pencernaan dan insulin.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Ditandai dengan: keluhan pemasukan makanan tidak adekuat, enggan makan, keluhan gangguan sensasi pengecap, penurunan berat badan.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 25.1pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l8 level1 lfo10; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">4.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";"> Resiko tinggi terhadap infeksi berhubungan dengan tidak adekuatnya pertahanan utama: statis cairan tubuh, gangguan peristaltik, perubahan pH pada sekresi. Defisiensi nutrisi.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Ditandai dengan: </span><span lang="EN-US" style="font-family: "Times New Roman","serif";">tidak dapat diterapkan adanya tanda dan gejala.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 25.1pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">J.<span style="font: 7pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Rencana Keperawatan</span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; mso-list: l7 level1 lfo11; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">1.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";"> Nyeri berhubungan dengan obstruksi pankreas, duktus bilier, kontaminasi kimia pada permukaan peritoneal oleh eksudat pankreas/autodigestif oleh pankreas.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Tujuan:</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">a. Mengatakan nyeri hilang/terkontrol.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">b. Mengikuti program terapeutik.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">c. Menunjukkan penggunaan metode yang menghilangkan nyeri.</span><span style="color: black; font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: -18.0pt;"><br />
</div><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; margin-left: 33.75pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 1184;"><tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;"> <td style="border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 1.0cm;" valign="top" width="38"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";">No</span></div></td> <td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 184.3pt;" valign="top" width="246"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Intervensi</span></div></td> <td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 7.0cm;" valign="top" width="265"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Rasional</span></div></td> </tr>
<tr style="mso-yfti-irow: 1;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 1.0cm;" valign="top" width="38"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";">1. </span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 184.3pt;" valign="top" width="246"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Selidiki keluhan verbal nyeri, lihat lokasi dan intensitas khusus (skala 0-10). Catat faktor-faktor yang meningkatkan dan menghilangkan nyeri</span><span style="font-family: "Times New Roman","serif";"></span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 7.0cm;" valign="top" width="265"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">nyeri sering menyebar, berat dan tidak berhubungan pada pankreatitis akut atau perdarahan. Nyeri berat sering merupakan gejala utama pada pasien pankreatitis kronik. Nyeri tersembunyi pada kuadran kanan atas menunjukkan keterlibatan kepala pankreas. Nyeri pada kuadran kiri atas diduga keterlibatan ekor pankreas. Nyeri terlokalisir menunjukkan terjadinya pseudokista atau abses.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><br />
</div></td> </tr>
<tr style="mso-yfti-irow: 2;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 1.0cm;" valign="top" width="38"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";">2.</span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 184.3pt;" valign="top" width="246"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Pertahankan tirah baring selama serangan akut. Berikan lingkungan tenang.</span><span style="font-family: "Times New Roman","serif";"></span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 7.0cm;" valign="top" width="265"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">menurunkan laju metabolik dan rangsangan/sekresi GI, sehingga menurunkan aktivitas pankreas.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><br />
</div></td> </tr>
<tr style="mso-yfti-irow: 3;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 1.0cm;" valign="top" width="38"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";">3.</span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 184.3pt;" valign="top" width="246"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Ajarkan teknik relaksasi.</span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 7.0cm;" valign="top" width="265"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">meningkatkan relaksasi dan memampukan pasien untuk memfokuskan perhatian; dapat meningkatkan koping.</span></div></td> </tr>
<tr style="mso-yfti-irow: 4;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 1.0cm;" valign="top" width="38"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";">4.</span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 184.3pt;" valign="top" width="246"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Pertahankan lingkungan bebas makanan berbau</span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 7.0cm;" valign="top" width="265"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">rangsangan sensoridapat mengaktifkan enzim pankreas, meningkatkan nyeri</span></div></td> </tr>
<tr style="mso-yfti-irow: 5;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 1.0cm;" valign="top" width="38"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";">5.</span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 184.3pt;" valign="top" width="246"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Be</span><span style="color: black; font-family: "Times New Roman","serif";"> Be</span><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">rikan analgesik pada waktu yang tepat (lebih kecil, dosis lebih sering).</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><br />
</div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 7.0cm;" valign="top" width="265"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">/ nyeri berat/lama dapat meningkatkan syok dan lebih sulit hilang, memerlukan dosis obat lebih besar, yang dapat mendasari masalah/komplikasi dan dapat memperberat depresi pernapasan</span></div></td> </tr>
<tr style="mso-yfti-irow: 6; mso-yfti-lastrow: yes;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 1.0cm;" valign="top" width="38"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";">6.</span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 184.3pt;" valign="top" width="246"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">. Pertahankan perawatan kulit, khususnya pada adanya aliran cairan dari fistula dinding abdomen.</span><span style="font-family: "Times New Roman","serif";"></span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 7.0cm;" valign="top" width="265"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">enzimpankreas dapat mencerna kulit dan jaringan dinding abdomen, menimbulkan luka bakar kimiawi. </span></div></td> </tr>
</tbody></table><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; mso-list: l7 level1 lfo11; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">2.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Resiko tinggi terhadap kekurangan volume cairan berhubungan dengan kebilangan berlebihan, peningkatan ukuran dasar vaskuler, gangguan proses pembekuan, perdarahan.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Tujuan: mempertahankan hidrasi adekuat dibuktikan oleh tanda vital stabil, turgor kulit baik, pengisian kapiler cepat, nadi perifer kuat, dan secara individu mengeluarkan jumlah urin adekuat.</span><span style="color: black; font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><br />
</div><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; margin-left: 33.75pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 1184;"><tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;"> <td style="border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 24.25pt;" valign="top" width="32"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";">No</span></div></td> <td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 188.4pt;" valign="top" width="251"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Intervensi</span></div></td> <td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 7.0cm;" valign="top" width="265"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Rasional</span></div></td> </tr>
<tr style="mso-yfti-irow: 1;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 24.25pt;" valign="top" width="32"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";">1. </span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 188.4pt;" valign="top" width="251"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";"> Awasi TD</span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 7.0cm;" valign="top" width="265"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">perpindahan cairan, perdarahan, dan menghilangkan vasodilator (kinin) dan factor depresan jantung yang dipicu oleh iskemia pankreas dapat menyebabkan hipertensi berat. Penurunan curah jantung/perfusi organ buruk sekunder terhadap episode hipotensi dapat mencetuskan luasnya komplikasi sistemik.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><br />
</div></td> </tr>
<tr style="mso-yfti-irow: 2;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 24.25pt;" valign="top" width="32"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";">2.</span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 188.4pt;" valign="top" width="251"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif";"> </span><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Ukur masukan dan haluaran termasuk muntah/aspirasi gaster,diare. Hitung keseimbangan cairan 24 jam.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><br />
</div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 7.0cm;" valign="top" width="265"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">indikator kebutuhan penggantian/keefektifan terapi.</span><span style="font-family: "Times New Roman","serif";"></span></div></td> </tr>
<tr style="mso-yfti-irow: 3;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 24.25pt;" valign="top" width="32"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";">3.</span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 188.4pt;" valign="top" width="251"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Catat warna dan karakter drainase gaster juga pH dan adanya darah.</span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 7.0cm;" valign="top" width="265"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">resiko perdarahan gaster tinggi.</span></div></td> </tr>
<tr style="mso-yfti-irow: 4;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 24.25pt;" valign="top" width="32"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";">4.</span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 188.4pt;" valign="top" width="251"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Timbang berat badan sesuai indikasi</span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 7.0cm;" valign="top" width="265"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">penurunan berat badan menunjukkan hipovolemia; namun edema, retensi cairan dan asites mungkin ditunjukkan oleh peningkatan atau berat badan stabil. </span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><br />
</div></td> </tr>
<tr style="mso-yfti-irow: 5;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 24.25pt;" valign="top" width="32"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";">5.</span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 188.4pt;" valign="top" width="251"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Be</span><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";"> </span><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Catat turgor kulit, kulit/membrane mukosa kering, keluhan haus.</span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 7.0cm;" valign="top" width="265"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">indikator fisiologis lanjut dari dehidrasi.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><br />
</div></td> </tr>
<tr style="mso-yfti-irow: 6; mso-yfti-lastrow: yes;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 24.25pt;" valign="top" width="32"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";">6.</span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 188.4pt;" valign="top" width="251"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">. Auskultasi bunyi jantung, catat frekuensi dan irama. Awasi/catat perubahan irama.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: -18.0pt;"><br />
</div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 7.0cm;" valign="top" width="265"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">perubahan jantung/distritmia dapat menunjukkan hipovolemia dan/atau ketidakseimbangan elektrolit, umumnya hipokalemia/hipokalsemia.</span></div></td> </tr>
</tbody></table><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; mso-list: l7 level1 lfo11; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">3.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";"> Perubahan nutrisi kurang dari kebutuhan tubuh berhubungan dengan muntah, penurunan pemasukan oral, pembatasan diet, kehilangan enzim pencernaan dan insulin.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Tujuan:</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 25.1pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l5 level1 lfo12; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">a.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Menunjukkan peningkatan berat badan mencapai tujuan dengan bilai laboratorium normal.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 25.1pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l5 level1 lfo12; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">b.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Tidak mengalami malnutrisi.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 25.1pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l5 level1 lfo12; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">c.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Menunjukkan perilaku, perubahan pola hidup untuk meningkatkan da/atau mempertahankan beratbdan normal.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; margin-left: 33.75pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 1184;"><tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;"> <td style="border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 24.25pt;" valign="top" width="32"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";">No</span></div></td> <td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 188.4pt;" valign="top" width="251"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Intervensi</span></div></td> <td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 7.0cm;" valign="top" width="265"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Rasional</span></div></td> </tr>
<tr style="mso-yfti-irow: 1;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 24.25pt;" valign="top" width="32"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";">1. </span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 188.4pt;" valign="top" width="251"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";"> </span><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Kaji abdomen, catat adanya/karakter bising usus, distensi abdomen, dan keluhan mual.</span><span style="font-family: "Times New Roman","serif";"></span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 7.0cm;" valign="top" width="265"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">disetensi abdomen dan atoni usus sering terjadi, mengakibatkan penurunan/tidak adanya bising usus.</span><span style="font-family: "Times New Roman","serif";"></span></div></td> </tr>
<tr style="mso-yfti-irow: 2;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 24.25pt;" valign="top" width="32"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";">2.</span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 188.4pt;" valign="top" width="251"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif";"> </span><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Berikan perawatan oral.</span><span style="font-family: "Times New Roman","serif";"></span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 7.0cm;" valign="top" width="265"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">menurunkan rangsangan muntah dan inflamasi/iritasi membran mukosa kering sehubungan dengan dehidrasi dan bernapas dengan mulut bila NG dipasang</span><span style="font-family: "Times New Roman","serif";"></span></div></td> </tr>
<tr style="mso-yfti-irow: 3;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 24.25pt;" valign="top" width="32"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";">3.</span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 188.4pt;" valign="top" width="251"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Observasi warna/konsistensi/jumlah feses dan bau</span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 7.0cm;" valign="top" width="265"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">steatore terjadi karna pencernaan lemak tidak sempurna.</span></div></td> </tr>
<tr style="mso-yfti-irow: 4; mso-yfti-lastrow: yes;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 24.25pt;" valign="top" width="32"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";">4.</span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 188.4pt;" valign="top" width="251"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Catat tanda peningkatan haus dan berkemih atau perubahan mental dan ketajaman visual</span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 7.0cm;" valign="top" width="265"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">mewaspadakan terjadinya hiperglikemia karna peningkatan pengeluaran glukagon (kerusakan sel alfa) atau penurunan pengeluaran insulin (kerusakan sel beta).</span><span style="color: black; font-family: "Times New Roman","serif";"></span></div></td> </tr>
</tbody></table><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; mso-list: l7 level1 lfo11; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">4.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Resiko tinggi terhadap infeksi berhubungan dengan tidak adekuatnya pertahanan utama: statis cairan tubuh, gangguan peristaltik, perubahan pH pada sekresi. Defisiensi nutrisi.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Tujuan:</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo13; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">a.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";"> Meningkatkan waktu penyembuhan, bebas tanda infeksi.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo13; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">b.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";"> Tidak demam.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo13; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">c.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";"> Berpartisipasi pada aktivitas untuk menurunkan resiko infeksi</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><br />
</div><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; margin-left: 33.75pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 1184;"><tbody>
<tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;"> <td style="border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 24.25pt;" valign="top" width="32"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";">No</span></div></td> <td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 188.4pt;" valign="top" width="251"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Intervensi</span></div></td> <td style="border-left: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 7.0cm;" valign="top" width="265"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";">Rasional</span></div></td> </tr>
<tr style="mso-yfti-irow: 1;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 24.25pt;" valign="top" width="32"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";">1. </span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 188.4pt;" valign="top" width="251"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Gunakan tehnik aseptik ketat bila mengganti balutan bedah atau bekerja dengan infus kateter/selang. Ganti balutan dengan cepat</span><span style="font-family: "Times New Roman","serif";"></span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 7.0cm;" valign="top" width="265"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">membatasi sumber infeksi, dimana dapat menimbulkan sepsis pada pasien.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><br />
</div></td> </tr>
<tr style="mso-yfti-irow: 2;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 24.25pt;" valign="top" width="32"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";">2.</span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 188.4pt;" valign="top" width="251"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif";"> </span><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Tekankan pentingnya mencuci tangan dengan baik.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: -18.0pt;"><br />
</div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 7.0cm;" valign="top" width="265"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">menurunkan resiko kontaminasi silang.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><br />
</div></td> </tr>
<tr style="mso-yfti-irow: 3;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 24.25pt;" valign="top" width="32"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";">3.</span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 188.4pt;" valign="top" width="251"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Observasi frekuensi dan karakteristik pernapasan, bunyi napas. Catat adanya batuk dan produksi sputum</span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 7.0cm;" valign="top" width="265"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">akumulasi cairan dan keterbatasan mobilitas mencetuskan infeksi pernapasan dan atelektasis. Akumulasi cairan asites dapat menyebabkan peningkatan diafragma dan pernapasan abdomen dangkal.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><br />
</div></td> </tr>
<tr style="mso-yfti-irow: 4; mso-yfti-lastrow: yes;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 24.25pt;" valign="top" width="32"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";">4.</span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 188.4pt;" valign="top" width="251"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: -18.0pt;"><span style="color: black; font-family: "Times New Roman","serif";"> Dorong </span><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";"> posisi sering, napas dalam dan batuk.</span><span style="font-family: "Times New Roman","serif";"></span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 7.0cm;" valign="top" width="265"><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">meningkatkan ventilasi segmen paru dan meningkatkan mobilitas sekresi</span><span style="color: black; font-family: "Times New Roman","serif";"></span></div></td> </tr>
</tbody></table><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 25.1pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">K.<span style="font: 7pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Evaluasi </span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 25.1pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l3 level1 lfo14; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">1.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Nyeri dapat teratasi dengan kriteria klien mengatakan nyeri hilang/terkontrol dan mengikuti program terapeutik.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 25.1pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l3 level1 lfo14; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">2.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Resiko tinggi terhadap kekurangan volume cairan tidak terjadi dengan kriteria klien mampu mempertahankan hidrasi adekuat dengan tanda vital dalam batas normal, turgor kulit baik, pengisian kapiler cepat, nadi perifer kuat, dan secara individu mengeluarkan jumlah urin adekuat.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 25.1pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l3 level1 lfo14; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">3.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">Perubahan nutrisi kurang dari kebutuhan tubuh dapat teratasi dengan kriteria klien mampu menunjukkan peningkatan berat badan mencapai tujuan dengan bilai laboratorium normal dan tidak mengalami malnutrisi.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 25.1pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l3 level1 lfo14; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";">4.<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif";"> Resiko tinggi terhadap infeksi tidak terjadi dengan kriteria klien bebas tanda infeksi.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif";">DAFTAR PUSTAKA</span></b><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: -37.4pt;"><span style="font-family: "Times New Roman","serif";"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Doenges, Marilynn E., 1999, <b><i>Rencana Asuhan Kepeawatan: Pedoman untuk Perencanaan dan Pendokumentasian Perawatan Pasien, </i></b>(Edisi 3), Jakarta<span style="color: black;">, EGC.</span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: -37.4pt;"><span style="font-family: "Times New Roman","serif";"> </span><span lang="SV" style="font-family: "Times New Roman","serif";">Mitchell, Richard N., 2008, <b><i>Buku Saku Dasar Patologis Penyakit</i></b>, Jakarta , EGC.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="ES" style="font-family: "Times New Roman","serif";">Smeltzer, Suzanne C., 2001, <b><i>Buku Ajar Keperawatan Medikal Bedah,</i></b> (Edisi 8), Jakarta, EGC.</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"><br style="mso-special-character: line-break;" /> <br style="mso-special-character: line-break;" /> </span></div><div class="MsoNormal" style="line-height: 150%;"><span lang="EN-US"><a href="http://meetabied.blogspot.com/2011/01/askep-pankreatitis.html"><span style="font-family: "Times New Roman","serif";">http://meetabied.blogspot.com/2011/01/askep-pankreatitis.html</span></a></span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal"><span lang="EN-US">http://bima22.wordpress.com/2007/12/27/pankreatitis/</span></div><div class="MsoNormal"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif";">PANKREATITIS KRONIS</span></b><b><span style="font-family: "Times New Roman","serif";"></span></b></div><ol start="1" style="margin-top: 0cm;" type="1"><li class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-list: l0 level1 lfo1; text-align: justify;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif";">DEFINISI</span></b><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></li>
</ol><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Pankreatitis Kronis merupakan peradangan pankreas yang menahun</span><span style="font-family: "Times New Roman","serif";">. </span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Pankreatitis kronik merupakan kelainan inflamasi yang ditandai oleh kehancuran anatomis dan fungsional yang progresif pada pankreas. (Brunner & Suddart, 2001:1348)</span><span style="font-family: "Times New Roman","serif";">. </span><span lang="EN-US" style="font-family: "Times New Roman","serif";">ankreatitis kronik diartikan sebagai destruksi parenkim eksokrin pankreas yang ireversibel. </span><span style="font-family: "Times New Roman","serif";"></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3YzKs3fbWHFlHu1FrF3flOMg5uPEXkYCN2vda6UBqdYuV0pMewA_xL5dgfhgIJV5zSqFdvwMF2fSJpeHK5NLpomblzYzpXckgZXLfR8XEGEFbLQ79XCRWfRsBAOC69ohWma6EwRAk_vBa/s1600/pankreatitiskronis1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3YzKs3fbWHFlHu1FrF3flOMg5uPEXkYCN2vda6UBqdYuV0pMewA_xL5dgfhgIJV5zSqFdvwMF2fSJpeHK5NLpomblzYzpXckgZXLfR8XEGEFbLQ79XCRWfRsBAOC69ohWma6EwRAk_vBa/s1600/pankreatitiskronis1.jpg" /></a></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif";">2.<span style="font: 7pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif";">ETIOLOGI</span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Keadaan yang paling sering menyebabkan pankreatitis kronik adalah alkoholisme. Penyebab lain adalah hiperkalsemia, hiperlipidemia, pankreas divisum, pankreatitis herediter dan malnutrisidefisiensi-protein.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif";">3.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span lang="EN-US" style="font-family: "Times New Roman","serif";">PENYEBAB</span></b><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Di Amerika Serikat, penyebab paling sering dari pankreatitis kronis adalah alkoholisme. <br />
Penyebab lainnya adalah faktor keturunan dan penyumbatan saluran pankreas yang disebabkan oleh penyempitan saluran atau kanker pankreas. </span><span lang="EN-US" style="font-family: "Times New Roman","serif";"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Pankreatitis akut jarang menyebabkan penyempitan pada saluran pankreas yang akan mengarah pada terjadinya pankreatitis kronis. </span><span lang="EN-US" style="font-family: "Times New Roman","serif";"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Pada banyak kasus, penyebab pankreatitis kronis tidak diketahui.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Di negara-negara tropis (Indonesia, India, Nigeria), pankreatitis kronis dengan sebab yang tidak diketahui yang terjadi pada anak-anak dan dewasa muda, bisa menyebabkan diabetes dan penumpukan kalsium di pankreas. Gejala awalnya umumnya berasal dari diabetes.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">4.<span style="font: 7pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">MANIFESTASI KLINIK</span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Pankreatitis kronik ditandai oleh serangan nyeri yang hebat di daerah abdomen dan punggung, disertai muntah. Dengan semakin berlanjutnya penyakit, serangan nyeri yang berulang-ulang tersebut terasa semakin hebat, semakin sering dan lama. Sebagian pasien mengeluhkan nyeri hebat; yang lain merasakan nyeri tumpul, konstan dan membandel. </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Penurunan berat badan merupakan masalah utama pada pankreatitis kronik. Hal ini disebabkan oleh penurunan asupan makanan akibat anoreksia atau perasaan takut bahwa makan akan memicu serangan berikutnya. Malabsorpsi terjadi kemudian pada penyakit tersebut ketika fungsi pankreas mash tersisa 10%. Akibatnya, proses pencernaan bahan makanan, khususnya protein dan lemak akan terganggu. Defekasi akan terjadi lebih sering dan feses menjadi berbuih serta berbau busuk akibat gangguan pencernaan lemak yang menyebabkan feses tersebut banyak mengandung lemak. Keadaan ini disebut <b>steatore</b>. Dengan semakin berlanjutnya proses penyakit, kalsifikasi pada kelenjar pankreas dan terbentuknya batu kalsium di dalam saluran kelenjar dapat terjadi. </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">5.<span style="font: 7pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">PATOFISIOLOGI </span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Pankreas mengalami kehancuran anatomis dan fungsional yang progresif. Dengan digantikannya sel-sel pankreas (sel-sel asiner pankreas) yang normal oleh jaringan ikat akibat serangan pankreatitis berulang-ulang dan efek toksik dari alkohol dan metabolitnya, maka tekanan dalam pankreas akan meningkat. Hasil akhirnya adalah obstruksi mekanis duktus pankreatikus, koledokus dan duodenum. Di samping itu akan terjadi pula atrofi epitel duktus tersebut, inflamasi dan destruksi sel-sel pankreas yang melaksanakan fungsi sekresi (destruksi parenkim endokrin pankreas). </span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif";">6.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span lang="EN-US" style="font-family: "Times New Roman","serif";">GEJALA</span></b><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Gejala pankreatitis kronis umumnya terbagi dalam dua pola. Yang pertama, penderita mengalami nyeri perut bagian tengah yang menetap, yang beratnya bervariasi. Yang kedua, penderita mengalami episode pankreatitis yang hilang timbul, dengan gejala yang mirip dengan pankreatitis akut ringan sampai sedang. Nyerinya kadang-kadang berat dan berlangsung selama beberapa jam atau beberapa hari.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Pada kedua pola tersebut, sejalan dengan perkembangan penyakitnya, sel-sel yang menghasilkan enzim pencernaan, secara perlahan mengalami kerusakan, sehingga akhirnya rasa nyeri tidak timbul. Dengan menurunnya jumlah enzim pencernaan, makanan tidak diserap secara optimal, dan penderita akan mengeluarkan tinja yang banyak dan berbau busuk. Tinja bisa berwarna terang dan berminyak dan bahkan bisa mengandung tetesan-tetesan minyak. Gangguan penyerapan juga menyebabkan turunnya berat badan. Pada akhirnya sel penghasil <i>insulin</i> mungkin mengalami kerusakan dan secara perlahan akan menyebabkan kencing manis (<i>diabetes</i>).</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraph" style="line-height: 150%; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif";">7.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span lang="EN-US" style="font-family: "Times New Roman","serif";">DIAGNOSA</span></b><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Diagnosis ditegakkan berdasarkan gejala atau adanya riwayat pankreatitis akut</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraph" style="line-height: 150%; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif";">8.<span style="font: 7pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif";">PEMERIKSAAN PENUNJANG</span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Pemeriksaan darah kurang bermanfaat dalam mendiagnosis pankreatitis kronis, tetapi bisa menunjukan adanya peningkatan kadar <i>amilase</i> dan <i>lipase</i>. Pemeriksaan darah juga dapat digunakan untuk mengetahui kadar gula darah , yang mungkin akan meningkat.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Foto rontgen perut dan pemeriksaan USG bisa menunjukan adanya batu pada pankreas.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><i><span lang="EN-US" style="font-family: "Times New Roman","serif";">Endoskopi pankreatografi retrograd</span></i><span lang="EN-US" style="font-family: "Times New Roman","serif";"> (tehnik sinar X yang memperlihatkan struktur dari saluran</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">pankreas) bisa memperlihatkan saluran yang melebar, penyempitan saluran atau batu pada saluran. <br />
<br />
CT scan bisa memperlihatkan adanya perubahan ukuran, bentuk dan tekstur dari pancreas</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">9.<span style="font: 7pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">PENATALAKSANAAN</span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Penatalaksanaan pankreatitis kronik bergantung pada kelainan yang mungkin menjadi penyebab pada setiap pasien. Terapi ditujukan untuk mencegah serta menangani serangan akut, mengurangi rasa nyeri sera gangguan rasa nyaman, dan menangani insufisiensi eksokrin serta endokrin yang terdapat pada pankreatitis. </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif";">Nyeri dan gangguan rasa nyaman pada badomen</span></b><span lang="EN-US" style="font-family: "Times New Roman","serif";"> diatasi dan dicegah dengan penggunaan metode nonopioid untuk mengatasi nyeri. Selaian itu, pasien dan keluarganya juga ditekankan tentang pentingnya menghindari alkohol serta makanan lain yang oleh pasien sendiri dirasakan cenderung menimbulkan nyeri dan gangguan rasa nyaman pada abdomen. Kenyataannya, tidak ada bentuk terapi lain yang dapat meredakan rasa nyeri tersebut jika pasien sendiri terus menerus mengkonsumsi alkohol dan hal ini harus ditegaskan pada pasien.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif";">Diabetes melitus</span></b><span lang="EN-US" style="font-family: "Times New Roman","serif";"> yang terjadi akibat disfungsi sel-sel pulau Langerhans pankreas dapat diatasi dengan diet, pemberian insulin atau obat-obatan hipoglikemia oral. Bahaya hipoglikemia yang berat akibat penggunaan alkohol harus ditekankan pada pasien dan anggota keluarganya. Terapi pengganti enzim pankreas diperlukan bagi pasien yang menderita malabsorpsi dan steatore.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif";">Pembedahan</span></b><span lang="EN-US" style="font-family: "Times New Roman","serif";"> umumnya dilakukan untuk mengurangi nyeri abdomen serta gangguan rasa nyaman, memulihkan drainase sekresi pankreas dan mengurangi frekuensi serangan pankreatitis akut. Tindakan bedah yang akan dilakukan tergantung pada kelainan anatomis dan fungsional pankreas yang mencakup lokasi penyakit di dalam pankreas, keberadaan penyakit diabetes, insufisiensi eksokrin, stenosis bilier dan pseudokista pankreas. </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif";">Pankreatikojejunostomi</span></b><span lang="EN-US" style="font-family: "Times New Roman","serif";"> dengan anastomosis side-to-side atau penyambungan duktus pankreatikus dengan jejunum memungkinkan drainase sekresi pankreas kedalam jejunum.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif";">10.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span lang="EN-US" style="font-family: "Times New Roman","serif";">PENGOBATAN</span></b><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Selama suatu serangan, yang sangat penting adalah menghindari alkohol. </span><span lang="EN-US" style="font-family: "Times New Roman","serif";"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Menghindari semua makanan dan hanya menerima cairan melalui infus, dapat mengistirahatkan pankreas dan usus juga bisa mengurangi rasa nyeri. </span><span lang="EN-US" style="font-family: "Times New Roman","serif";"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Tetapi pereda nyeri golongan narkotik, masih sering diperlukan untuk mengurangi rasa nyeriUntuk mengurangi serangan, dianjurkan makan 4-5 kali/hari, yang mengandung sedikit lemak dan protein, dan banyak karbohidrat. Alkohol harus tetap dihindari</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Bila sakit berlanjut, kemungkinan telah terjadi komplikasi, seperti masa peradangan di kepala pankreas atau suatu <i>pseudokista</i>. Masa peradangan memerlukan terapi pembedahan. Pseudokista yang menyebabkan nyeri sejalan dengan perkembangannya, mungkin harus menjalani <i>dekompresi</i> (pengurangan penekanan). Bila penderita terus menerus merasakan nyeri dan tidak ada komplikasi, biasanya dokter menyuntikan penghambat nyeri ke saraf pankreas sehingga rangsangannya tidak sampai ke otak. </span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Bila cara ini gagal, mungkin diperlukan pembedahan. ika saluran pankreasnya melebar, pembuatan jalan pintas dari pankreas ke usus halus, akan mengurangi rasa nyeri pada sekitar 70-80% penderita. Jika salurannya tidak melebar, sebagian dari pankreas mungkin harus diangkat. <br />
Bila kepala pankreas terkena, bagian ini diangkat bersamaan dengan usus dua belas jari. Pembedahan ini dapat mengurangi nyeri pada 60-80% penderita. Pada pecandu alkohol yang mengalami penyembuhan, pengangkatan sebagian pankreas dilakukan hanya pada mereka yang dapat mengatasi diabetes yang akan terjadi setelah pembedahan</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Dengan meminum tablet atau kapsul yang mengandung ekstrak enzim pankreas pada saat makan, dapat membuat tinja menjadi kurang berlemak dan memperbaiki penyerapan makanan, tapi masalah ini jarang dapat teratasi. Bila perlu, larutan antasid atau penghambat H2 dapat diminum bersamaan dengan enzim pankreas. Dengan pengobatan tersebut, berat badan penderita biasanya akan meningkat, buang air besarnya menjadi lebih jarang, tidak lagi terdapat tetesan minyak pada tinjanya dan secara umum akan merasa lebih baik. Jika pengobatan diatas tidak efektif, penderita dapat mencoba mengurangi asupan lemak. </span><span lang="EN-US" style="font-family: "Times New Roman","serif";"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Mungkin juga dibutuhkan tambahan vitamin yang larut dalam lemak (vitamin A, D, E dan K).</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: -18.0pt;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="EN-US"><a href="http://www.medicastore.com/" target="_blank">Apotik online dan media informasi obat - penyakit :: m e d i c a s t o r e . c o m</a></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif";">TRAUMA TUMPUL PANKREAS</span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: center;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: center;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif";">A.<span style="font: 7pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif";">Pengertian</span></b></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Trauma tumpul pankreas relatif jarang terjadi dibandingkan trauma tumpul yang mengenai organ-organ intraabdomen lainnya. Diantara trauma tumpul abdomen, trauma tumpul pankreas berada pada urutan ketiga setelah trauma tumpul pada hati dan limpa. Angka kejadian trauma tumpul pankreas berkisar 3-12 %. Diperkirakan diantara 100 pasien dengan trauma tumpul abdomen, tercatat kurang dari 10 pasien mengalami trauma tumpul pada pancreas</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Kematian akibat post trauma tumpul pankreas berkisar 9-34 % seperti yang dilaporkan oleh Furkovich. Peningkatan angka kematian post trauma tumpul pankreas disebabkan oleh keterlambatan diagnosis dan keterlambatan penanganan yang definitif</span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCRltpXPJ46Fx8emMWoyQWBlTK6cJGT-imJpQ-Vy0akBNM2poWLRs3xAZ6n_rVpTkTH4GLEoPZSnIli8KlDHKt3uyvsIsifcdVGa88sXP-cr-HPHxHDAmWZo66384g6g1rBvauF5w4vRI6/s1600/200802291636_38133_000.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="194" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCRltpXPJ46Fx8emMWoyQWBlTK6cJGT-imJpQ-Vy0akBNM2poWLRs3xAZ6n_rVpTkTH4GLEoPZSnIli8KlDHKt3uyvsIsifcdVGa88sXP-cr-HPHxHDAmWZo66384g6g1rBvauF5w4vRI6/s320/200802291636_38133_000.jpg" width="320" /></a></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 18pt;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: center;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">B.<span style="font: 7pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Hubungan Anatomi Pankreas dengan Trauma Tumpul Pankreas </span></b></div><div class="pj" style="line-height: 150%; text-align: justify; text-indent: 18.0pt;"><span lang="EN-US" style="font-size: 11pt; line-height: 150%;">Lokasi pankreas yang relatif terproteksi pada cavum abdomen dan terfiksasi pada posisi retroperitonial memberikan perlindungan pankreas terhadap trauma langsung maupun tidak langsung. Tulang-tulang rusuk menyediakan proteksi struktural tulang dan dilindungi oleh otot-otot dorsal paraspinous yang tebal. Sebelah anterior, otot rectus dan otot-otot abdomen yang matur, dikombinasikan pula dengankarakteristik liver, colon, duodenum, gaster, usus halus yang mengabsorbsi energi menyediakan proteksi pankreas terhadap trauma tumpul. Pada trauma tumpul yang berat, posisi anatomi pankreas mungkin menyebabkan trauma pancreas seperti pada fraktur corpus columna spinalis di sebelah atas dan corpus vertabrae sebelah posterior.2Corpus pankreas yang terletak sebelah anterior terhadap spinal lumbar kedua sampai keempat membuatnya rentan terhadap trauma tumpul.</span><span style="font-size: 11pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 39.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Struktur pembuluh darah yang letaknya berdekatan dengan caput dan corpus pankreas memiliki dampak terhadap terjadinya peningkatan angka morbiditas dan mortalitas pada penderita dengan trauma tumpul pankreas. Pembuluh darah vena cava inferior subhepatik dan aorta terletak sebelah posterior terhadap caput pankreas pada sisi kanan, dan vena mesenterik superior masuk ke dalam vena porta di bawah pankreas. Perdarahan yang bersumber dari pembuluh darah tersebut seringkali menjadi penyebab kematian pada pasien dengan trauma tumpul pada pankreas. </span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 39.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Pembuluh darah arteri splenik dari cabang trunkus celiak dan vena porta berjalan di sebelah posterior dan superior corpus dan cauda pancreas, dimana posisi tersebut relatif mudah terpapar dan robek dibandingkan vena cava inferior dan vena porta jika terjadi trauma yang mengenai pankreas. Perdarahan yang bersumber dari pembuluh darah tersebut seringkali juga menyebabkan kematian pada pasien post trauma tumpul pankreas apabila tidak tertangani dengan </span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">C.<span style="font: 7pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Etiologi dan Mekanisme Trauma Tumpul Pankreas </span></b></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 39.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Trauma tumpul yang hanya mengenai pankreas relatif jarang terjadi dan biasanya terjadi akibat adanya trauma tumpul abdomen dan seringkali berhubungan dengan trauma pada organ di sekitarnya.7 Posisi pankreas yang relatif terproteksi menyebabkan trauma tumpul pankreas akan terjadi bila terdapat energi tinggi yang langsung mengenai abdomen ataupun energi tinggi yang langsung jatuh tepat pada epigastrium misalnya pada kecelakaan.3 Mekanisme terjadinya trauma tumpul pankreas adalah melalui mekanisme kompresi dan trauma deselerasi. Mekanisme kompresi terutama akibat energi tinggi yang terlokalisir mengenai epigastrium, dengan menekan pankreas yang terletak di bawahnya melawan corpus vertebra. Disebutkan bahwa kecelakaan lalu lintas adalah penyebab paling sering terjadinya trauma tumpul pankreas. Pada trauma tumpul pankreas, fraktur di atas columna vertebralis seringkali terjadi pada anak-anak dan disebabkan oleh trauma langsung mengenai abdomen karena posisi sabuk pengaman yang tidak tepat. Untuk dapat menegakkan diagnosis adanya trauma tumpul pankreas, harus dikenali jenis trauma apakah trauma tumpul atau trauma tajam dan informasi mengenai benda penyebab trauma (seperti meja, kayu, atau pisau) akan dapat membantu klinisi. </span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">D.<span style="font: 7pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Gejala klinik dan Pemeriksaan Fisik Trauma Tumpul Pankreas </span></b></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 39.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Pada banyak kasus post trauma tumpul pankreas pada stadium dini sering tanpa gejala dan kesan tampak tidak ada kelainan. Seringkali pasien merasa sehat sebelumnya dan tidak menyadari adanya trauma pankreas. Selama pemeriksaan fisik tanda sabuk pengaman, flank ecchymosis, akan membangun kewaspadaan klinisi terhadap trauma yang potensial. Fraktur limpa dengan hematom retroperitonial atau manifestasi kebocoran cairan, nyeri epigastrium, nyeri punggung sangat jarang ditemukan pada keadaan post trauma.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 39.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";"> Terdapat laporan pada pasien dengan transeksi duktus pankreas yang komplit tetap asimtomatik dalam berminggu-minggu, berbulan- bulan bahkan bertahun-tahun setelah trauma awal. Seringkali pasien dengan trauma tumpul yang mengenai pankreas menunjukkan manifestasi krisis abdominal yang tidak spesifik post trauma. Trauma pankreas seringkali sulit dideteksi dengan temuan fisik dan pasien awalnya mungkin menunjukkan tanda-tanda fisik yang minimal</span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Alasan mengapa gejala-gejala dan tanda-tanda fisik tidak ditemukan segera setelah trauma dihubungkan dengan lokasi pankreas yang terletak retroperitonial, enzim pankreas yang tidak aktif setelah trauma yang tersembunyi dan penurunan sekresi cairan pankreas setelah trauma. </span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Akan tetapi bila dilakukan skenario atau pemeriksaan yang lebih lengkap pada pasien dengan post trauma tumpul abdomen menunjukkan iritasi peritonial yang berat dan temuan pemeriksaan fisik abdomen. Trauma tumpul pankreas sering kali disebabkan oleh trauma pada organ-organ intraabdomen lainnya. Gejala trauma pada struktur-struktur lain sering kali mengaburkan trauma tumpul pankreas dengan demikian dibutuhkan kewaspadaan yang tinggi dari klinisi untuk memastikan adanya trauma tumpul pada pankreas.1,2 Adanya contusio jaringan lunak pada abdomen bagian atas atau disrupsi pada tulang- tulang rusuk bawah atau costal cartilage menandakan kemungkinan adanya trauma pankreas.3 Dengan adanya laserasi pada pankreas, diikuti dengan adanya trauma pada duktus pankreas yang selanjutnya menyebabkan masuknya sekresi pankreas ke dalam cavum abdomen dan menghasilkan chemical peritonitis.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">E.<span style="font: 7pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Pemeriksaan Laboratorium Trauma Tumpul Pankreas </span></b></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 39.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Amilase adalah enzim pencernaan yang disekresikan oleh pankreas. Karena hiperamilasemia ditemukan lebih dari 75% pasien dengan trauma tumpul abdomen dan menunjukkan kecurigaan adanya trauma tumpul pankreas, hiperamilasemia harus dipertimbangkan sebagai tanda kemungkinan adanya trauma pankreas post trauma tumpul abdomen dan mengindikasikan pemeriksaan lebih lanjut.6 Hal ini disebabkan oleh karena kerusakan pada pankreas menyebabkan pelepasan enzim amilase yang menyebabkan kerusakan pada pankreas itu sendiri dan pada jaringan sekitarnya berupa retroperitonial plegmon dengan nekosis lemak dan abses. Kerusakan yang terjadi akibat autodigestive enzim amilase terhadap pankreas itu sendiri.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="pj" style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="font-size: 11pt; line-height: 150%;">Walaupun konsentrasi tertinggi amilase pada tubuh manusia adalah pada pankreas, hiperamilasemia bukan merupakan indikator reliabel terhadap adanya trauma pankreas. Sebanyak 40 % pasien dengan trauma pankreas pada awalnya memiliki kadar amilase serum yang normal. Sebagai tambahan, terdapat bukti bahwa trauma yang tersembunyi pada otak juga dapat menyebabkan peningkatan serumamilase melalui mekanisme sentral yng masih belum jelas. Hiperamilasemia juga ditemukan pada pasien dengan trauma duodenal, trauma hepatik, serta pasien dengan intoksikasi. </span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 39.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Waktu antara terjadinya trauma tumpul pankreas dan penentuan kadar serum amilase memegang peranan penting. Disebutkan bahwa pada 73 pasien yang dicatat mengalami trauma tumpul pankreas, kadar serum amilase meningkat pada 61 pasien (84%) dan normal pada 12 pasien (16%). Sensitivitas kadar serum amilase dalam mendeteksi adanya trauma tumpul pankreas berkisar antara 48% sampai dengan 85% dan spesifitas berkisar antara 0 sampai dengan 81%. Nilai prediktif negatif serum amilase setelah trauma tumpul adalah sekitar 95%. Sensitivitas dan nilai prediktif positif mungkin meningkat jika kadar serum amilase diperoleh lebih dari tiga jam setelah trauma. Jadi dapat disimpulkan bahwa 95% pasien dengan trauma tumpul abdomen dengan kadar serum amilase yang normal tidak mengalami trauma tumpul pankreas. Deteksi amilase pada kumbah cairan peritoneal lebih sensitif dan spesifik untuk diagnosis trauma tumpul pankreas dibandingkan kadar amilase pada serum atau darah. Akan tetapi prosedur diagnostik ini bukan tes rutin pada banyak institusi.2 </span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">F.<span style="font: 7pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Pemeriksaan Pencitraan Trauma Tumpul Pankreas </span></b></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 39.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Pasien dengan trauma tumpul abdomen dengan peningkatan serum amilase yang persisten atau menunjukkan perkembangan gejala-gejala krisis abdominal mengindikasikan untuk dilakukan evaluasi yang lebih lanjut, meliputi foto polos abdomen, </span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">a)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif";">ultrasonografy,</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">b)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif";">CT scan abdomen,</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">c)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif";">endocopic retrograde </span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">d)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif";">cholangiopancreatography (ERCP), atau bedah eksplorasi.</span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 39.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Foto polos abdomen mungkin menunjukkan kalsifikasi pancreas dari episode pancreatitis sebelumnya, akan tetapi jarang bermanfaat dalam mendeteksi trauma tumpul pankreas. Foto polos abdomen lebih bermanfaat dalam mendeteksi trauma tajam dengan memvisualisasi dan melokalisir benda asing seperti fragmen peluru dan proyektil yang menginduksi trauma pada tulang. Walaupun tidak bermanfaat secara spesifik dalam mendeteksi trauma tumpul pankreas, foto thorak posisi PA mungkin menunjukkan adanya udara bebas di bawah diafragma, yang menandakan trauma</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">pada lambung, duodenal, atau trauma pada usus halus yang seringkali dihubungkan </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">dengan trauma pada pankreas.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 39.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Ultrasonografy (USG) telah digunakan bertahun-tahun untuk mengevaluasi penyakit yang mengenai pankreas, akan tetapi USG tidak digunakan secara rutin dalam mendeteksi trauma pankreas karena sensitivitas dan spesifitasnya yang rendah. Bahkan dengan peningkatan penggunaan USG abdomen yang terfokus untuk mengidentifikasi cairan abdominal atau hemoperitonium pada pasien trauma, tidak ada pengalaman yang nyata penggunaan USG secara spesifik pada trauma pankreas akut.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 39.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">CT scans abdomen pada pasien yang secara hemodinamik stabil menyediakan prosedur diagnostik yang paling komprehensif dalam menegakkan diagnosis trauma tumpul pankreas. CT scans abdomen dilaporkan memiliki sensitivitas dan spesifitas 70-80% untuk mendiagnosis trauma tumpul pankreas. Karakteristik temuan CT scans yang dihubungkan dengan trauma pancreas meliputi visualisasi langsung fraktur parenkimal, hematom intrapankreatik, cairan pada lesser sakulus, cairan yang memisahkan pembuluh vena splenik dengan corpus pankreas, penebalan fascia renal sebelah anterior, dan hematom retroperitoneal atau akumulasi cairan pada retroperitoneal. Temuan ini sering tak kentara dan jarang seluruh temuan tersebut dijumpai pada satu pasien dengan trauma tumpul pankreas. Jika pasien diperiksa segera setelah trauma, beberapa temuan CT scans mungkin tidak tampak, yang mana merupakan bagian keterangan negatif palsu CT scans yang dilaporkan pada 40% pasien dengan trauma pankreas. </span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 39.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">ERCP tidak berperan dalam evaluasi akut pada pasien yang secara hemodinamik tidak stabil, tetapi sejumlah laporan pada dekade sebelumnya ERCP bermanfaat dalam diagnosis dan manajemen trauma pankreas. Penggunaan ERCP untuk mendiagnosis trauma pankreas pertama kali dilaporkan oleh Gougeon dan kawan-kawan pada tahun 1976. Saat ini ERCP merupakan modalitas pencitraan yang terbaik untuk pankreas, akan tetapi selalu melibatkan anastesi dan tidak tersedia secara luas. ERCP sebagai standar untuk diagnosis awal trauma pankreas pada pasienyang secara hemodinamik stabil dengan nyeri abdomen yang persisten, peningkatan </span><span lang="EN-US" style="font-family: "Times New Roman","serif";"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif";">erum amilase, dan temuan CT scans yang masih kabur. </span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">G.<span style="font: 7pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Klasifikasi Trauma Tumpul Pankreas </span></b></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 19.8pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Saat ini klasifikasi trauma pankreas yang digunakan secara luas adalah menurut American Association for the Surgery of Trauma (AAST) berdasarkan status duktus pancreas dan memfokuskan lokasi anatomi trauma. AAST mengklasifikasikan trauma pankreas menjadi lima grading yatu: </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">• Grade I meliputi hematom yang kecil tanpa adanya jejas pada duktus. Laserasi </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">superfisial tanpa adanya jejas pada duktus pankreas </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">• Grade II meliputi hematom yang luas tanpa adanya jejas pada duktus tanpa adanya jejas pada duktus pankreas. Laserasi luas tanpa adanya jejas pada duktus pankreas tanpa adanya jejas pada duktus pankreas </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">• Grade III meliputi transeksi distal atau laserasi parenkimal dengan disertai </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">jejas pada duktus pankreas </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">• Grade IV meliputi transeksi proksimal atau laserasi parenkimal yang </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">melibatkan ampulla pankreas </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">• Grade V meliputi disrupsi masif caput pankreas </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Klasifikasi tersebut di atas menentukan manajemen terapi dan berkorelasi dengan </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">morbiditas dan mortalitas trauma tumpul pankreas.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">H.<span style="font: 7pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Manajemen terapi Trauma Tumpul Pankreas </span></b></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 39.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Pada sebagian besar kasus trauma tumpul pankreas, reseksi tidak selalu dibutuhkan. Pada kasus laserasi kapsular yang kecil atau superfisial, kontusio atau hematom parenkimal yang kecil tanpa jejas pada duktus pankreas dan tanpa hilangnya jaringan parenkimal (Grade I dan II), manajemen terapi yang terbaik adalah tanpa suture, akan tetapi terapi yang dibutuhkan adalah drainase eksternal. Transeksi distal parenkimal páncreas (Grade III) melawan corpus vertabra mungkin membutuhkan reseksi corpus dengan distal pancreatectomy dan drainase. Sementara transeksi proksimal pankreas (Grade IV) pada pasien yang secara hemodinamik tidak</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif";">stabil, terlebih dahuli tangani hemostasisnya dan drainase, sedangkan pada pasien dengan hemodinamik yang stabil manajemennya adalah membagi páncreas secara komplit, lakukan proksimal pankreatektomi dan lakukan anatomosis sisa distal páncreas ke jejunum. Pada disrupsi masif caput pankreas yang masif manajemennya adalah dengan mengerjakan pancreaticoduodenectomy (Whipple procedure). </span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">I.<span style="font: 7pt "Times New Roman";"> </span></span></b><span lang="EN-US" style="font-family: "Times New Roman","serif";"> <b style="mso-bidi-font-weight: normal;">Komplikasi Trauma Tumpul Pankreas </b></span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 39.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Komplikasi trauma tumpul pankreas cukup tinggi, dan berkorelasi dengan grading klasifikasi trauma pankreas. Komplikasi trauma tumpul pancreas bervariasi mulai dari pankreatitis ringan sampai dengan kematian akibat perdarahan yang masif.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 39.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Pembentukan fistula merupakan komplikasi tersering yang dilaporkan, akan tetapi dengan drainase local dan nutrisi yang baik serta terapi suportif, fistula biasanya sembuh secara spontan dalam 2 minggu setelah trauma.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 39.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Insiden pembentukan abses post trauma tumpul pankreas adalah berkisar 10 sampai dengan 25% tergantung pada jumlah dan trauma intraabdomen lain yang muncul. Pada sebagian besar kasus, tipe abses adalah subfascial atau peripankreatik. Abses pakreatik murni insidennya jarang dan biasanya dihasilkan dari debridemen jaringan mati yang tidak adekuat atau dihasilkan dari drainase awal yang tidak adekuat.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 39.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Nyeri abdominal yang hilang timbul dan peningkatan kadar serum amylase menghasilkan pankreatitis terutama diantisipasi pada 8% sampai dengan 18% pasien post operasi. Tipe pankreatitis ini ditangani dengan dekompresi nasogastrik, menistrahatkan usus, dan terapi suportif, dapat diharapkan menyembuhkan secara spontan pankreatitis. Lebih jauh lagi pankreatitis yang jarang terjadi adalah pankreatitis hemorrhagik yang dapat menimbulkan kematian</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 39.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Trauma tumpul terhadap pankreas dapat menghasilkan pseudokista residual baik intrapankreatik atau peripankreatik.8 Komplikasi lain trauma tumpul pancreas adalah insufisiensi hormon-hormon kelenjar endokrin dan eksokrin pankreas. </span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">J.<span style="font: 7pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif";">P</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">atofisiologi Kematian Post Trauma Tumpul Pankreas </span></b></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 39.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Kematian post trauma tumpul pankreas lebih jarang dilaporkan dibandingkan kematian akibat post trauma tumpul organ intraabdomen lain. Trauma tumpul pankreas diakibatkan oleh energi tinggi dari vektor anterior-posterior atau sebaliknya yang mengenai abdomen atau secara langsung mengenai pankreas menyebabkan ruptur pankreas. Ruptur pankreas post trauma tumpul merobek sistem duktus dan menyebabkan sekresi getah pankreas dalam hal ini enzim amilase memasuki parenkim kelenjar sehingga terjadi kerusakan pankreas. Kerusakan kecil pada pankreas menyebabkan kerusakan yang besar pada kelenjar pankreas. Hal ini disebabkan oleh karena getah pankreas (enzim amilase) bersifat autodigestif terhadap parenkim pankreas dan jaringan disekitarnya. Kerusakan pankreas yang menyeluruh menyebabkan terjadinya perdarahan yang masif, apabila tidak ditangani menyebabkan kematian. Sebagai tambahan, kematian post trauma tumpul pankreas disebabkan pula oleh adanya sepsis intra abdomonal.4 ,7 </span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 39.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Kematian post trauma tumpul pankreas juga disebabkan karena robeknya dan erosi pada pembuluh darah vena cava inferior subhepatik dan aorta terletak sebelah posterior terhadap caput pankreas pada sisi kanan, dan vena mesenterik superior masuk ke dalam vena porta di bawah pankreas. Pembuluh darah arteri splenik dari cabang trunkus celiak dan vena porta berjalan di sebelah posterior dan superior corpus dan cauda pancreas relatif mudah terpapar dan robek Perdarahan yang bersumber dari pembuluh darah tersebut seringkali menjadi penyebab kematian pada pasien dengan trauma tumpul pada pankreas.2</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 39.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">referensi </span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal"><span lang="EN-US"><a href="http://www.scribd.com/doc/25784768/Kematian-Akibat-Trauma-Tumpul-Pankreas">http://www.scribd.com/doc/25784768/Kematian-Akibat-Trauma-Tumpul-Pankreas</a></span></div><div class="MsoNormal"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 3; text-align: center;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif";">TUMOR PANKREAS</span></b></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif";">A.<span style="font: 7pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">PENGERTIAN </span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif";"></span></b></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; tab-stops: 18.0pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; tab-stops: 18.0pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";"> Walaupun letak terlindung, ternyata sering juga terkena trauma dengan mortalitas dan morbiditas yang cukup tinggi</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwznS1j9FRhnaS-u57UxnKZ2i9UMn70OJlzi4kqLMJfyCpEBttHGvOWtz_B6zxYKz-D2KO481AQ945KniWozyXMtrOsXTQG7hG0BA8pbIo22rtdR-M96ZWG69fhO2CbY8pEXVFsZh5T7JG/s1600/pankreas4.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="202" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwznS1j9FRhnaS-u57UxnKZ2i9UMn70OJlzi4kqLMJfyCpEBttHGvOWtz_B6zxYKz-D2KO481AQ945KniWozyXMtrOsXTQG7hG0BA8pbIo22rtdR-M96ZWG69fhO2CbY8pEXVFsZh5T7JG/s320/pankreas4.jpg" width="320" /></a></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";"><br />
</span><span style="font-family: "Times New Roman","serif";"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Insiden </span><span style="font-family: "Times New Roman","serif";">tumor </span><span lang="EN-US" style="font-family: "Times New Roman","serif";"> pancreas terus meningkat sejak 20 hingga 30 tahun yang lalu. Khususnya diantara orang- orang yang bukan kulit putih. Tumor pankreas merupakan penyebab kematin terkemuka yang menempati urutan keempat di AS dan paling sering ditemukan pada usia 60 hingga 70-an tahun. Kebiasaan merokok, kontak dengan zat kimia industri atau toksin dalam lingkungan, dan diet tinggi lemak, daging ataupun keduanya, memiliki hubungan dengan peningkatan insiden kanker pankreas meskipun peranannya dalam menyebabkan kelainan keganasan ini masih belum jelas seluruhnya. Resiko kanker pankreas akan meningkat bersamaan dengan tingginya kebiasaan merokok. Diabetes Melitus, pankreatitis kronis dan pankreatitis herediter juga memiliki kaitannya dengan kanker pancreas. Pankreas dapat pula menjadi tempat metastasis dari tumor lain. </span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";"><br />
</span><span style="font-family: "Times New Roman","serif";"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Penyakit </span><span style="font-family: "Times New Roman","serif";">ini</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"> dapat tumbuh pada setiap bagian pankreas (pada bagian kaput, korpus atau kauda) dengan menimbulkan manifestasi klinik yang bervariasi menurut lokasi lesinya dan apakah sel- sel pulau Langerhans yang mensekresikan insulin itu turut terlibat. Tumor yang berasal dari kaput pankreas yang merupakan lokasi yang paling sering akan memberikan gambaran klinik tersendiri. Tumor pada sel- sel pulau Langerhans yang fungsional, apakah yang jinak (adenoma) ataukah yang ganas (karsinoma), merupakan penyebab terjadinya sindrom hiper insulin. Dengan pengecualian ini, gejala tumor pankreas bersifat non spesifik dan biasanya pasien baru mencari pertolongan medik setelah sakitnya memasuki stadium lanjut 80% hingga 85% pasien sudah menderita tumor yang lanjut dan tidak dapat direseksi ketika tumor tersebut ditemukan untuk pertama kalinya. Dalam kenyataanya, karsinoma pankreas memiliki angka keberhasilan hidup 5 tahun. Paling rendah bila dibandingkan dengan 60 lokasi kanker lainnya.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif";">B.<span style="font: 7pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";"> ETIOLOGI</span></b><span style="font-family: "Times New Roman","serif";"> </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 18.0pt;"><span style="font-family: "Times New Roman","serif";"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Kebiasaan merokok, kontak dengan zat kimia industri atau toksin dalam lingkngan, minum-minuman beralkohol dan diet tinggi lemak daging atau keduanya memiliki hubungan dengan kanker pancreas meskipun peranannya dalam menyebabkan kelainan keganasan ini masih belum jelas seluruhnya. Diabetes Melitus, pankreatitis kronis dan pankreatitis herediter juga memiliki kaitan dengan kanker pankreas. Tapi penyebab ini juga masih belum jelas seluruhnya. </span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 18.0pt;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif";">C.<span style="font: 7pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">MANIFESTASI KLINIK</span></b><span lang="EN-US" style="font-family: "Times New Roman","serif";"> </span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif";"></span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Rasa nyeri, ikterus atau keduanya terdapat pada lebih dari 90% pasien, dan sering dengan penurunan berat badan, gejala tersebut dipandang sebagian tanda- tanda klasik karsinoma pankreas. Manifestasi ini mungkin baru tampak setelah penyakitnya memasuki stadium yang sangat lanjut. Tanda- tanda lain mencakup penurunan berat badan yang cepat, mencolok dan progresif disamping gangguan rasa nyaman atau nyeri yang samara- samara pada abdomen bagian atas atau bagian tengah, gangguan ini sulit untuk dijelaskan dan tidak disertai gangguan fungsi gastrointestinal.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";"><br />
</span><span style="font-family: "Times New Roman","serif";"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Gangguan rasa nyaman tersebut menyebar sebagai rasa nyeri yang menjengkelkan ke bagian tengah pungung dan tidak berhubungan dengan postur tubuh maupun aktivitas. Penderita karsinoma pankreas sering merasakan bahwa serangan nyerinya dapat dikurangi jika ia duduk membungkuk, rasa nyeri tersebut acap kali bertambah parah ketika ia berbaring telentang, nyeri dapat bersifat progresif dan hebat sehingga memerlukan penggunaan preparat analgesik narkotik. Serangan nyeri ini sering terasa lebih hebat pada malam harinya. </span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";"><br />
</span><span style="font-family: "Times New Roman","serif";"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Sel- sel ganas dari kanker pankreas sering terlepas dan masuk ke dalam rongga peritonium sehingga meningkatkan kemungkinan terjadinya metastasis. Asites umumnya terjadi. <br />
Suatu tanda yang sangat penting jika ada adalah timbulnya gejala- gejala defisiensi insulin yang terdiri atas glukosuria, hiperglikemia dan toleransi glukosa yang abnormal. Diabetes dapat menjadi tanda dini karsinoma pankreas. Makan sering meningkatkan nyeri epigastrium dan gambaran ini biasanya sudah terjadi beberapa minggu sebelum munculnya ikterus serta pruritus. Pembuatan foto-gastro intestinal memperlihatkan deformitas organ visera di dekat pankreas yang disebabkan oleh masa pankreas yang terjepit itu. </span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif";">D.<span style="font: 7pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif";">PEMERIKSAAN </span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";"> DIAGNOSTIK</span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif";"></span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Pemeriksaan USG dan pemindai CT dilakukan untuk mendeteksi keberadaan tumor pankreas. ERCP merupakan pemeriksaan diagnostik yang penting untuk menegakkan diagnosis karsinoma pankreas. Sel-sel yang diperoleh melalui ERCP harus dikirim ke laboratorium untuk dilakukan pemeriksaan. </span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";"><br />
</span><span style="font-family: "Times New Roman","serif";"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Biopsi aspirasi perkutan dengan jarum halus pada jaringan pankreas dilakukan untuk mendiagnosis tumor pankreas dan memastikan diagnosisnya pada pasien-pasien yang tumornya sudah tidak dapat direseksi, pemeriksaan ini akan menghilangkan stres dan nyeri akibat pembedahan yang sudah tidak akan memberikan hasil. Dalam prosedur ini, sebilah jarum biopsi ditusukkan lewat dinding anterior abdomen ke dalam massa pankreas dengan dipandu pemindai CT, USG, ERCP, ataupun teknik-teknik pencitraan lainnya. Bahan-bahan aspirasi tersebut diperiksa untuk mencari sel-sel ganas. Meskipun tindakan biopsi perkutan ini merupakan sarana diagnostik yang berharga, namun tindakan tersebut masih memiliki kekurangan. Hasil negatif-palsu akan didapat jika tumor yang kecil liput dari sasaran biopsi, dan penyebaran sel- sel kanker lewat jalur tusukan jarum biopsi juga dapat terjadi. Penyinaran dengan dosis rendah dapat dilakukan sebelum biopsi untuk mengurangi risiko penyebaran sel-sel kanker. Pemeriksaan kolangiografi transhepatik perkutan (PTC, percutaneus transhepatic cholangiography ) merupakan tindakan lain yang dapat dilakukan sebelum biopsi untuk mengenali obstruksi saluran empedu oleh tumor pankreas. </span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Beberapa penanda tumor (mis CA 19-9, CEA, rasio testosteron terhadap dihidrotestosteron) sekarang sedang dipertimbangkan untuk dimasukkan dalam perangkat sarana diagnostik, meskipun demikian, sampai saat ini masih belum berhasil ditemukan penanda tumor karsinoma pankreas yang dapat diandalkan. Pemeriksaan angiografi, pemindai CT dan laparoskopi dapat dilakukan untuk menentukan apakah tumor tersebut masih dapat diangkat melalui pembedahan.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">E.<span style="font: 7pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">PENATALAKSANAAN</span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif";"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif";">Tindakan bedah yang harus dilakukan biasanya cukup luas jika kita ingin mengangkat tumor terlokalisir yang masih dapat direseksi. Namun demikian, terapi bedah definitif (yaitu, eksisi total lesi) sering tidak mungkin dilaksanakan karena pertumbuhan yang sudah begitu luas ketika tumor tersebut terdiagnosis dan kemungkinan terdapatnya metastase- khususnya ke hepar, paru-paru, dan tulang. Tindakan bedah tersebut sering terbatas pada tindakan paliatif. Meskipun tumor pankreas mungkin resisten terhadap radiasi standar, pasien dapat diterapi dengan radio terapi dan kemoterapi (Flourourasil [5-Fu]). Jika pasien menjalani pembedahan, terapi radiasi dosis tinggi pada jaringan tumor dengan cidera yang minimal pada jaringan lain. Terapi radiasi intraoperatif ini dapat pula mengurangi rasa nyeri. Implantasi interstisial sumber radioaktif juga telah dilakukan meskipun angka kompikasinya tinggi. Pemasangan stent bilier yang besar dan dilakukan secara perkutan atau melalui endoskopi dapat dilikukan untuk mengurangi gejala ikterus. Penelitian kini sedang dilaksanakan untuk mengkaji efek preparat antiestrogen dan anti androgen terhadap kanker pankreas. </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">F.<span style="font: 7pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">DIAGNOSA KEPERAWATAN</span></b></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;"><span lang="EN-US" style="font-family: "Times New Roman","serif";"><br />
1. Nyeri akut b/d agen cedera biologis (tumor pankreas).<br />
2. Ketidak seimbangan nutrisi kurang dari kebutuhan tubuh b/d Tidak mampu dalam memasukkan dan mencerna dan mengabsorbsi makanan.<br />
3. Kekurangan volume cairan b/d kegagalan dalam mekanisme tubuh. <br />
4. Gangguan pola tidur b/d nyeri.<br />
5. Cemas b/d perubahn status fungsi kesehatan. <br />
6. Devisit perawatan diri b/d nyeri. </span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span lang="EN-US" style="font-family: "Times New Roman","serif";"><br />
<br />
DAFTAR PUSTAKA<br />
<br />
Mansjoer Arief dkk. 2001. Kapita Selekta Kedokteran. Media aesculapius. UI PRESS<br />
<br />
Santosa budi. 2005. Panduan Diagnosa Keperawatan Nanda. Prima Medika<br />
<br />
Suddarh & Brunner. 2001. Buku Ajar Keperawatan Medikal Bedah. EGC. Jakarta <br />
<br />
http:// www. Majalah_farmacia. Com. Jumat 22 februari 2008<br />
<br />
http://www.medicastro.com<br />
<br />
Johnson, Marion. 2000. Nursing Outcomes Classification(Noc). St.Louis, Missouri: Mosby<br />
<br />
McCloskey, Joanne C. 1996. Nursing Interventions Classification(Nic). St.Louis, Missouri: Mosby<br />
<br />
Price, Sylvia A & Wilson, LM. 1995. Patofisiologi. EGC : Jakarta</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Suyono, Slamet. 2001. Buku Ajar Penyakit Dalam. Jakarta: Balai Penerbit FKUI </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif";"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif";">http://kmbekp.blogspot.com/2010/04/askep-tumor-pankreas.html</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div align="center" class="MsoNormal" style="line-height: normal; text-align: center; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 9pt;"> PEMERINTAH KABUPATEN GARUT</span></div><div align="center" class="MsoNormal" style="line-height: normal; text-align: center; text-indent: 36.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 9pt;">AKADEMI KEPERAWATAN</span></b></div><div style="border-bottom: solid windowtext 1.0pt; border: none; mso-border-bottom-alt: solid windowtext .5pt; mso-element: para-border-div; padding: 0cm 0cm 1.0pt 0cm;"><div align="center" class="MsoNormal" style="border: none; line-height: normal; mso-border-bottom-alt: solid windowtext .5pt; mso-padding-alt: 0cm 0cm 1.0pt 0cm; padding: 0cm; text-align: center; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 9pt;">Jalan Proklamasi No. 5 Telp. (0262) 232212 Fax (0262) 232212 Garut 44151</span></div></div><div align="center" class="MsoNormal" style="line-height: normal; text-align: center;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 9pt;">DAFTAR PENGAMATAN PROSEDUR</span></div><div class="MsoNormal" style="line-height: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 9pt;">NAMA ASSESOR : TGL / WAKTU :</span></div><div class="MsoNormal" style="line-height: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 9pt;">NAMA PESERTA : TEMPAT :</span></div><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 1184;"><tbody>
<tr style="height: 23.35pt; mso-yfti-firstrow: yes; mso-yfti-irow: 0;"> <td style="border: solid black 1.0pt; height: 23.35pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 28.8pt;" width="38"><div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 9pt;">NO</span></b></div></td> <td style="border-left: none; border: solid black 1.0pt; height: 23.35pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 277.8pt;" width="370"><div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 9pt;">STANDAR OPERASIONAL PROSEDUR</span></b></div></td> <td style="border-left: none; border: solid black 1.0pt; height: 23.35pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 77.95pt;" width="104"><div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 9pt;">SESUAI</span></b></div></td> <td style="border-left: none; border: solid black 1.0pt; height: 23.35pt; mso-border-alt: solid black .5pt; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-themecolor: text1; mso-border-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 77.7pt;" width="104"><div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 9pt;">TIDAK</span></b></div></td> </tr>
<tr style="mso-yfti-irow: 1;"> <td style="border-top: none; border: solid black 1.0pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 28.8pt;" valign="top" width="38"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 9pt;">1</span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 277.8pt;" valign="top" width="370"><div class="MsoNormal" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; tab-stops: 90.0pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Perawatan Luka gangren</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l2 level1 lfo1; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">a.<span style="font: 7pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Persiapan alat </span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo2; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">1)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Bak instrument besar</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo2; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">2)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Pincet sirurgis 1</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo2; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">3)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Pinset anatomis 2</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo2; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">4)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Gunting jaringan 1</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo2; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">5)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Sarung tangan </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo2; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">6)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Kom steril 2</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo2; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">7)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Kassa steril</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo2; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">8)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Kapas steril</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo2; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">9)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Korentang </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo2; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">10)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Gentamisin sesuai order</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo2; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">11)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Spuit 3ml </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo2; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">12)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Nacl</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo2; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">13)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Bengkok 2 </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo2; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">14)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Perlak alas</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo2; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">15)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Gunting verban (bila perawatan luka tertutup)</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo2; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">16)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Plester </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo2; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">17)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Was bensin dan kom kecil </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo2; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">18)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Barak short </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo2; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">19)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Lysol</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo2; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">20)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Buku catatan klien </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l2 level1 lfo1; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">b.<span style="font: 7pt "Times New Roman";"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Prosedur pelaksanaan </span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo3; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">1)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Mencuci tangan di air mengalir </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo3; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">2)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Memasang barak short</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo3; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">3)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Memasang alas perlak </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo3; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">4)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Bengkok didekatkan </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo3; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">5)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Bak instrument buka dengan benar dan jaga kesterilan </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo3; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">6)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Ambil sarung tangan dengan korentang kemudian pakai dengan benar </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo3; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">7)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Balutan lama diangkat dengan mengunakan pinset anatomis bila lengket disiram telebih dahulu dengan NaCl 0,9%. </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo3; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">8)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Balutan lama buang kebengkok </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo3; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">9)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Bersihkan luka dengan menggunakan NaCl 0,9% + Gentamicyn atau sesuai order (perhatikan keadaan luka dan respon klien)</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo3; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">10)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Keringkan dengan menggunakan kassa steril</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo3; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">11)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Bila ada jaringan yang mati ambil pincet cirurgis dan gunting jaringan (bila tidak ada jaringan mati langsung kelangkah 17)</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo3; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">12)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Lakukan nekrotomy (bila ada jaringan mati)</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo3; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">13)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Simpan gunting jaringan dan pinset kedalam bengkok yang berisi desinfektan </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo3; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">14)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"> Bilas kembali luka dengan kapas yang sudah dibasahi NaCl 0,9%</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo3; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">15)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Keringkan dengan menggunakan kassa steril </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo3; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">16)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Tutup dengan kasa steril </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo3; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">17)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Bereskan alat </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo3; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">18)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Buka sarung tangan dan cuci tangan</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo3; tab-stops: 90.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">19)<span style="font: 7pt "Times New Roman";"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Dokumentasikan waktu, nama perawat, kondisi luka, respon klien selama perawatan, cairan untuk membersihka luka dan obat yang digunakan.</span></div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 77.95pt;" valign="top" width="104"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div></td> <td style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 77.7pt;" valign="top" width="104"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div></td> </tr>
<tr style="height: 6.75pt; mso-yfti-irow: 2;"> <td rowspan="2" style="border-top: none; border: solid black 1.0pt; height: 6.75pt; mso-border-alt: solid black .5pt; mso-border-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 28.8pt;" valign="top" width="38"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div></td> <td rowspan="2" style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 6.75pt; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 277.8pt;" valign="top" width="370"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Catatan</span></div></td> <td colspan="2" style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 6.75pt; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.65pt;" valign="top" width="208"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Nama Assesor :</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Tanda Tangan:</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Tanggal :</span></div></td> </tr>
<tr style="height: 63.4pt; mso-yfti-irow: 3; mso-yfti-lastrow: yes;"> <td colspan="2" style="border-bottom: solid black 1.0pt; border-left: none; border-right: solid black 1.0pt; border-top: none; height: 63.4pt; mso-border-alt: solid black .5pt; mso-border-bottom-themecolor: text1; mso-border-left-alt: solid black .5pt; mso-border-left-themecolor: text1; mso-border-right-themecolor: text1; mso-border-themecolor: text1; mso-border-top-alt: solid black .5pt; mso-border-top-themecolor: text1; padding: 0cm 5.4pt 0cm 5.4pt; width: 155.65pt;" valign="top" width="208"><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Nama Peserta :</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;">Tanda Tangan :</span></div></td> </tr>
</tbody></table><div class="MsoNormal" style="line-height: normal;"><br />
</div><div class="MsoNormal" style="line-height: normal;"><br />
</div><div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: center;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt;">Cara pemberian insulin</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Insulin kerja singkat :</span></div><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l3 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">IV, IM, SC</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l3 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Infus ( AA / Glukosa / elektrolit )</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l3 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Jangan bersama darah ( mengandung enzim merusak insulin )</span></li>
</ul><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Insulin kerja menengah / panjang : </span></div><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Jangan IV karena bahaya emboli.</span></li>
</ul><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pemberian insulin secara sliding scale dimaksudkan agar pemberiannya lebih efisien dan tepat karena didasarkan pada kadar gula darah pasien pada waktu itu. Gula darah diperiksa setiap 6 jam sekali.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Dosis pemberian insulin tergantung pada kadar gula darah, yaitu :</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Gula darah </span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"> < 60 mg % = 0 unit</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"> < 200 mg % = 5 – 8 unit</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"> 200 – 250 mg% = 10 – 12 unit</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"> 250 - 300 mg% = 15 – 16 unit</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"> 300 – 350 mg% = 20 unit</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"> > 350 mg% = 20 – 24 unit</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt;">Teknik Penyuntikan Insulin</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Sebelum menggunakan insulin, diabetesein ataupun keluarga tentunya perlu untuk diberikan pengetahuan dan wawasan mengenai cara dan prosedur menyuntikkan insulin eksogen;</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">1 Sebelum menyuntikkan insulin, kedua tangan dan daerah yang akan disuntik haruslah bersih. Bersihkanlah dengan cairan alkohol 70% dengan menggunakan kapas bersih dan steril.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">2 Tutup vial insulin harus diusap dengan cairan alkohol 70%.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">3 Untuk semua insulin, kecuali insulin kerja cepat, harus digulung-gulung secara perlahan-lahan denga kedua telapak tangan. Hal ini bertujuan untuk melarutkan kembali suspensi. (<i>Jangan dikocok</i>).</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">4 Ambillah udara sejumlah insulin yang akan diberikan. Lalu suntikkanlah ke dalam vial untuk mencegah terjadi ruang vakum dalam vial. Hal ini terutama diperlukan bila akan dipakai campuran insulin.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">5 Bila mencampur insulin kerja cepat dengan kerja cepat harus diambil terlebih dahulu.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">6 Setelah insulin masuk ke dalam alat suntik, periksa apakah mengandung gelembung atau tidak. Satu atau dua ketukan pada alat suntik dalam posisi tegak akan dapat mengurangi gelembung tersebut. Gelembung yang ada sebenarnya tidaklah terlalu membahayakan, namun dapat mengurangi dosis insulin.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">7 Penyuntikan dilakukan pada jaringan bawah kulit (subkutan). Pada umumnya suntikan dengan sudut 90 derajad. Pada pasien kurus dan anak-anak, kulit dijepit dan insulin disuntikkan dengan sudut 45 derajat agar tidak terjadi penyuntikkan otot (intra muskular).</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Perlu diperhatikan daerah mana saja yang dapat dijadikan tempat menyuntikkan insulin. Bila kadar glukosa darah tinggi, sebaiknya disuntikkan di daerah perut dimana penyerapan akan lebih cepat. Namun bila kondisi kadar glukosa pada darah rendah, hindarilah penyuntikkan pada daerah perut.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Secara urutan, area proses penyerapan paling cepat adalah dari perut, lengan atas dan paha. Insulin akan lebih cepat diserap apabila daerah suntikkan digerak-gerakkan. Penyuntikkan insulin pada satu daerah yang sama dapat mengurangi variasi penyerapan.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Penyuntikkan insulin selalu di daerah yang sama dapat merangsang terjadinya perlemakan dan menyebabkan gangguan penyerapan insulin. Daerah suntikkan sebaiknya berjarak 1inchi (+ 2,5cm) dari daerah sebelumnya.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Lakukanlah rotasi di dalam satu daerah selama satu minggu, lalu baru pindah ke daerah yang lain.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div align="center" class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: center;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Bila proses penyuntikkan terasa sakit atau mengalami perdarahan setelah proses penyuntikkan, maka daerah tersebut sebaiknya ditekan selama 5-8 detik. Untuk mengurangi rasa sakit pada waktu penyuntikkan dapat ditempuh usaha-usaha sebagai berikut:</span></div><ol start="1" type="1"><li class="MsoNormal" style="line-height: normal; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Menyuntik dengan suhu kamar</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Pastikan bahwa dalam alat suntik tidak terdapat gelembung udara</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Tunggulah sampai alkohol kering sebelum menyuntik</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Usahakanlah agar otot daerah yang akan disuntik tidak tegang</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Tusuklah kulit dengan cepat</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Jangan merubah arah suntikkan selama penyuntikkan atau mencabut suntikan</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l2 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Jangan menggunakan jarum yang sudah tampak tumpul</span></li>
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</div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt;">Jenis alat suntik (syringe) insulin</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">1. Siring (syringe) dan jarumSiring dari bahan kaca sulit dibersihkan, mudah pecah dan sering menjadi kurang akurat.Siring yang terbaik adalah siring yang terbuat dari plastik sekali pakai. Walaupun banyak pasien diabetes yang menggunakan lebih dari sekali pakai, sangat disarankan hanya dipakai sekali saja setelah itu dibuang.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">2. Pena insulin (Insulin Pen)Siring biasanya tertalu merepotkan dan kebanyakan pasien diabetes lebih suka menggunakan pena insulin. Alat ini praktis, mudah dan menyenangkan karena nyaris tidak menimbulkan nyeri. Alat ini menggabungkan semua fungsi didalam satu alat tunggal.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">3. Pompa insulin (Insulin Pump)Pompa insulin (insulin pump) diciptakan untuk mneyediakan insulin secara berkesinambungan. Pompa harus disambungkan kepada pasien diabetes (melalui suatu tabung dan jarum). Gula (Glucose) darah terkontrol dengan sangat baik dan sesuai dengan kebutuhan.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt;">Penyimpanan Insulin Eksogen</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Bila belum dipakai :</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Sebaiknya disimpan 2-8 derajat celcius (jangan sampai beku), di dalam gelap (seperti di lemari pendingin, namun hindari freezer.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Bila sedang dipakai :</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Suhu ruang 25-30 derajat celcius cukup untuk menyimpan selama beberapa minggu, tetapi janganlah terkena sinar matahari.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Sinar matahari secara langsung dapat mempengaruhi percepatan kehilangan aktifitas biologik sampai 100 kai dari biasanya.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Suntikkan dalam bentuk pena dan insulin dalam suntikkan tidak perlu disimpan di lemari pendingin diantara 2 waktu pemberian suntikkan.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Bila tidak tersedia lemari pendingin, simpanlah insulin eksogen di tempat yang teduh dan gelap.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt;">Efek samping penggunaan insulin</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l1 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Hipoglikemia</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l1 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Lipoatrofi</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l1 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Lipohipertrofi</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l1 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Alergi sistemik atau lokal</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l1 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Resistensi insulin</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l1 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Edema insulin</span></li>
<li class="MsoNormal" style="line-height: normal; mso-list: l1 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Sepsis</span></li>
</ul><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Hipoglikemia merupakan komplikasi yang paling berbahaya dan dapat terjadi bila terdapat ketidaksesuaian antara diet, kegiatan jasmani dan jumlah insulin. Pada 25-75% pasien yang diberikan insulin konvensional dapat terjadi Lipoatrofi yaitu terjadi lekukan di bawah kulit tempat suntikan akibat atrofi jaringan lemak. Hal ini diduga disebabkan oleh reaksi imun dan lebih sering terjadi pada wanita muda terutama terjadi di negara yang memakai insulin tidak begitu murni. Lipohipertrofi yaitu pengumpulan jaringan lemak subkutan di tempat suntikan akibat lipogenik insulin. Lebih banyak ditemukan di negara yang memakai insulin murni. Regresi terjadi bila insulin tidak lagi disuntikkan di tempat tersebut.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Reaksi alergi lokal terjadi 10x lebih sering daripada reaksi sistemik terutama pada penggunaan sediaan yang kurang murni. Reaksi lokal berupa eritem dan indurasi di tempat suntikan yang terjadi dalam beberpa menit atau jam dan berlagsung.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Selama beberapa hari. Reaksi ini biasanya terjadi beberapa minggu sesudah pengobatan insulin dimulai. Inflamasi lokal atau infeksi mudah terjadi bila pembersihan kulit kurang baik, penggunaan antiseptiK yang menimbulkan sensitisasi atau terjadinya suntikan intrakutan, reaksi ini akan hilang secara spontan. Reaksi umum dapat berupa urtikaria, erupsi kulit, angioudem, gangguan gastrointestinal, gangguan pernapasan dan yang sangat jarang ialah hipotensi dan shock yang diakhiri kematian.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt;">Interaksi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Beberapa hormon melawan efek hipoglikemia insulin misalnya hormon pertumbuhan, kortikosteroid, glukokortikoid, tiroid, estrogen, progestin, dan glukagon. Adrenalin menghambat sekresi insulin dan merangsang glikogenolisis. Peningkatan hormon-hormon ini perlu diperhitungkan dalam pengobatan insulin.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Guanetidin menurunkan gula darah dan dosis insulin perlu disesuaikan bila obat ini ditambahkan / dihilangkan dalam pengobatan. Beberapa antibiotik (misalnya kloramfenikol, tetrasiklin), salisilat dan fenilbutason meningkatkan kadar insulin dalam plasma dan mungkin memperlihatkan efek hipoglikemik.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Hipoglikemia cenderung terjadi pada penderita yang mendapat penghambat adrenoseptor ß, obat ini juga mengaburkan takikardi akibat hipoglikemia. Potensiasi efek hipoglikemik insulin terjadi dengan penghambat MAO, steroid anabolik dan fenfluramin.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
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</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Diposting Oleh Ita Nurmalitasari</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">IIA</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">05200ID09017</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">AKPER PEMDA GARUT</span></div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><br />
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</div><div class="MsoNormal" style="line-height: 150%;"><br />
</div>ita_2A_SISTEM_ENDOKRINhttp://www.blogger.com/profile/01283161728267260485noreply@blogger.com0tag:blogger.com,1999:blog-2572653943791789476.post-10291111083041272992011-06-02T21:20:00.000-07:002011-06-02T21:20:25.352-07:00TUGAS KE III LAPORAN PENDAHULUAN DIABETES MELITUS<!--[if gte mso 10]> <style>
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</style> <![endif]--> <div align="center" class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: center;"><span style="font-size: small;"><b><span>LAPORAN PENDAHULUAN DIABETES MELITUS</span></b><span></span></span></div><div align="center" class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: center;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify; text-indent: -18pt;"><span style="font-size: small;"><b><span>A.</span></b><span> <b>A. Definisi</b></span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify; text-indent: 18pt;"><span style="font-size: small;"><span>Diabetes Mellitus ( DM ) adalah penyakit metabolik yang kebanyakan herediter, demham tanda – tanda hiperglikemia dan glukosuria, disertai dengan atau tidak adanya gejala klinik akut ataupun kronik, sebagai akibat dari kuranganya insulin efektif di dalam tubuh, gangguan primer terletak pada metabolisme karbohidrat yang biasanya disertai juga gangguan metabolisme lemak dan protein. ( Askandar, 2000 ).</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; text-align: justify; text-indent: 39.5pt;"><span style="font-size: small;"><span style="line-height: 115%;">Diabetes mellitus adalah suatu penyakit kronik yang komplek</span><span style="line-height: 115%;"> </span><span style="line-height: 115%;">melibatkan kelainan metabolisme karbohidrat, protein, lemak, dan</span><span style="line-height: 115%;"> </span><span style="line-height: 115%;">berkembangnya komplikasi makrovaskuler, mikrovaskuler dan neurologis.</span><span style="line-height: 115%;"> </span><span style="line-height: 115%;">(Barbara C. Long, 1996)</span><span style="line-height: 115%;"> </span><span style="line-height: 115%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; text-align: justify; text-indent: 39.5pt;"><span style="font-size: small;"><span style="line-height: 115%;">Diabetes mellitus adalah penyakit karena kekurangan hormon</span><span style="line-height: 115%;"> </span><span style="line-height: 115%;">insulin sehingga glukosa tidak dapat diolah tubuh dan kadar glukosa dalam</span><span style="line-height: 115%;"> </span><span style="line-height: 115%;">darah meningkat lalu dikeluarkan kemih yang menjadi merasa manis</span><span style="line-height: 115%;"> </span><span style="line-height: 115%;">(Ahmad Ramali, 2000)</span><span style="line-height: 115%;"> </span><span style="line-height: 115%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; text-align: justify; text-indent: 39.5pt;"><span style="font-size: small;"><span style="line-height: 115%;">Diabetes mellitus adalah masalah yang mengancam hidup atau</span><span style="line-height: 115%;"> </span><span style="line-height: 115%;">kasus darurat yang disebabkan oleh defisiensi insulin relatif atau absolut</span><span style="line-height: 115%;"> </span><span style="line-height: 115%;">(Mariyinn E. Donges, 2000)</span><span style="line-height: 115%;"> </span><span style="line-height: 115%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; text-align: justify; text-indent: 39.5pt;"><span style="font-size: small;"><span style="line-height: 115%;">Diabetes mellitus adalah kelainan heterogen yang ditandai oleh</span><span style="line-height: 115%;"> </span><span style="line-height: 115%;">kenaikan kadar glukosa dalam darah atau hiperglikemia (Smletzer C.</span><span style="line-height: 115%;"> </span><span style="line-height: 115%;">Suzanne, 2001).</span><span style="line-height: 115%;"> </span><span style="line-height: 115%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify; text-indent: -18pt;"><span style="font-size: small;"><b><span>B.</span></b><span> <b>B. Anatomi Fisiologi</b></span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify; text-indent: -18pt;"><br />
</div><div align="center" class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: center;"><span style="font-size: small;"><span><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbx-Cz1OsImkV7Tr5eNxZybq6bR05Yu0gEr_hmZ6Xo1Vo_jDHBhCJnWeJiDICN-cqN1XK2N5pNGHnzG_DnUr6yM7J81hfcwPTsENRWuqrD8-lepW7Y43OK-GtgITnE9nlZhD1g_oz4ed4s/s1600/Pathway+Diabetes+Melitus.jpg"><span style="color: blue;"><br />
</span></a></span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal;"><br />
</div><div class="separator" style="clear: both; font-family: Arial,Helvetica,sans-serif; text-align: center;"><span style="font-size: small;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEikv2kJulD-nkdJu6nlvc4MBkg717pjaQq9w56T9DGcdKbCIdhbZCEDuE4KIHXMb3PDlvDr68EFdFC15WFDO0Vp1KwUHWbNNVES48zDiohZU4Y9hC801nKFJtmMKnvrO4LpWoj-L9wJeAST/s1600/pankreas.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="268" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEikv2kJulD-nkdJu6nlvc4MBkg717pjaQq9w56T9DGcdKbCIdhbZCEDuE4KIHXMb3PDlvDr68EFdFC15WFDO0Vp1KwUHWbNNVES48zDiohZU4Y9hC801nKFJtmMKnvrO4LpWoj-L9wJeAST/s320/pankreas.jpg" width="320" /></a></span></div><div align="center" class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: center;"><span style="font-size: small;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEikv2kJulD-nkdJu6nlvc4MBkg717pjaQq9w56T9DGcdKbCIdhbZCEDuE4KIHXMb3PDlvDr68EFdFC15WFDO0Vp1KwUHWbNNVES48zDiohZU4Y9hC801nKFJtmMKnvrO4LpWoj-L9wJeAST/s1600/pankreas.jpg"><span style="color: blue; text-decoration: none;"><span><br />
</span></span></a><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify; text-indent: -18pt;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify; text-indent: -18pt;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><span style="font-size: small;"><span>Pankreas merupakan sekumpulan kelenjar yang panjangnya kira – kira 15 cm, lebar 5 cm, mulai dari duodenum sampai ke limpa dan beratnya rata – rata 60 – 90 gram. Terbentang pada vertebrata lumbalis 1 dan 2 di belakang lambung.</span><span> </span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span>Pankreas merupakan kelenjar endokrin terbesar yang terdapat di dalam tubuh baik hewan maupun manusia. Bagian depan ( kepala ) kelenjar pankreas terletak pada lekukan yang dibentuk oleh duodenum dan bagian pilorus dari lambung. Bagian badan yang merupakan bagian utama dari organ ini merentang ke arah limpa dengan bagian ekornya menyentuh atau terletak pada alat ini. Dari segi perkembangan embriologis, kelenjar pankreas terbentuk dari epitel yang berasal dari lapisan epitel yang membentuk usus.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span>Pankreas terdiri dari dua jaringan utama, yaitu :</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span>(1). Asini sekresi getah pencernaan ke dalam duodenum.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span>(2). Pulau Langerhans yang tidak tidak mengeluarkan sekretnya keluar, tetapi menyekresi insulin dan glukagon langsung ke darah.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span>Pulau – pulau Langerhans yang menjadi sistem endokrinologis dari pamkreas tersebar di seluruh pankreas dengan berat hanya 1 – 3 % dari berat total pankreas. Pulau langerhans berbentuk ovoid dengan besar masing-masing pulau berbeda. Besar pulau langerhans yang terkecil adalah 50 m, sedangkan yang terbesar 300 m, terbanyak adalah yang besarnya 100 – 225 m. Jumlah semua pulau langerhans di pankreas diperkirakan antara 1 – 2 juta.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span>Pulau langerhans manusia, mengandung tiga jenis sel utama, yaitu :</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span>(1). Sel – sel A ( alpha ), jumlahnya sekitar 20 – 40 % ; memproduksi glikagon yang manjadi faktor hiperglikemik, suatu hormon yang mempunyai “ anti insulin like activity “.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span>(2). Sel – sel B ( betha ), jumlahnya sekitar 60 – 80 % , membuat insulin.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span>(3). Sel – sel D ( delta ), jumlahnya sekitar 5 – 15 %, membuat somatostatin.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span>Masing – masing sel tersebut, dapat dibedakan berdasarkan struktur dan sifat pewarnaan. Di bawah mikroskop pulau-pulau langerhans ini nampak berwarna pucat dan banyak mengandung pembuluh darah kapiler. Pada penderita DM, sel beha sering ada tetapi berbeda dengan sel beta yang normal dimana sel beta tidak menunjukkan reaksi pewarnaan untuk insulin sehingga dianggap tidak berfungsi.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span>Insulin merupakan protein kecil dengan berat molekul 5808 untuk insulin manusia. Molekul insulin terdiri dari dua rantai polipeptida yang tidak sama, yaitu rantai A dan B. Kedua rantai ini dihubungkan oleh dua jembatan ( perangkai ), yang terdiri dari disulfida. Rantai A terdiri dari 21 asam amino dan rantai B terdiri dari 30 asam amino. Insulin dapat larut pada pH 4 – 7 dengan titik isoelektrik pada 5,3. Sebelum insulin dapat berfungsi, ia harus berikatan dengan protein reseptor yang besar di dalam membrana sel.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span>Insulin di sintesis sel beta pankreas dari proinsulin dan di simpan dalam butiran berselaput yang berasal dari kompleks Golgi. Pengaturan sekresi insulin dipengaruhi efek umpan balik kadar glukosa darah pada pankreas. Bila kadar glukosa darah meningkat diatas 100 mg/100ml darah, sekresi insulin meningkat cepat. Bila kadar glukosa normal atau rendah, produksi insulin akan menurun.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span>Selain kadar glukosa darah, faktor lain seperti asam amino, asam lemak, dan hormon gastrointestina merangsang sekresi insulin dalam derajat berbeda-beda. Fungsi metabolisme utama insulin untuk meningkatkan kecepatan transport glukosa melalui membran sel ke jaringan terutama sel – sel otot, fibroblas dan sel lemak.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-indent: 36pt;"><span style="font-size: small;"><b><span>C.</span></b><span> <b> Klasifikasi</b></span><span> </span><span><br />
1. Tipe I : Diabetes mellitus tergantung insulin (IDDM)<br />
2. Tipe II : Diabetes mellitus tidak tergantung insulin (NIDDM)<br />
3. Diabetes mellitus yang berhubungan dengan keadaan atau sindrom lainnya<br />
4. Diabetes mellitus gestasional (GDM)</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify; text-indent: -18pt;"><span style="font-size: small;"><b><span>D.</span></b><span> D. <b>Etiologi </b></span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span>DM mempunyai etiologi yang heterogen, dimana berbagai lesi dapat menyebabkan insufisiensi insulin, tetapi determinan genetik biasanya memegang peranan penting pada mayoritas DM. Faktor lain yang dianggap sebagai kemungkinan etiologi DM yaitu :</span><span></span></span></div><ol start="1" style="font-family: Arial,Helvetica,sans-serif;" type="1"><li class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-size: small;"><span>Kelainan sel beta pankreas, berkisar dari hilangnya sel beta sampai kegagalan sel beta melepas insulin.</span><span></span></span></li>
<li class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-size: small;"><span>Faktor – faktor lingkungan yang mengubah fungsi sel beta, antara lain agen yang dapat menimbulkan infeksi, diet dimana pemasukan karbohidrat dan gula yang diproses secara berlebihan, obesitas dan kehamilan.</span><span></span></span></li>
<li class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-size: small;"><span>Gangguan sistem imunitas. Sistem ini dapat dilakukan oleh autoimunitas yang disertai pembentukan sel – sel antibodi antipankreatik dan mengakibatkan kerusakan sel – sel penyekresi insulin, kemudian peningkatan kepekaan sel beta oleh virus.</span><span></span></span></li>
<li class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-size: small;"><span>Kelainan insulin. Pada pasien obesitas, terjadi gangguan kepekaan jaringan terhadap insulin akibat kurangnya reseptor insulin yang terdapat pada membran sel yang responsir terhadap insulin.</span><span></span></span></li>
</ol><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify; text-indent: -18pt;"><span style="font-size: small;"><b><span>E.</span></b><span> <b>E. Patofisiologi Diabetes Melitus</b> <b> (Brunner & Suddarth, 2002)</b></span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 52pt; text-align: justify; text-indent: -17pt;"><span style="font-size: small;"><span>1. Diabetes Tipe I</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span>Terdapat ketidakmampuan untuk menghasilkan insulin karena sel-sel ? pankreas telah dihancurkan oleh proses autoimun. Glukosa yang berasal dari makanan tidak dapat disimpan dalam hati meskipun tetap berada dalam darah dan menimbulkan hiperglikemia postprandial (sesudah makan).</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span>Jika konsentrasi glukosa dalam darah cukup tinggi, ginjal tidak dapat menyerap kembali semua glukosa yang tersaring keluar akibatnya glukosa tersebut diekskresikan dalam urin (glukosuria). Ekskresi ini akan disertai oleh pengeluaran cairan dan elektrolit yang berlebihan, keadaan ini dinamakan diuresis osmotik. Pasien mengalami peningkatan dalam berkemih (poliuria) dan rasa haus (polidipsi).</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span>2. Diabetes Tipe II </span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span>Terdapat dua masalah utama yang berhubungan dengan insulin, yaitu: resistensi insulin dan gangguan sekresi insulin. Normalnya insulin akan terikat dengan reseptor khusus pada permukaan sel. Sebagai akibat terikatnya insulin dengan reseptor tersebut, terjadi suatu rangkaian reaksi dalam metabolisme glukosa di dalam sel. Resistensi insulin pada diabetes tipe II disertai dengan penurunan reaksi intrasel, dengan demikian insulin menjadi tidak efektif untuk menstimulasi pengambilan glukosa oleh jaringan.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span>Untuk mengatasi resistensi insulin dan mencegah terbentuknya glukosa dalam darah harus terdapat peningkatan insulin yang disekresikan. Pada penderita toleransi glukosa terganggu, keadaan ini terjadi akibat sekresi insulin yang berlebihan dan kadar glukosa akan dipertahankan pada tingkat yang normal atau sedikit meningkat. Namun jika sel-sel ? tidak mampu mengimbangi peningkatan kebutuhan akan insulin maka kadar glukosa akan meningkat danterjadi diabetes tipe II.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span>Meskipun terjadi gangguan sekresi insulin yang merupakan ciri khas diabtes tipe II, namun terdapat jumlah insulin yang adekuat untuk mencegah pemecahan lemak dan produksi badan keton. Oleh karena itu, ketoasidosis diabetik tidak terjadi pada diabetes tipe II. Meskipun demikan, diabetes tipe II yang tidak terkontrol dapat menimbulkan masalah akut lainnya yang dinamakan sindrom hiperglikemik hiperosmoler nonketotik. Akibat intoleransi glukosa yang berlangsung lambat dan progresif, maka awitan diabetes tipe II dapat berjalan tanpa terdeteksi, gejalanya sering bersifat ringan dan dapat mencakup kelelahan, iritabilitas, poliuria, polidipsia, luka pada kulit yang tidak sembuh-sembuh, infeksi dan pandangan yang kabur. </span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span>3. Diabetes Gestasional</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span>Terjadi pada wanita yang tidak menderita diabetes sebelum kehamilannya. Hiperglikemia terjadi selama kehamilan akibat sekresi hormone-hormon plasenta. Sesudah melahirkan bayi, kadar glukosa darah pada wanita yang menderita diabetes gestasional akan kembali normal.</span><span></span></span></div><div class="separator" style="clear: both; font-family: Arial,Helvetica,sans-serif; text-align: center;"><span style="font-size: small;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbx-Cz1OsImkV7Tr5eNxZybq6bR05Yu0gEr_hmZ6Xo1Vo_jDHBhCJnWeJiDICN-cqN1XK2N5pNGHnzG_DnUr6yM7J81hfcwPTsENRWuqrD8-lepW7Y43OK-GtgITnE9nlZhD1g_oz4ed4s/s1600/Pathway+Diabetes+Melitus.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="197" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbx-Cz1OsImkV7Tr5eNxZybq6bR05Yu0gEr_hmZ6Xo1Vo_jDHBhCJnWeJiDICN-cqN1XK2N5pNGHnzG_DnUr6yM7J81hfcwPTsENRWuqrD8-lepW7Y43OK-GtgITnE9nlZhD1g_oz4ed4s/s320/Pathway+Diabetes+Melitus.jpg" width="320" /></a></span></div><div align="center" class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: center;"><span style="font-size: small;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhbx-Cz1OsImkV7Tr5eNxZybq6bR05Yu0gEr_hmZ6Xo1Vo_jDHBhCJnWeJiDICN-cqN1XK2N5pNGHnzG_DnUr6yM7J81hfcwPTsENRWuqrD8-lepW7Y43OK-GtgITnE9nlZhD1g_oz4ed4s/s1600/Pathway+Diabetes+Melitus.jpg"><span style="color: blue; text-decoration: none;"><span><br />
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</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify; text-indent: -18pt;"><span style="font-size: small;"><b><span>F.</span></b><span> <b> F. Manifestasi Klinis </b></span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span>Diagnosis DM Tipe II (<i>Non Insulin Dependent Diabetes Mellitus)</i> ditandai dengan adanya gejala berupa polifagia, poliuria, polidipsia, lemas dan berat badan turun. Gejala lain yang mungkin dikeluhkan pasien adalah kesemutan, gatal, mata kabur dan impoteni pada pria serta pruritus vulva pada wanita.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%;"><span style="font-size: small;"><b><span style="line-height: 150%;"> G. PENATALAKSANAAN MEDIS DIABETES MELITUS </span></b><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-size: small;"><span style="line-height: 150%;">Tujuan Pengelolaan DM Secara Umum</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Hilangnya tanda dan keluhan DM dan mempertahankan kenyamanan dan kesehatan<br />
Tercegahya dan terhambatnya progresifitas komplikasi mikroangioopati, makroangiopati, neuropati dengan tujuan akhir untuk menurunkan morbiditas dan mortalitas. Untuk itu dilakukan:<br />
Pengendalian hiperglikemi, tekanan darah, berat badan, dan lipid, melalui pengeloaan pasien secara holistik dengan mengajarkan perawatan mandiri dan perubahan prilaku.<br />
LANGKAH LANGKAH YANG PERLU DILAKUKAN PADA PENGELOLAAN PASIEN DM (Konsensus Perkeni, 2002)</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Anamnesa dan pemeriksaan fisik lengkap</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Evaluasi medis khusus diabetes pada pertemuan awal</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Anamnesis keluhan hiperglikemi dan komplikasi</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Pemeriksaan fisik tiap kali pertemuan :</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">TB,BB, TD (diperiksa pada posisi tidur dan duduk)</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Tanda neuropati</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Mata <br />
Gimul<br />
Keadaan kaki (termasuk rabaan nadi kaki) kulit dan kuku</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Laboratorium :<br />
Hb, leukosit, LED</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">GDP dan GPP</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Urinalisis rutin</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Pemeriksaan laboratorium tambahan yang disarankan, tergantung fasilitas yang tersedia :<br />
HbA1c (glycosilated haemoglobin)</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Mikroalbuminuri<br />
Kreatinin<br />
Albumin/termasuk SGPT</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Kolesterol total, HDL, LDL dan trigliserida</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">EKG<br />
Ro thorax</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Funduskopi<br />
Pilar Pengelolaan DM</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Edukasi<br />
Perencanaan makan</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Latihan Jasmani</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Intervensi farmakologis</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;"><br />
1. EDUKASI</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Pendekatan tim (perawat edukator diabetes, dokter, ahli gizi, podiatris, psikiatris dan pekerja sosial) Komunikasi tim yang baik diperlukan untuk mencegah kebingungan pasien<br />
Salah satu metode edukasi tim: Burger Materi Edukasi:</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Pengetahuan tentang patofisiologi DM. Komplikasi dan pencegahan komplikasi<br />
Diet<br />
Olah raga</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">OHO dan insulin (termasuk cara penyuntikan insulin)</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Perawatan kaki</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Follow up care</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Penanganan hipo dan hiperglikemi</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">PGDM (Pemeriksaan Gula Darah Mandiri)</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Perawatan diri dikala sakit</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Melakukan perjalanan jauh </span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;"><br />
2. PERENCANAAN MAKAN</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Merupakan salah satu pilar penanganan pasien DM tipe ½ Prinsip:</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Harus disesuaikan dengan kebiasaan tiap individu</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Jumlah kalori disesuaikan dengan pertumbuhan, stutus gizi, umur, ada tidaknya stress akut, dan kegiatan jasmani</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Jumlah kalori yang masuk lebih penting dari pada jenis asal kalori Menghitung kebutuhan kalori dengan menggunakan:</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Rumus Broca (yang dipakai di klinik)</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">BBI=(TB-100)-10%<br />
Status gizi:</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">BB kurang BB<90%BBI</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">BB normal BB90-110%BBI</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">BB lebih BB110-120%BBI</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">BB gemuk BB>120% BBi</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">IMT (Index Massa Tubuh)</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">3. PERENCANAAN MAKAN</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Contoh perhitungan Kalori dengan rumus Broca:</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">BBI=(TB-100)-10% dikalikan dengan kebutuhan kalori untuk metabolisme basal (30kkal/kgBB untuk pria;24 kkal/kgBB untuk wanita)</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Penambahan:<br />
10-30% aktifitas</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">20% stress akut</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Koreksi bila gemuk</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Makanan dibagi atas 3 porsi besar: pagi (20%), siang(30%), sore (25%) dan sisa untuk snack diantara makan pagi siang dan siang-sore. Selanjutnya perubahan disesuaikan dengan pola makan pasien.</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Standar yang dianjurkan untuk komposisi makanan:</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">KH 60-70%</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Protein 10-15%</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Lemak 20-25%</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">PERENCANAAN MAKAN</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">KH diklasifikasikan berdasarkan efeknya terhadap peningkatan glukosa (Index glikemik):</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Lambat (a.l. roti whole grain, nasi, kentang, cereal, apel)</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Sedang <br />
Cepat<br />
Untuk mencegah peningkatkan glukosa secara cepat maka dipilih makanan dengan index glikemik lambat</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Gula murni tidak perlu dihindari</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">4. LATIHAN JASMANI</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Manfaat olah raga bagi pasien DM:</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Meningkatkan kontrol GD</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Menurunkan resiko penyakit KV, jika dilakukan minimal 30 menit,3-4kali/minggu sampai HR mencapai 220-umur/menit</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Menurunkan BB</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Menimbulkan kegembiraan</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Sebelum melakukan olah raga, pasien DM:</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Melakukan evaluasi medis</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Diidentifikasi kemungkinan adanya masalah mikro dan makroangiopati yang akan bertambah buruk dengan olah raga</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Jenis olah raga:</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Rekreasional maupun profesional sport boleh dilakukan oleh pasien DM</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Hindari olah raga dengan kontak tubuh</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Informasi yang perlu disampaikan pada pasien </span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Cek gula darah sebelum olah raga, cek apakah butuh tambahan glukosa</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">LATIHAN JASMANI</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Hindari dehidarasi, minum 500cc</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Diperlukan teman selama berolah raga</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Pakai selalu tanda pengenal sebagai diabetisi</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Selalu bawa makanan sumber glukosa cepat:permen, jelly</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Makan snack sebelum mulai</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Jangan olah raga jika merasa ‘tak enak badan’</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Gunakan alas kaki yang baik</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">5. INTERVENSI FARMAKOLOGIS</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Intervensi farmakologis ditambahkan jika sasaran kadar glukosa darah belum tercapai dengan pengaturan makan dan latihan jasmani</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Intervensi Farmakologis meliputi:</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">OHO (Obat Hipoglikemik Oral)</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Insulin<br />
OBAT HIPOGLIKEMIK ORAL</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Lokasi kerja OHO pada tubuh</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">OBAT HIPOGLIKEMIK ORAL</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Digolongkan berdasarkan cara kerjanya:</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;"><br />
Pemicu sekresi insulin/secretagogue (Sulfonilurea dan Glinit)<br />
Penambah sensitifitas terhadap insulin: Metformin dan Tiazolidindion. Penghambat absorbsi glukosa:penghambat oksidase alfa</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">SULFONILUREA<br />
Bekerja dengan cara meningkatkan sekresi insulin. Semua Sulfonilurea meningkatkan berat badan dan beresiko menyebabkan hipoglikemi . Menurunkan GDP sampai 50–70 mg/dl dan menurunkan HbA1c sampai 0.8–1.7% </span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Semua obat menyebabkan hipoglikemi berat, maka dosis yang diberikan sekecil mungkin dan harus dimonitor GDP sampai 110-140mg/dL.</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Generasi pertama (Tolbutamide, Acetohexamide, Tolazamide, and Chlorpropamide)<br />
sudah tidak digunakan lagi (terutama di US) karena meningkatkan reaksi obat dengan obat lain.<br />
sangat kuat efek hipoglikeminya (Chlorpropamide): hanya dimetabolisme pada pasien gangguan ginjalàterakumulasi pada ginjalàsebagian menyebabkan hipoglikemi memanjang dan berat<br />
TIAZOLIDINDION<br />
Contoh:Troglitazone Maretà(Rezulin), rosiglitazone (Avandia) and pioglitazone (Actos). 2000 Troglitazone ditarik dari pasaran US karena terbukti menyebabkan 60 laporan hepatotoksik.<br />
Bekerja dengan cara meningkatkan sensitifitas insulin pada jaringan otot dan adipose dan sedikit menghambat produksi glukosa di hati. </span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Relatif aman untuk pasien gangguan ginjal karena dimetabolisme di hati dan dikeluarkan melalui feses. Penggunaan pada pasien gangguan hati dapat menyebabkan akumulasi Tiazolidindion, kontra indikasi untuk CHF fc III dan IVàTerjadi sedikit peningkatan volume plasma pada penggunaan obat ini</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">PENGHAMBAT<br />
GLUKOSIDASE ALFA/GLUKOSIDASE INHIBITORS </span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Generik:Acarbose (Glucobay)</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">lansung menurunkan GDPP.àBekerja dengan cara menghambat absorbsi karbohidrat pada usus halus .Absorbsi dextrins, maltose, sucrose, and KH tergangu dengan pemberian Acarbose tetapi tidak menghambat penyerapan glucose dan lactose. <br />
Dimakan bersamaan suapan pertama</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Pengobatan dengan Arcabose dapat menurunkan GDP sampai 35–40 mg/dl dan HbA1c sampai 0.4–0.7%. Terapi Acarbose tidak menyebabkan peingkatan berat badan atau hipoglikemi (karena hanya berefek lokal). </span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">KI: gangguan hepar, ginjal (keatinin>2mg/dl) dan GI</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Efek samping: peningkatan flatus, nyeri abdominal, dan diare. </span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">BIGUANID<br />
Mekanisme kerja terutama menurunkan pengeluaran glukosa hati. </span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Mampu meningkatkan sensitifitas terhadap insulin dengan meningkatkan aktifitas reseptor insulin tirosin kinase, meingkatkan sistesis glikogen dan meningkatkan transport GLUT $4 transporter ke dalam plasma membran. Contoh: Metformin. Mampu menurunkan GDP sampai 50–70 mg/dl dan the HbA1c sampai 1.4–1.8%. </span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Tidak begitu berbahaya dalam menyebabkan hipoglikemi. Efek samping yang sering terjadi: ketidak nyamanan GI dan mual. Hampir 0.03 kasus/1,000 pasien-tahun, mengalami asidosis laktat terutama pada pasien yang mengalami renal insufisiensi dan gangguan hati<br />
Metformin tidak direkomendasikan untuk pasien dengan kreatinin >1.5 mg/dl. <br />
Baik digunakan bagi pasien gemuk.</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">TERAPI KOMBINASI</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">INSULIN<br />
Cara kerja Insulin: Fungsi utama mengkounter hormon peningkat glukosa dan mempertahankan gula darah normal, menstimulasi lipogenesis, menurunkan lipolisis dan meningkatkan transport asam amino ke dalam sel, menstimulasi pertumbuhan, sintesis DNA dan replikasi sel.<br />
Indikasi terapi insulin:</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">DM tipe 1/IDDM</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">DM tipe 2/NIDDM yang tidak berespon dengan pengobatan OHO</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">DM tipe 2 dengan stress</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Penurunan BB yang cepat</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Ketoasidosis diabetic</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">INSULIN<br />
Penyuntikan: subkutan dan vena (dalam keadaan akut)</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Lokasi subkutan, </span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">KRITERIA PENGENDALIAN DMPENANGANAN DM DENGAN KOMPLIKASI DIABETES DAN HIPERTENSI</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Indikasi pengobatan: TD sistolik lebih atau sama dengan 130mmHg dan TD diastolik lebih sama dengan 90mmHg</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Pengelolaan<br />
Non farmakologis: modifikasi gaya hidup. Menurunkan BB, OR, menghendtikan rokok dan mengurangi konsumsi garam</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Farmakologis:<br />
Hal yang perlu diperhatikan dalam memilih OAH (Obat Anti Hipertensi)):</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Pengaruh OAH pada profil lipid</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Pengaruh OAH pada metabolisme glukosa</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Pengaruh OAH terhadap resisensi insulin</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Pengaruh OAH terhadap hipoglikemi</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">PENANGANAN DM DENGAN KOMPLIKASI</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Obat Anti Hipertensi yang dianjurkan:</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Penghambat ACE (memperbaiki mikroalbuminuria)</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Penyekat reseptor angiotensin II</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Penyekat reseptor beta, selektif, dosis rendah</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Diuretik dosis rendah (dalam jangka panjang memperburuk toleransi glukosa)</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Penghambat alfa</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Antagonis kalsium golongan non dihidropiridin </span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">PENANGANAN DM DENGAN KOMPLIKASI</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Nefropati Diabetik</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Diagnosis: jika terdapat kadar albumin urin lebih atau sama dengan 30mg pada 2-3 kali pemeriksaan dalam jangka waktu 3-6 bulan tanpa penyebab albuminuria lain (aktivitas fisik berat, ISK, gagal jantung, hipertensi berat, demam tinggi)<br />
Penatalaksanaan:<br />
Kendalikan gd</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Kendaikan TD</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Diet protein 0.8gr/hr</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">Libatkan ahli nefrologi jika serum kreatinin telah mencapai lebih atau sama dengan 2.0mg/dl<br />
PENANGANAN DM DENGAN KOMPLIKASI DM DENGAN GANGGUAN FUNGSI EREKSI</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">DE (Disfungsi Ereksi) akibat dari neuropati otonom, angiopati dan problem psikis<br />
tanyakan pada saat pengkajianàDE sumber kecemasan tapi jarang disampaikan pasien<br />
Diagnosis DE menggunakan International Index of Erectil Function. Pengobatan lini pertama: terapi psikoseksual, obat oral (sildenafil)</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span style="line-height: 150%;"> Obat Obat DM</span></b><span style="line-height: 150%;"> </span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-left: 46.4pt; text-align: justify; text-indent: -18pt;"><span style="font-size: small;"><span style="line-height: 150%;">1. Kalsium Hyperglycemia</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-left: 18pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">fungsi : menormalkan kerja pankreas untuk menghasilkan insulin</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-left: 18pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">cara minum :</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-left: 18pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;"> - diminum setelah makan, dengan air hangat (60-70 derajat)</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-left: 18pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">- khusus untuk usia > 12 th</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-left: 18pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">- yang belum terbiasa perlu bertahap, termasuk penderita ginjal :</span><span style="line-height: 150%;"> </span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-left: 18pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">* 7-10 hari pertama : pagi 1/2 sachet, sore 1/2 sachet</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-left: 18pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">* selanjutnya 2x1 sachet/hari</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-left: 46.4pt; text-align: justify; text-indent: -18pt;"><span style="font-size: small;"><span style="line-height: 150%;">2. Chitosan</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-left: 18pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">fungsi : - menurunkan kadar gula darah dan menyembuhkan luka (untuk luka dapat ditabur)<br />
- menurunkan kadar kolesterol karena sifatnya yang mengikat</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-left: 18pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">- meningkatkan fungsi hati</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-left: 18pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">- memperkuat kekebalan tubuh</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-left: 18pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">- memperkuat daya serang sel tubuh terhadap sel kanker</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-left: 18pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">cara minum : - 2x2 kapsul/hari, dengan air hangat</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-left: 18pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">- sebaiknya diminum 1 jam sebelum atau setelah makan maupun produk lain karena sifatnya mengikat tidak untuk dikonsumsi anak-anak dan ibu hamil</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-left: 46.4pt; text-align: justify; text-indent: -18pt;"><span style="font-size: small;"><span style="line-height: 150%;">3. Diacont</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-left: 18pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">fungsi :</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-left: 18pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;"> - menurunkan kadar gula darah</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-left: 18pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">- detoxifikasi racun dalam darah dan meningkatkan sistim imun</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-left: 18pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">- memperbaiki fungsi kerja limpa (pankreas) agar menghasilkan insulin</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-left: 18pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">-mengontrol nafsu makan yang berlebihan</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-left: 18pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">- mencegah terjadinya infeksi pada kulit</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-left: 18pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;">cara minum : 2x2 kapsul/hari setelah makan</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%; margin-bottom: 0.0001pt;"><span style="font-size: small;"><b><span style="line-height: 150%;"> H. PENATAKSANAAN KEPERAWATAN</span></b><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%;"><span style="font-size: small;"><span style="line-height: 150%;">Tujuan utama penatalaksanaan klien dengan diabetes mellitus adalah untuk mengatur glukosa darah dan mencegah timbulnya komplikasi acut dan kronik. Jika klien berhasil mengatasi diabetes yang dideritanya, ia akan terhindar dari hyperglikemia atau hypoglikemia. Penatalaksanaan diabetes tergantung pada ketepatan interaksi dari tiga faktor aktifitas fisik, diet dan intervensi farmakologi dengan preparat hyperglikemik oral dan insulin.<br />
Pada penderita dengan diabetes mellitus harus rantang gula dan makanan yang manis untuk selamanya. Tiga hal penting yang harus diperhatikan pada penderita diabetes mellitus adalah tiga J (jumlah, jadwal dan jenis makanan) yaitu :<br />
J I : jumlah kalori sesuai dengan resep dokter harus dihabiskan.<br />
J 2 : jadwal makanan harus diikuti sesuai dengan jam makan terdaftar.<br />
J 3 : jenis makanan harus diperhatikan (pantangan gula dan makanan manis).</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%;"><span style="font-size: small;"><span style="line-height: 150%;">Diet pada penderitae diabetes mellitus dapat dibagi atas beberapa bagian antara lain :<br />
a.Diet A : terdiri dari makanan yang mengandung karbohidrat 50 %, lemak 30 %, protein 20 %.<br />
b.Diet B : terdiri dari karbohidrat 68 %, lemak 20 %, protein 12 %.<br />
c.Diet B1 : terdiri dari karbohidrat 60 %, lemak 20 %, protein 20 %.<br />
d.Diet B1 dan B2 diberikan untuk nefropati diabetik dengan gangguan faal ginjal.<br />
Indikasi diet A :<br />
Diberikan pada semua penderita diabetes mellitus pada umumnya.<br />
Indikasi diet B :<br />
Diberikan pada penderita diabetes terutama yang :<br />
a.Kurang tahan lapan dengan dietnya.<br />
b.Mempunyai hyperkolestonemia.<br />
c.Mempunyai penyulit mikroangiopati misalnya pernah mengalami cerobrovaskuler acident (cva) penyakit jantung koroner.<br />
d.Mempunyai penyulit mikroangiopati misalnya terdapat retinopati diabetik tetapi belum ada nefropati yang nyata.<br />
e.Telah menderita diabetes dari 15 tahun<br />
Indikasi diet B1<br />
Diberikan pada penderita diabetes yang memerlukan diet protein tinggi, yaitu penderita diabetes terutama yang :<br />
a.Mampu atau kebiasaan makan tinggi protein tetapi normalip idemia.<br />
b.Kurus (underweight) dengan relatif body weight kurang dari 90 %.<br />
c.Masih muda perlu pertumbuhan.<br />
d.Mengalami patah tulang.<br />
e.Hamil dan menyusui.<br />
f.Menderita hepatitis kronis atau sirosis hepatitis.<br />
g.Menderita tuberkulosis paru.<br />
h.Menderita penyakit graves (morbus basedou).<br />
i.Menderita selulitis.<br />
j.Dalam keadaan pasca bedah.<br />
Indikasi tersebut di atas selama tidak ada kontra indikasi penggunaan protein kadar tinggi.<br />
Indikasi B2 dan B3<br />
Diet B2<br />
Diberikan pada penderita nefropati dengan gagal ginjal kronik yang klirens kreatininnya masih lebar dari 25 ml/mt.<br />
Sifat-sifat diet B2<br />
a.Tinggi kalori (lebih dari 2000 kalori/hari tetapi mengandung protein kurang.<br />
b.Komposisi sama dengan diet B, (68 % hidrat arang, 12 % protein dan 20 % lemak) hanya saja diet B2 kaya asam amino esensial.<br />
c.Dalam praktek hanya terdapat diet B2 dengan diet 2100 – 2300 kalori / hari.<br />
Karena bila tidak maka jumlah perhari akan berubah.<br />
Diet B3<br />
Diberikan pada penderita nefropati diabetik dengan gagal ginjal kronik yang klibers kreatininnya kurang dari 25 MI/mt<br />
Sifat diet B3<br />
a.Tinggi kalori (lebih dari 2000 kalori/hari).<br />
b.Rendah protein tinggi asam amino esensial, jumlah protein 40 gram/hari.<br />
c.Karena alasan No 2 maka hanya dapat disusun diet B3 2100 kalori dan 2300 / hari. (bila tidak akan merubah jumlah protein).<br />
d.Tinggi karbohidrat dan rendah lemak.<br />
e.Dipilih lemak yang tidak jenuh.<br />
Semua penderita diabetes mellitus dianjurkan untuk latihan ringan yang dilaksanakan secara teratur tiap hari pada saat setengah jam sesudah makan. Juga dianjurkan untuk melakukan latihan ringan setiap hari, pagi dan sore hari dengan maksud untuk menurunkan BB.<br />
Penyuluhan kesehatan.<br />
Untuk meningkatkan pemahaman maka dilakukan penyuluhan melalui perorangan antara dokter dengan penderita yang datang. Selain itu juga dilakukan melalui media-media cetak dan elektronik.</span><span style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><b><i><span lang="IN">DASAR DATA PENGKAJIAN PASIEN</span></i></b><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Data bergantung pada berat dan lamanyaketidakseimbangan metabolik dan pengaruh pada fungsi organ.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><b><i><span lang="IN">AKTIVITAS ATAU ISTIRAHAT</span></i></b><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">Gejala:<span> </span></span></b><span lang="IN"><span> </span></span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Lemah, letih, sulit bergerak atau berjalan.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Kram otot, tonus otot menurun. Gangguan tidur atau istirahat.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">Tanda:<span> </span></span></b><span lang="IN"><span> </span></span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Takikardia dan takipnea pada keadaan istirahat atau dengan aktivitas.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Letargi atau disorientasi, koma.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Penurunan kekuatan otot.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><b><i><span lang="IN">SIRKULASI</span></i></b><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">Gejala:<span> </span></span></b><span lang="IN"><span> </span></span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Adanya riwayat hipertensi;IM akut.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Klaudikasi, kebas, dan kesemutan pada ekstremitas.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Ulkus pada kaki, penyembuhan yang lama.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">Tanda:<span> </span></span></b><span lang="IN"><span> </span></span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Takikardia.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Perubahan tekanan darah postural; hipertensi.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Nadi menurun atau tak ada.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Distrimia.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Krekels; DVJ (GJK).</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Kulit panas, kering dan kemerahan; bola mata cekung.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><b><i><span lang="IN">INTERGRITAS EGO</span></i></b><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">Gejala:<span> </span></span></b><span lang="IN"><span> </span></span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Stres; tergantung pada orang lain.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Masalah finansial yang berhubungan dengan kondisi.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">Tanda:<span> </span></span></b><span lang="IN"><span> </span></span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Ansietas, peka rangsang.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><b><i><span lang="IN">ELIMINASI</span></i></b><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">Gajala:<span> </span></span></b><span lang="IN"><span> </span></span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Perubahan pola berkemih (poliuria), nokturia.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><b><i><span lang="IN">Diabetes Melitus / Diabetik Ketoasidosis (DKA)</span></i></b><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">Gejala:<span> </span></span></b><span lang="IN"><span> </span></span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Rasa nyeri / tebakar, kesulitan berkemih (infeksi), ISK baru atau berulang.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Nyeri tekan abdomen.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Diare.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 36pt; text-align: justify; text-indent: -36pt;"><span style="font-size: small;"><b><span lang="IN">Tanda:<span> </span></span></b><span lang="IN"><span> </span></span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 36pt; text-align: justify; text-indent: -36pt;"><span style="font-size: small;"><span lang="IN">Urine encer, pucat, kuning; poluri (dapat berkembang menjadioliguria</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 36pt; text-align: justify; text-indent: -36pt;"><span style="font-size: small;"><span lang="IN">/ Anuria jika tejadi hipovolemia berat).</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Urine berkabut, bau busuk (infeksi).</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Abdomen keras, adanya asites.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Bising usus lemah dan menurun; hiperaktif (diare).</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><b><i><span lang="IN">MAKANAN / CAIRAN</span></i></b><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">Gejala:<span> </span></span></b><span lang="IN"><span> </span></span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Hilang napsu makan.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Mual/ muntah.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Tidak mengikuti diet; peningkatan masukan glukosa/ karbohidrat.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Penurunan berat badan lebih dari beberapa periode hari/ minggu.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Haus.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Penggunaan diuretik (tiazid).</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">Tanda:<span> </span></span></b><span lang="IN"><span> </span></span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Kulit kering/ bersisik, turgor jelek.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Kekakuan/ distensi abdomen, muntah.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Pembesaran tiroid (peninggkatam kebutuhan metabolik dengan </span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Peningkatan gula darah).</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Bau halitosis/ manis, bau buah (napas aseton).</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><b><i><span lang="IN">NEUROSENSORI</span></i></b><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">Gejala:<span> </span></span></b><span lang="IN"><span> </span></span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Pusing/ pening.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Sakit kepala.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Kesemutan, kebas kelemahan pada otot, parestesia.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Gangguan penglihatan.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">Tanda:<span> </span></span></b><span lang="IN"><span> </span></span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Disorientasi; mengantuk, letargi, stupor/koma (tahap lanjut).</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Gangguan memori (baru, masa lalu); kacau mental</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><b><i><span lang="IN">NYERI/ KENYAMANAN</span></i></b><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">Gejala:<span> </span></span></b><span lang="IN"><span> </span></span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Abdomen yang tegang/ nyeri (sedang/ berat).</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">Tanda:<span> </span></span></b><span lang="IN"><span> </span></span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Wajah meringis dengan palpitasi; tampak sangat berhati-hati.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><b><i><span lang="IN">PERNAPASAN<span> </span></span></i></b><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 108pt; text-align: justify; text-indent: -108pt;"><span style="font-size: small;"><b><span lang="IN">Gejala:</span></b><span lang="IN"> <span> </span></span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 108pt; text-align: justify; text-indent: -108pt;"><span style="font-size: small;"><span lang="IN">Merasa kekurangan oksigen, batuk dengan/ tanpa sputum purulem (tergantung adanya infeksi).</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 108pt; text-align: justify; text-indent: -108pt;"><span style="font-size: small;"><b><span lang="IN">Tanda:</span></b><span lang="IN"><span> </span></span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 108pt; text-align: justify; text-indent: -108pt;"><span style="font-size: small;"><span lang="IN">Lapar udara.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 108pt; text-align: justify; text-indent: -108pt;"><span style="font-size: small;"><span lang="IN">Batuk dengan/ tanpa sprutum purulem (infeksi).</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 108pt; text-align: justify; text-indent: -108pt;"><span style="font-size: small;"><span lang="IN">Frekuensi pernapasan.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 108pt; text-align: justify; text-indent: -108pt;"><span style="font-size: small;"><b><i><span lang="IN">KEAMANAN</span></i></b><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 108pt; text-align: justify; text-indent: -108pt;"><span style="font-size: small;"><b><span lang="IN">Gejala:</span></b><span lang="IN"><span> </span></span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 108pt; text-align: justify; text-indent: -108pt;"><span style="font-size: small;"><span lang="IN">Kulit kering, gatal; ulkus kulit.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 108pt; text-align: justify; text-indent: -108pt;"><span style="font-size: small;"><b><span lang="IN">Tanda:</span></b><span lang="IN"><span> </span></span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 108pt; text-align: justify; text-indent: -108pt;"><span style="font-size: small;"><span lang="IN">Deman diaforesis.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 108pt; text-align: justify; text-indent: -108pt;"><span style="font-size: small;"><b><i><span lang="IN">SEKSUALITAS</span></i></b><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 108pt; text-align: justify; text-indent: -108pt;"><span style="font-size: small;"><b><span lang="IN">Gejala:</span></b><span lang="IN"><span> </span></span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 108pt; text-align: justify; text-indent: -108pt;"><span style="font-size: small;"><span lang="IN">Rabas vagina (cenderung infeksi).</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 108pt; text-align: justify; text-indent: -108pt;"><span style="font-size: small;"><span lang="IN">Masalah impoten pada pria; kesulitan orgasme pada wanita.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 108pt; text-align: justify; text-indent: -108pt;"><span style="font-size: small;"><b><i><span lang="IN">PENYULUHAN/ PEMBELAJARAN</span></i></b><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 108pt; text-align: justify; text-indent: -108pt;"><span style="font-size: small;"><b><span lang="IN">Gejala:</span></b><span lang="IN"> <span> </span></span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 108pt; text-align: justify; text-indent: -108pt;"><span style="font-size: small;"><span lang="IN">Faktor resiko keluarga;DM, penyakit jantung, stroke, hipertensi. Penyembuhan yang lambat.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 108pt; text-align: justify; text-indent: -108pt;"><span style="font-size: small;"><span lang="IN">Penggunaan obat seperti steroid, diuretik (tiazid); dilatin dan fenobarbital (dapat meningkatkan kadar glukosa darah).</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 108pt; text-align: justify; text-indent: -108pt;"><span style="font-size: small;"><span lang="IN">Mungkin/ tidak mamerlukan obat diabetik sesuai pesanan.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 108pt; text-align: justify; text-indent: -108pt;"><span style="font-size: small;"><b><span lang="IN">Pertinbangan </span></b><span lang="IN"><span> </span>DRG menunjukan rerata lama dirawat:5,9 hari</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 108pt; text-align: justify; text-indent: -108pt;"><span style="font-size: small;"><b><span lang="IN">Rencana pemulangan</span></b><span lang="IN">:</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 108pt; text-align: justify; text-indent: -108pt;"><span style="font-size: small;"><span lang="IN"><span> </span>Mungkin memerlukan bantuan dalam pengaturan diet, pengobatan,<span> </span>perawatan diri, pemantauan terhadap glukosa darah.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 108pt; text-align: justify; text-indent: -108pt;"><span style="font-size: small;"><b><span lang="IN">PEMERIKSAAN DIAGNOSTIK</span></b><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 108pt; text-align: justify; text-indent: -108pt;"><span style="font-size: small;"><span lang="IN">GLUKOSA DARAH: Meningkat 200-100 mg/dL, atau lebih.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 108pt; text-align: justify; text-indent: -108pt;"><span style="font-size: small;"><span lang="IN">Aseton plasma (keton): positif secara mencolok.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 108pt; text-align: justify; text-indent: -108pt;"><span style="font-size: small;"><span lang="IN">Asam lemak bebas: kadar lipid dan kolesterol meninggakt.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 108pt; text-align: justify; text-indent: -108pt;"><span style="font-size: small;"><span lang="IN">Osmolalitas serum: meninggkat tetapi biasanya kurang dari 330 mOsm/1.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 108pt; text-align: justify; text-indent: -108pt;"><span style="font-size: small;"><span lang="IN">Elektrolit:</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 49.65pt; text-align: justify; text-indent: -49.65pt;"><span style="font-size: small;"><span lang="IN"><span> </span>Natrium: mungkin normal, meningkat atau menurun.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 49.65pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Kalium: Normal atau peningkatan senu (perpindahan seluler), selanjutnya akan menurun.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-left: 49.65pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Fosfor: Lebih sering menurun.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Hemoglobin glikosilat: Kadarnya meninggkat 2-4 kalilipat dari normal yang mencerminkan kontrol DM yang kurang selama 4 bulan terakhir (lama hidup SDM) dan karenanya sangat bermanfaay dalam menbedakan DKA dengan kontrol tidak adekuat versus DKA yang berhubungan dengan insiden (mis., ISK baru).</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Gas darah arteri: Biasanya menunjukan pH rendah dan penurunan pada HCO3 (asidosis metabolik) dengan konpensasi alkalosis respiratorik.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Trombosit darah: Ht mungkin meningkat (dehidrasi); leukositosis, hemokonsentrasi, merupakan respon terhadap sters atau infeksi.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Ureum/ kreatinin: Mungkin meningakat atau normal (dehidrasi/ penurunan fungsi ginjal).</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Amilase darah: Mungkin meningkat yang mengindikasikan adanya pankreastitis<span> </span>akut sebagai penyebab DKA.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Diabetes Mellitus/ Diabetik Ketoasidosis (DKA)</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">INSULIN DARAH: Mungkin menurun atau bahkan sampai tidak ada (pada tipe I) atau nolmal sampai tinggi (tipe II) yang mengindikasikan insufiensi insulin/ gangguan dalam penggunaannya (endogen/eksogen). Resisten insulin dapat berkembang sekunder terhadap pembetukan antibodi.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Pemeriksaan fungsi tiroid: Peningkatan aktivitas tiroid dapat meninggkatkan glukosa darah dan kebutuhan akan insulin.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Urine: Gula dan aseton positif; berat jenis dan osmolalitas mungkin meningkat.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Kultur dan sensitivitas; kemungkinan adanya infeksi pada saluran kemih, infeksi pernapasan pada luka.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">DIAGNOSA KEPERAWATAN:<span> </span>KEKURANGAN VOLUME CAIRAN</span></b><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Dapat berhubungan dengan:<span> </span> <span> </span></span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Diuresis osmotik (dari hiperglikimia).</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Kehilangan gastrik yang berlebihan;diare, muntah.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Masukan dibatasi; Mual, kacau mental.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Kemungkinan di buktikan oleh: <span> </span></span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Peningkatan haluaran urine, urine encer.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Kelemahan; haus; penurunan berat badan tiba-tiba.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Kulit/ membran mukosa kering, tugor kulit buruk.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Hipotensi, takikardia, pelambatan pengisian kapiler.</span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">HASIL YANG DI HARAPKAN/<span> </span></span></b><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">Mendemostrasikan hidrasi adekuat dibuktikan oleh tanda </span><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">KRITERIA EVALUASIPASIEN AKAN<span> </span></span></b><span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; text-align: justify;"><span style="font-size: small;"><span lang="IN">vital stabil, nadi periper dapat diraba, turgor kulit dari pengisian kapiler baik, haluaran urine tepat secara individu, <span> </span>dan kadar elektrolit dalam batas normal.</span><span></span></span></div><table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: medium none; font-family: Arial,Helvetica,sans-serif;"><tbody>
<tr> <td style="border: 1pt solid black; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">No </span></b><span></span></span></div></td> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 189.85pt;" valign="top" width="253"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">TINDAKAN/INTERVENSI</span></b><span></span></span></div></td> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 263.75pt;" valign="top" width="352"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">RASIONAL</span></b><span></span></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">1</span></b><span></span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 189.85pt;" valign="top" width="253"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">Mandiri </span></b><span></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Dapatkan riwayat pasien/orang terdekat sehubungan dengan lamanya/intensitas dari gejala seperti muntah, pengeluaram urine yang sangat berlebihan.</span><span></span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 263.75pt;" valign="top" width="352"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Membantu dalam memperkirakan kekurangan volume total. Tanda dan gejala mungkin sudah ada pada beberapa waktu sebelumnya (beberapa jam sampai beberapa hari). Adanya proses infeksi mengakibatkan demam dan keadaan hipermetabolik yang akan meningkatkan kehilangan air tidak kasat mata.</span><span></span></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">2</span></b><span></span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 189.85pt;" valign="top" width="253"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Pantau tanda-tanda vital, cacat adanya perubahan TD ortostatik.</span><span></span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 263.75pt;" valign="top" width="352"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Hipovolemia dapat dimanisfestasikan oleh hipotensi dan takikardia. Perkiraan berat ringannya hipovolemia dapat di buat ketika tekanan darah sistolik pasien turun lebih dari10 mm Hg dari posisi berbaring ke posisi duduk/berdiri. Catatan: Neuropati jantung dapat memutuskan repleks-repleks yang secara normal meningkatkan denyut jantung.</span><span></span></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">3</span></b><span></span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 189.85pt;" valign="top" width="253"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Pola napas seperti adanya pernapasan kussmaul atau pernapasa yang berbau keton.</span><span></span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 263.75pt;" valign="top" width="352"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Paru-paru mengeluarkan asam karbonat melalui pernapasan yang menghasilkan kompensasi alkalosis resviratoris terhadap keadaan ketoasidosis. Pernapasan yang berbau aseton berhubungan pemecahan asam aseto-asetat dan harus berkurang bila ketosis yang harus terkoreksi.</span><span></span></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">4</span></b><span></span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 189.85pt;" valign="top" width="253"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Suhu, warna kulit, atau kelembabannya.</span><span></span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 263.75pt;" valign="top" width="352"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Meskipun deman, menggigil dan diaporesis merupakan hal umum terjadi pada proses infeksi, demam dengan kulit yang kemerahan, kering mungkin sebagai cermnan dehidrasi.</span><span></span></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">5</span></b><span></span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 189.85pt;" valign="top" width="253"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Kaji nadi perifer, pengisian kapiler, togor kulit, dan membran mukosa.</span><span></span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 263.75pt;" valign="top" width="352"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Merupakan indikator dari tingkat dehidrasi, atau volume sirkulasi yang adekuat.</span><span></span></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">6</span></b><span></span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 189.85pt;" valign="top" width="253"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Pantau masukan dan pengeluaran, catat berat jenis urine</span><span></span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 263.75pt;" valign="top" width="352"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Memberikan perkiraan kebutuhan akan cairan pengganti, fungsi ginjal, dan keefektipan dari terapi yang diberikan.</span><span></span></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">7</span></b><span></span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 189.85pt;" valign="top" width="253"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Ukur berat badan setiap hari.</span><span></span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 263.75pt;" valign="top" width="352"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Memberikan hasil pengkajian yang terbaik dari status cairan yang sedang berlangsung dan selanjutnya dalam memberikan cairan pengganti.</span><span></span></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">8</span></b><span></span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 189.85pt;" valign="top" width="253"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">Kolaborasi</span></b><span></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Berikan terapi cairan sesuai indikasi;</span><span></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Normal salin atau setengah normal salin dengan atau tanpa dektrosa.</span><span></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Albumin, plasma, atau dekstran.</span><span></span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 263.75pt;" valign="top" width="352"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Tipe dan jumlah cairan tergantung pada derajat kekurangan cairan dan respons pasien secara individual.</span><span></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Palsma ekspander (pengganti) kadang di bituhkan jika kekurangan tersebut mengancam kehidupan atau tekanan darah sudah tidak dapat kembali normal dengan usaha-usaha rehidrasi yang telah di </span><span></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">lakukan.</span><span></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">9</span></b><span></span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 189.85pt;" valign="top" width="253"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Pantau pemeriksaan laboratorium seperti:</span><span></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Hematokrit (Ht)</span><span></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">BUN/kreatinin.</span><span></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Osmolalitas darah</span><span></span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 263.75pt;" valign="top" width="352"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Mengkaji tingkat hidrasi dan seringkali meningkat akibat hemokonsentrasi yang terjadi setelah diuresis osmotik.</span><span></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Peningkatan nilai dapat mencerminkan kerusakan sel karena dehidrasi atau tanda awitan kegagalan ginjal.</span><span></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Meningkat sehubungan dengan adanya hiperglikemia dan dehidrasi.</span><span></span></span></div></td> </tr>
</tbody></table><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span style="line-height: 115%;"> </span><b><span lang="IN" style="line-height: 115%;">DIAGNOSA KEPERAWATAN: <span> </span>NUTRISI, PERUBAHAN: KURANG DARI KEBUTUHAN TUBUH</span></b><span lang="IN" style="line-height: 115%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><b><span lang="IN" style="line-height: 115%;">Dapat di hubungkan dengan:</span></b><span lang="IN" style="line-height: 115%;"><span> </span></span><span style="line-height: 115%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Ketidakcukupan insulin (penurunan ambilan dan penggunaan glukosa oleh jaringan</span><span lang="IN" style="line-height: 115%;"> </span><span lang="IN" style="line-height: 115%;">mengakibatkan peningkatan metabolisme protein/lemak).</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Penurunan masukan oral; anoreksia, mual, lanbung penuh, nyeri abdomen, perubahan kesadaran.</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Status hipermetabolisme; Pelepsan hormon stres (mis., epinetrin, kortisol, dan hormon pertumbuhan), proses infeksius.</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><b><span lang="IN" style="line-height: 115%;">Kemungkinan dibuktikan oleh:</span></b><span lang="IN" style="line-height: 115%;"><span> </span></span><span style="line-height: 115%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Melaporkan masukan makanan takadekuat, kurang minat pada makanan.</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Penurunan berat badan; kelemahan, kelelahan, tonus otot buruk.</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Diare. </span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><b><span lang="IN" style="line-height: 115%;">HASIL YANG DIHARAPKAN/</span></b><span lang="IN" style="line-height: 115%;"><span> </span></span><span style="line-height: 115%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Mencerna jumlah kalori/nutrien yang tepat.</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><b><span lang="IN" style="line-height: 115%;">KRITERIA EVALUASI PASIAEN</span></b><b><span lang="IN" style="line-height: 115%;"> </span></b><b><span lang="IN" style="line-height: 115%;">AKAN:</span></b></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Menunjukan tingkat energi biasanya.</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Mendemonstrasikan berat badan stabil atau penambahan ke arah rentang biasanya/yang di inginkan dengan nilai laboratorium normal.</span></span></div><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none; font-family: Arial,Helvetica,sans-serif;"><tbody>
<tr> <td style="border: 1pt solid black; padding: 0cm 5.4pt; width: 26.7pt;" valign="top" width="36"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">No</span></b></span></div></td> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 205.5pt;" valign="top" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">TINDAKAN/INTERVEVSI</span></b></span></div></td> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 246.6pt;" valign="top" width="329"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">RASIONAL</span></b></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 26.7pt;" valign="top" width="36"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">1</span></b></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 205.5pt;" valign="top" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">Mandiri</span></b></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Timbang berat badan setiap hari atau sesuai dengan indikasi.</span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 246.6pt;" valign="top" width="329"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Mengkaji pemasukan makanan yang adekuat (termasuk absorpsi dan utilisasinya).</span></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 26.7pt;" valign="top" width="36"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">2</span></b></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 205.5pt;" valign="top" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Tentukan progam diet dengan pola makan pasien dan bandingkan dengan makanan yang dapat di habiskan pasien.</span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 246.6pt;" valign="top" width="329"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Mengindentifikasi kekurangan dan penyimpanan dari kebutuhan terapeitik. </span></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 26.7pt;" valign="top" width="36"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">3</span></b></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 205.5pt;" valign="top" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Identivikasi makanan yang disukai/dikehendaki ternasuk kebutuhan etnik/kultural.</span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 246.6pt;" valign="top" width="329"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Jika makanan yang disukai pasien dapat dimasukan dalam perencanaan makanan, kerjasama ini dapat diupayakan setelah pulang.</span></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 26.7pt;" valign="top" width="36"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">4</span></b></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 205.5pt;" valign="top" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">Kolaborasi</span></b></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Lakukan pemeriksaan gula darah dengan menggunakan “finger stick”.</span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 246.6pt;" valign="top" width="329"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Analisa di tempat tidur terhadap gula darah lebih akurat (menunjukan keadaan saat dilakukan pemeriksaan) dari pada memantau gula dalam urine (reduksi urine) yang tidak culup akurat untuk mendeteksi fluktuasi kadar gula darah dan dapat di pengaruhi oleh ambang gula pasien secara individual atau adanya retensi urine/gagal ginjal. Catatan: Beberapa penelitian telah menemukan bahwa glukosa urine 20% berhubungan dengan gula darah antara 140-360 mg/dl.</span></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 26.7pt;" valign="top" width="36"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">5</span></b></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 205.5pt;" valign="top" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Berikan lalutan glukosa, misalnya dekstrosa dan setengah salin normal.</span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 246.6pt;" valign="top" width="329"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Dengan metabolisme karbohidrat mendekati normal, perawatan harus di berikan untuk menghindari terjadinya hipoglikemia.</span></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 26.7pt;" valign="top" width="36"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">6</span></b></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 205.5pt;" valign="top" width="274"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Lakukan konsultasi dengan ahli diet.</span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 246.6pt;" valign="top" width="329"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Sangat bermanfaat dalam perhitungan an penyesuaian diet untuk memenuhi kebutuhan nutrisi pasien; menjawab pertanyaan dan dapat pula membantu pasien atau orang terekat dalam mengembangkan perencanaan makan.</span></span></div></td> </tr>
</tbody></table><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; text-align: justify;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;"><span> </span><span> </span></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 49.65pt; text-align: justify; text-indent: -49.65pt;"><span style="font-size: small;"><b><span lang="IN" style="line-height: 115%;">DIAGNOSAKEPERWATAN:</span></b><span lang="IN" style="line-height: 115%;"><span> </span><b>INFEKSI, RISIKO TINGGI TERHADAP [SEPSIS]</b></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><b><span lang="IN" style="line-height: 115%;">Faktor risiko meliputi:</span></b><span lang="IN" style="line-height: 115%;"><span> </span></span><span style="line-height: 115%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Kadar glukosa tinggi, penurunan funfsi leukosit, perubahan pada sirkulasi.</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Infeksi pernapasan yang ada sebelumnya, atau ISK.</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><b><span lang="IN" style="line-height: 115%;">Kemungkinan dibuktikan oleh:</span></b><span lang="IN" style="line-height: 115%;"><span> </span></span><span style="line-height: 115%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">[tidak dapat di terapkan: adanya tanda-tanda dan gejala-gejala membuat diagnosa aktual].</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><b><span lang="IN" style="line-height: 115%;">HASIL YANG DIHARAPKAN/ <span> </span></span></b><b><span style="line-height: 115%;"></span></b></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Mengindentifikasi intervensi untuk mencegah/</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><b><span lang="IN" style="line-height: 115%;">KRITERIA EVALUASI PASIEN AKAN:<span> </span></span></b><b><span style="line-height: 115%;"></span></b></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">menurunkan risiko infeksi.</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Mendemonstrasikan teknik, perubahan gaya hidup untuk mencegah terjadinya infeksi.</span></span></div><table align="left" border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none; font-family: Arial,Helvetica,sans-serif; margin-left: 6.75pt; margin-right: 6.75pt; width: 659px;"><tbody>
<tr> <td style="border: 1pt solid black; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">No</span></b></span></div></td> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 231.25pt;" valign="top" width="308"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">TINDAKAN/ITERVENSI</span></b></span></div></td> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 238pt;" valign="top" width="317"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">RASIONAL</span></b></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">1</span></b></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 231.25pt;" valign="top" width="308"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">Mandiri</span></b></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Observasi tanda-tanda infeksi dan peradangan, seperti demam, kemerahan, adanya pus pada luka, sputum puluren, urine warna keruh atau berkabut.</span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 238pt;" valign="top" width="317"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Pasien mungkin masu dengan infeksi yang biasanya telah<span> </span>mencetuskan keadaan ketoasidosis atau dapat mengalami infeksi nosokomial.</span></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">2</span></b></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 231.25pt;" valign="top" width="308"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Posisikan pasien pada posisi semi-Fowler.</span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 238pt;" valign="top" width="317"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Memberikan kemudahan bagi paru untuk berkembang; menurunkan risiko terjadi aspirasi.</span></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">3</span></b></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 231.25pt;" valign="top" width="308"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Berikan tisu dan tempat sputum pada tempat yang mudah dijangkau untuk penampungan sputum/sekret yang lainya.</span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 238pt;" valign="top" width="317"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Mengurangi penyebaran infeksi.</span></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">4</span></b></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 231.25pt;" valign="top" width="308"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Bantu pasien untuk melakukan higiene oral.</span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 238pt;" valign="top" width="317"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Menurunkan risiko terjadinya prnyakit mulut/gusi.</span></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">5</span></b></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 231.25pt;" valign="top" width="308"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">Kolaborasi</span></b></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Lakukan pemeriksaan kultur dan sensivitas sesuai dengan indikasi.</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Berikan obat antibiotik yang sesuai.</span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 238pt;" valign="top" width="317"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Untuk mengidentifikasi organisme<span> </span>sehingga dapat memilih/memberikan terapi antibiotik yang terbaik.</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Penanganan awal dapat membantu mencegah timbulnya sepsis.</span></span></div></td> </tr>
</tbody></table><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><b><span lang="IN" style="line-height: 115%;">DIAGNOSAKEPERAWATAN:<span> </span>PERUBAHAN SENSORI-PERSEPTUAL: (URAIKAN), RISIKO TINGGI TERHADAP</span></b></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><b><span lang="IN" style="line-height: 115%;">Faktor risiko meliputi:<span> </span></span></b><b><span style="line-height: 115%;"></span></b></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Perubaha kimia endogen; ketidakseimbangan glukosa/insulin dan elektrolit.</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><b><span lang="IN" style="line-height: 115%;">Kemungkinan dibuktikan oleh:</span></b><span lang="IN" style="line-height: 115%;"> </span><span style="line-height: 115%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">[tidak dapat diterapkan; adanya tanda-tanda dan gejala-gejala membuat diagnosa aktual].</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><b><span lang="IN" style="line-height: 115%;">HASIL YANG DIHARAPKAN/<span> </span></span></b><b><span style="line-height: 115%;"></span></b></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Mempertahankan tingkat mental biasanya.</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><b><span lang="IN" style="line-height: 115%;">KRITERIA EVALUASI PASIENAKAN:</span></b></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Mengnali dan mengkompensasi adanya kerusakan sensori.</span></span></div><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none; font-family: Arial,Helvetica,sans-serif; margin-left: -8.8pt;"><tbody>
<tr> <td style="border: 1pt solid black; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">No</span></b></span></div></td> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 232.1pt;" valign="top" width="309"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">TINDAKAN/INTRVENS</span></b></span></div></td> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 230.3pt;" valign="top" width="307"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">RASIONAL</span></b></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">1</span></b></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 232.1pt;" valign="top" width="309"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">Mandiri</span></b></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Pantau tanda-tanda vital dan status mental.</span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 230.3pt;" valign="top" width="307"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Sebagai dasar untuk membandingkan temuan abnormal, seperti suhu yang meningkat dapat mempengaruhi fungsi mental.</span></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">2</span></b></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 232.1pt;" valign="top" width="309"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Jadwalkan intervensi keperawatan agar tidak mengganggu waktu istirahat pasien.</span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 230.3pt;" valign="top" width="307"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Meninggkatkan tidur, menurunkan rasa letih, dan dapat memperbaiki daya pikir.</span></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">3</span></b></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 232.1pt;" valign="top" width="309"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Pelihara aktivitas rutin pasien sekonsisten mungkin, dorong untuk melakukan kegiatan sehari-hari sesuai kemampuannya.</span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 230.3pt;" valign="top" width="307"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Membantu memelihara pasien tetap berhubungan dengan realitas dan mempertahankan orientasi pada lingkungannya.</span></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">4</span></b></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 232.1pt;" valign="top" width="309"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Bantu pasien dalam ambulasi atau perubhan posisi.</span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 230.3pt;" valign="top" width="307"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Meningkatkan keamnan pasien terutama ketika rasa keseimbangan dipengaruhi.</span></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">5</span></b></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 232.1pt;" valign="top" width="309"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">Kolaborasi </span></b></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Berikan pengobatan sesuai dengan obat yanag ditentukan untuk mengatasi DKA sesuai indikasi.</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Bantu dengan memblok saraf setempat, mempertahankan unit TENS.</span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 230.3pt;" valign="top" width="307"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Gangguan dalam proses pikir/potensial terhadap aktivitas kejang biasanya hilang bila keadaan hiperosmolaritas teratasi.</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Dapat memberikan rasa nyaman yanag berhubungan dengan neuropati.</span></span></div></td> </tr>
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</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><b><span lang="IN" style="line-height: 115%;">DIAGNOSA KEPERAWATAN:<span> </span>KELELAHAN</span></b></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><b><span lang="IN" style="line-height: 115%;">Dapat dihubungkan:</span></b><span lang="IN" style="line-height: 115%;"><span> </span></span><span style="line-height: 115%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Penurunan produksi energi metabolik.</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Perubahan kimia darah; insufiensi insulin.</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Peningkatan kebutuhan energi; status hipermetabolik/infeksi.</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><b><span lang="IN" style="line-height: 115%;">Kemungkinan dibuktikan oleh:</span></b><span lang="IN" style="line-height: 115%;"><span> </span></span><span style="line-height: 115%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Kurang energi yang berlebihan. Ketidakmampuan untuk mempertahankan rutinitas biasanya, penurunan kinerja, kecenderungan untuk kecelakaan.</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><b><span lang="IN" style="line-height: 115%;">HASIL YANG DIHARAPKAN</span></b><span lang="IN" style="line-height: 115%;"><span> </span></span><span style="line-height: 115%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Mengungkapkan peningkatan tingkat energi.</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><b><span lang="IN" style="line-height: 115%;">KRITERIA EVALUASI PASIEN AKAN:</span></b></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Menunjukan perbaikan kemampuan<span> </span>untuk berpartisipasi dalam aktifitas yang diinginkan.</span></span></div><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none; font-family: Arial,Helvetica,sans-serif; margin-left: 5.4pt;"><tbody>
<tr> <td style="border: 1pt solid black; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">No</span></b></span></div></td> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 218.1pt;" valign="top" width="291"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">TIDAKAN/INTERVENSI</span></b></span></div></td> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 230.1pt;" valign="top" width="307"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">RASIONAL</span></b></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">1</span></b></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 218.1pt;" valign="top" width="291"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">Mandiri</span></b></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Diskusikan dengan pasien kebutuhan akan aktivitas. Buat jadwal perencanaan dengan pasien dan identifikasi aktivitas yang menimbulkan kelelahan.</span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 230.1pt;" valign="top" width="307"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Pendidikan dapat memberikan motivasi untuk meningkatkan tingkat aktivitas meskipun pasien mungkin sangat lemah.</span></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">2</span></b></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 218.1pt;" valign="top" width="291"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Berikan aktivitas alternatif dengan periode istirahat yang cukup tanpa di ganggu.</span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 230.1pt;" valign="top" width="307"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Mencegah kelelahan yang berlebihan.</span></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">3</span></b></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 218.1pt;" valign="top" width="291"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Pantau nadi, frekuensi pernapasan dan tekanan darah sebelum/sesudah melakukan aktivitas.</span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 230.1pt;" valign="top" width="307"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Mengindikasikan tingkat aktivitas yang dapat ditoleransi secara fisiologis.</span></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">4</span></b></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 218.1pt;" valign="top" width="291"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Diskusikan cara menghemat kalori selama mandi, berpindah tempat dan sebagainya.</span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 230.1pt;" valign="top" width="307"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Pasien akan dapat melakukan lebih banyak kegiatan dengan penurunan kebutuhan akan energi pada setiap kegiatan.</span></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">5</span></b></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 218.1pt;" valign="top" width="291"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Tingkatan partisipasi pasien dalam melakukan aktivitas sehari-hari sesuai dengan yang dapat di toleransi.</span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 230.1pt;" valign="top" width="307"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Meningkatkan kepercayaan harga diri yang positif sesuai tingkat aktivitas yang dapat di toleransi pasien.</span></span></div></td> </tr>
</tbody></table><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><b><span lang="IN" style="line-height: 115%;">DIAGNOSA KEPERAWATAN:<span> </span>KETIDAKBERDAYAAN</span></b></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><b><span lang="IN" style="line-height: 115%;">Dapat dihubungkan dengan:</span></b><span lang="IN" style="line-height: 115%;"><span> </span></span><span style="line-height: 115%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Penyakit jangka panjang yang tidak dapat diobati.</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Ketergantungan pada orang laian.</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><b><span lang="IN" style="line-height: 115%;">Kemungkinan dibuktikan oleh:</span></b><span lang="IN" style="line-height: 115%;"><span> </span></span><span style="line-height: 115%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Penolakan untuk mengekspresikan perasaan sebenarnya; ekspresi tentang mengalami situasi tidak terkontrol.</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Apatis, menarik diri, marah</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Tidak memantau kemajuan, tidak berpartisipasi dalam perawatan/pembuatan keputusan.</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Penekanan terhadap penyimpangan/komplikasi fisik meskipun pasien bekerja sama dengan aturan.</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><b><span lang="IN" style="line-height: 115%;">HASIL YANG DIHARAPKAN</span></b><span lang="IN" style="line-height: 115%;"><span> </span></span><span style="line-height: 115%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Mengakui perasaan putus asa.</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><b><span lang="IN" style="line-height: 115%;">KRITERIA EVALUASI PASIEN AKAN:<span> </span></span></b></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Mengidentivikasi cara-cara sehat untuk menghadapi perasaan.</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Membantu dalam merencanakan perawatannya sendiri dan secara mandiri mengambil tanggung jawab untuk aktivitas perawatan diri.</span></span></div><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none; font-family: Arial,Helvetica,sans-serif; margin-left: 5.4pt;"><tbody>
<tr> <td style="border: 1pt solid black; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">No</span></b></span></div></td> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 225pt;" valign="top" width="300"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">TINDAKAN/INTERVENSI</span></b></span></div></td> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 223.2pt;" valign="top" width="298"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">RASIONAL</span></b></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">1</span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 225pt;" valign="top" width="300"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">Mandiri</span></b></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Anjurkan pasien/keluarga untuk mengekspresikan perasaanya tentang perawatan di rumah sakit dan penyakitnya secara keseluruhan.</span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 223.2pt;" valign="top" width="298"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Mengidentifikasi area perhatianya dan memudahkan cara pemecahan masalah.</span></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">2</span></b></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 225pt;" valign="top" width="300"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Tentukan tujuan atau harapan dari pasien/keluarga.</span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 223.2pt;" valign="top" width="298"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Harapan yang tidak realisyis atau adanya tekanan dari orang laian atau diri sendiri dapat mengakibatkan perasaan frustasi/kehilangan kontrol diri dan mungkin mengganggu kemampuan koping.</span></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">3</span></b></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 225pt;" valign="top" width="300"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Anjurkan pasien untuk membuat keputusan sehubungan dengan perawatanya, seperti ambulasi, waktu berativitas, dan seterusnya.</span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 223.2pt;" valign="top" width="298"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Mengkomunikasikan pada pasien<span> </span>bahwa beberapa pengendalian dpat dilatih pada saat perawatam dilakukan.</span></span></div></td> </tr>
</tbody></table><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><b><span lang="IN" style="line-height: 115%;">DIAGNOSA KEPERAWATAN:<span> </span>KURANG PENGETAHUAN [KEBUTUHAN BELAJAR], MENGENAL PENYAKIT, PROGNOSIS, DAN KEBUTUHAN PENGOBATAN</span></b></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><b><span lang="IN" style="line-height: 115%;">Dapat dihubungkan dengan:</span></b><span lang="IN" style="line-height: 115%;"><span> </span></span><span style="line-height: 115%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;"><span> </span>Kurang pemajanan/mengingat kesalahan interprestasi informasi.</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Tidak mengenal informasi.</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><b><span lang="IN" style="line-height: 115%;">Kemungkinan dibuktikan oleh:</span></b><span lang="IN" style="line-height: 115%;"><span> </span></span><span style="line-height: 115%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Pertanyaan meminta informasi, mengungkapkan masalah.</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Ketidakakuratan mengikuti instruksi, terjadinya komplikasi yang dapt di cegah.</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><b><span lang="IN" style="line-height: 115%;">HASIL YANG DIHARAPKAN</span></b><span lang="IN" style="line-height: 115%;"><span> </span></span><span style="line-height: 115%;"></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Mengungkapkan pemahaman tentang penyakit.</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><b><span lang="IN" style="line-height: 115%;">KRITERIA EVALUASI PASIEN AKAN:</span></b></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Mengidentifikasi hubungan/gejala dengan proses penyakit dan menghubungkan gejala dengan faktor penyebab.</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Dengan benar melakukan prosedur yang perlu dan menjelaskan rsional tindakan.</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; margin-left: 180pt; text-align: justify; text-indent: -180pt;"><span style="font-size: small;"><span lang="IN" style="line-height: 115%;">Melakukan perubahan gaya hidup dan berpartisipasi dalam program pengobatan.</span></span></div><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none; font-family: Arial,Helvetica,sans-serif; margin-left: -8.8pt;"><tbody>
<tr> <td style="border: 1pt solid black; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">No</span></b></span></div></td> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 246.2pt;" valign="top" width="328"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">TINDAKAN/INTERVENSI</span></b></span></div></td> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: black black black -moz-use-text-color; border-style: solid solid solid none; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 216.2pt;" valign="top" width="288"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">RASONAL</span></b></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">1</span></b></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 246.2pt;" valign="top" width="328"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">Mandiri</span></b></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Ciptakan lingkungan saling percaya dengan mendengarkan penuh perhatian, dan selalu ada untuk pasien.</span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 216.2pt;" valign="top" width="288"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Menanggapi dan memperhatikan perlu diciptakan sebelum pasien bersedia mengambil bagian dalam proses belajar.</span></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">2</span></b></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 246.2pt;" valign="top" width="328"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Bekerja dengan pasien dalam menata tujuan belajar yang diharapkan.</span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 216.2pt;" valign="top" width="288"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Partisipasi dalam perencanaan meningkatkan antusias dan kerjasama pasien dengan prinsip-prinsip yang dipelajari.</span></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">3</span></b></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 246.2pt;" valign="top" width="328"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Diskusikan topik-topik utama, seperti:</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Apakah kadar glukosa normal itu dan bagaimana<span> </span>hal tersebut dibandingkan dengan kadar gula darah pasien, tipe DM yang dialami pasien, hubungan antara kekurangan insulin dengan kadar gula darah yang tinggi.</span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 216.2pt;" valign="top" width="288"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Memberikan pengetahun dasar dimana psien dapat membuat pertimbangan dalan memilih gaya hidup.</span></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">4</span></b></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 246.2pt;" valign="top" width="328"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Tinjau ulang program pengobatan meliputi awitan, puncak dan lamanya dosis insulin yang diresepkan, bila disesuaikan dengan pasien atau keluarga.</span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 216.2pt;" valign="top" width="288"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Pemahaman tentang semua aspek yang digunakan obat meningkatkan penggunaan yang tepat. Algoritme dosis dibuat, yang masuk dalam perhitungan dosis obat yang dibuat selama evaluasi rawat inap; jumlah dan jadwal aktivitas fisik biasanya.</span></span></div></td> </tr>
<tr> <td style="-moz-border-bottom-colors: none; -moz-border-image: none; -moz-border-left-colors: none; -moz-border-right-colors: none; -moz-border-top-colors: none; border-color: -moz-use-text-color black black; border-right: 1pt solid black; border-style: none solid solid; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 25.2pt;" valign="top" width="34"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><b><span lang="IN">5</span></b></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 246.2pt;" valign="top" width="328"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Tekanan pentingnya penggunaan dari gelang bertanda khusus.</span></span></div></td> <td style="border-color: -moz-use-text-color black black -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 216.2pt;" valign="top" width="288"> <div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-size: small;"><span lang="IN">Dapat mempercepat masuk ke dalam pusat-pusat sistem kesehatan dan perawatan yang sesuai dengan skibat komplikasi yang lebih kecil pada keadaan darurat.</span></span></div></td> </tr>
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</style> <![endif]--> </div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; text-align: justify;"><span style="font-size: small;">Referensi </span></div><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">Doenges, Marilynn E, (1999), Rencana Asuhan Keperawatan: Pedoman Untuk Perencanaan dan Pendokumentasian Perawatan Pasien, Edisi 3, EGC, Jakarta</span></span><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; text-align: justify;"><span style="font-size: small;"><a href="http://hidayat2.wordpress.com/2009/07/07/askep-diabetes-melitus-dm/">http://hidayat2.wordpress.com/2009/07/07/askep-diabetes-melitus-dm/</a></span></div><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"> </span></span><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; text-align: justify;"><span style="font-size: small;"><a href="http://forum.ciremai.com/index.php?option=com_content&view=article&id=7:konsep-diabetes-melitus&catid=7:keperawatan-medikal-bedah&Itemid=20">http://forum.ciremai.com/index.php?option=com_content&view=article&id=7:konsep-diabetes-melitus&catid=7:keperawatan-medikal-bedah&Itemid=20</a></span></div><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"> </span></span><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%;"><span style="font-size: small;"><span style="line-height: 150%;"><a href="http://harnawatiaj.wordpress.com/2008/04/16/askep-diabetes-mellitus/"><span style="color: windowtext;">http://harnawatiaj.wordpress.com/2008/04/16/askep-diabetes-mellitus/</span></a></span></span></div><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"> </span></span><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%;"><span style="font-size: small;"><span style="line-height: 150%;"><a href="http://httpyasirblogspotcom.blogspot.com/2009/02/penatalaksanaan-diabetes-melitus.htm"><span style="color: windowtext;">http://httpyasirblogspotcom.blogspot.com/2009/02/penatalaksanaan-diabetes-melitus.htm</span></a></span></span></div><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"> </span></span><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%;"><span style="font-size: small;"><span style="line-height: 150%;"><a href="http://obatdiabetesmellitus.blogspot.com/">http://obatdiabetesmellitus.blogspot.com/</a></span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%;"><span style="font-size: small;"><span style="line-height: 150%;">Dipostingkan Oleh:</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%;"><span style="font-size: small;"><span style="line-height: 150%;">Ita Nurmalitasari</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%;"><span style="font-size: small;"><span style="line-height: 150%;">05200ID09017</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%;"><span style="font-size: small;"><span style="line-height: 150%;">IIA</span></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%;"><span style="font-size: small;"><span style="line-height: 150%;">AKADEMI KEPERAWATAN PEMDA GARUT</span></span></div><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"> </span></span> <div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: 150%;"><br />
</div>ita_2A_SISTEM_ENDOKRINhttp://www.blogger.com/profile/01283161728267260485noreply@blogger.com1tag:blogger.com,1999:blog-2572653943791789476.post-9127600721133398172011-05-27T03:18:00.000-07:002011-05-27T03:18:32.959-07:00TUGAS II (PENGKAJIAN PADA SISTEM ENDOKRIN)<!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--"/> <m:smallFrac m:val="off"/> <m:dispDef/> <m:lMargin m:val="0"/> <m:rMargin m:val="0"/> <m:defJc m:val="centerGroup"/> <m:wrapIndent m:val="1440"/> <m:intLim m:val="subSup"/> <m:naryLim m:val="undOvr"/> </m:mathPr></w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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</style> <![endif]--> <div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">PENGKAJIAN UMUM SISTEM ENDOKRIN</span></b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Data Demografi</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div> </div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Usia dan</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>jenis kelamin </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">merupakan data dasar </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">yang </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">penting</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">.. </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">B</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">eberapa gangguan endokrinbaru jelas dirasakan pada usia tertentu merupakan proses patologis sudah berlangsung</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">sejak lama.</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kelainan-kelainan somatik harus selalu dibandingkan dengan usia dan gender ,misalnya berat badan dan tinggi badan</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">.</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tenpat tinggal juga merupakan data yang perlu di</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">kaji, khususnya tempat tinggal pada masa bayi dan kanak-kanak dan juga tempat tinggalklien sekarang</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">.</span></div><div style="text-align: justify;"> </div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 18pt;"><br />
</div><div style="text-align: justify;"> </div><div class="MsoListParagraph" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Riwayat Kesehatan Keluarga</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div style="text-align: justify;"> </div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Mengkaji kemungkinan adanya anggota keluarga yang mengalami gangguan seperti yang dialami klien atau gangguan tertentu yang berhubungan secara langsumg dengan gangguanhormonal seperti:</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div style="text-align: justify;"> </div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Obesitas</span></div><div style="text-align: justify;"> </div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Gangguan pertumbuhan dan perkembangan</span></div><div style="text-align: justify;"> </div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kelainan pada kelenjar tiroid</span></div><div style="text-align: justify;"> </div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Diabetes melitus</span></div><div style="text-align: justify;"> </div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Infertilitas</span></div><div style="text-align: justify;"> </div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">D</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">alam mengidentivikasi informasi ini tentunya perawat harus dapat menerjemahkan informasiyang ingin diketahui dengan bahasa yang sederhana dan di mengerti oleh klien atau keluarga</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">.</span></div><div style="text-align: justify;"> </div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div style="text-align: justify;"> </div><div class="MsoListParagraph" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Riwayat Kesehatan dan Keperawatan Klien</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div><div style="text-align: justify;"> </div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Perawat mengkaji kondisi yan pernah dialami oleh klien di luar gangguan yang dirasakan<span style="letter-spacing: -.75pt;">sekarang khususnya gangguan yang mungkin sudah berlangsung lama bila di hubungkandengan usia dan kemungkinan penyebabnya namun karena tidak mengganggu aktivitas klien,kondisi ini tidak di keluhkan</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">.</span></div><div style="text-align: justify;"> </div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tanda-tanda seks sekunder yang tidak berkembang, misalnya amenore, bulu rambut</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">tidak tumbuh, buah dada tidak berkembang dan lain-lain</span></div><div style="text-align: justify;"><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--"/> <m:smallFrac m:val="off"/> <m:dispDef/> <m:lMargin m:val="0"/> <m:rMargin m:val="0"/> <m:defJc m:val="centerGroup"/> <m:wrapIndent m:val="1440"/> <m:intLim m:val="subSup"/> <m:naryLim m:val="undOvr"/> </m:mathPr></w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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</style> <![endif]--> </div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Berat badan yang tidak sesuai dengan usia, misalnya selalu kurus meskipun banyak makan dan lain-lain</span></div><div style="text-align: justify;"> </div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Gangguan psikologia seperti mudah marah, sensiif, sulit bergaul dan tidak mampu</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">ber</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">konsentrasi, dan lain-lain</span></div><div style="text-align: justify;"> </div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Hospitalisasi, perlu dikaji alasan hospitalisasi dan kapan kejadiannya</span></div><div style="text-align: justify;"> </div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">B</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">ila kliendirawat beberapa kali, urutkan sesuai dengan waktu kejadiannya</span></div><div style="text-align: justify;"> </div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Juga perlu memperoleh informasi tentang penggunaan obat-obatan di saat sekarang dan masa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">lalu</span></div><div style="text-align: justify;"> </div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Penggunaan obat-obatan ini mencakup obat yang di peroleh dari dokter atau petugas</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">kesehatan </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">maupun obat-obatan yang di peroleh secara bebas</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div><div style="text-align: justify;"> </div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">jenis obat-obatan yang</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">mengandung hormon atau yang dapat merangsang aktivitas hormonal seperti</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">hidrokortison;levothyroxine; kontrasepsi oral; dan obat-obatan anti hipertensif </span></div><div style="text-align: justify;"> </div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Riwayat Diit</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div><div style="text-align: justify;"> </div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Perubahan status nutrisi atau gangguan pada saluran pencernaan dapat saja mencerminkangangguan endokrin tertentu atau pola dan kebiasaan makan yang salah dapat menjadi</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">faktor penyebab, pleh karena itu kondisi berikut ini perlu di kaji:</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div style="text-align: justify;"> </div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Adanya nausea, muntah dan nyeri abdomen</span></div><div style="text-align: justify;"> </div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Penurunan atau penambahan berat badan yang drastis</span></div><div style="text-align: justify;"> </div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">S</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">elera makan yang menurun atau bahkan berlebihan</span></div><div style="text-align: justify;"> </div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pola makan dan minum sehari-hari</span></div><div style="text-align: justify;"> </div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kebiasaan mengkonsumsi makanan yang dapat mengganggu fungsi endokrinseperti makanan yang bersifat goitrogenik terhadap kelenjar tiroid </span></div><div style="text-align: justify;"> </div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div style="text-align: justify;"> </div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Status Sosial Ekonomi</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div><div style="text-align: justify;"> </div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify;"><br />
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</style> <![endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">jumlah atau nilai</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">pendapatan melainkan lebih di fokuskan pada kualitas pengelolaan suatu nilai tertentu</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">. Mendiskusikan bersama-sama bagaiman klien dan keluarganya memperoleh makananyang sehat dan bergizi, upaya mendapatkan pengobatan bila klien dan keluarganya sakit</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">dan upaya mempertahankan kesehatan klien dan keluarga tetap optimal dapat</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">mengungkapkan keadaan sosial ekonomi klien dan menyimpulkan bersama-sama</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">merupakan upaya untuk mengurangi kesalahan penafsiran </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">.</span> <div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 18pt;"><br />
</div><div style="text-align: justify;"> </div><div class="MsoListParagraph" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 18pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Masalah Kesehatan Sekarang</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Atau disebut juga keluhan utama</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div><div style="text-align: justify;"> </div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Perawat memfokuskan pertanyaan pada hal-hal yang</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">menyebabkan klien meminta bantuan pelayanan seperti</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">: </span></div><div style="text-align: justify;"> </div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Apa yang di rasakan klien</span></div><div style="text-align: justify;"> </div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Apakah masalah atau gejala yang dirasakan terjadi secara tiba-tiba atau poerlahandan sejak kapan dirasakan</span></div><div style="text-align: justify;"> </div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Bagaimana gejala itu mempengaruhi aktivitas hidup sehari-hari</span></div><div style="text-align: justify;"> </div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">B</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">agaimana pola eliminasi baik fekal maupun urine</span></div><div style="text-align: justify;"> </div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">B</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">agaiman fungsi seksual dan reproduksi</span></div><div style="text-align: justify;"> </div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Apakah ada perubahan fisik tertentu yang sanat menggangu klien</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">. </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Halhal yang berhubungan dengan fungsi hormonal secara umum </span></div><div style="text-align: justify;"> </div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div style="text-align: justify;"> </div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tingkat energy</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Perubahan kekuatan fisik di hubungkan dengan sejumlah gangguan hormonal</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">khususnya disfungsi kelenjar tiroid dan adrenal</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> : </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div><div style="text-align: justify;"> </div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> - </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Perawat mengakaji bagaimana</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">kemampuan klien dalam melakukan aktivitas sehari-hari, apakah dapat dilakukan sendiri tanpa bantuan, dengan bantuan atau sama sekali klien tidak berdaya melakukannya atau bahkan klien tidur sepanjang hari merupakan </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">informasi yang sangat penting</span></div><div style="text-align: justify;"> </div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> - </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kaji juga bagaimana asupan makanan klien</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">ap</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">a</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">kah berlebih atau kurang</span></div><div style="text-align: justify;"> </div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div style="text-align: justify;"> </div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pola eliminasi dan keseimbangan cairan</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">. </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pola eliminasi khususnya urine dipengaruhi oleh fungsi endokri</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">n</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Secara</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">langsung oleh A</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">DH,</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Aldosteron, dan kortisol</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> : </span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--"/> <m:smallFrac m:val="off"/> <m:dispDef/> <m:lMargin m:val="0"/> <m:rMargin m:val="0"/> <m:defJc m:val="centerGroup"/> <m:wrapIndent m:val="1440"/> <m:intLim m:val="subSup"/> <m:naryLim m:val="undOvr"/> </m:mathPr></w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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</style> <![endif]--> </div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> - </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Perawat menanyakan tentang</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">pola berkemih dan jumlah volume urine</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">.</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Dan apakah klien sering terbangunmalam hari untuk berkemih</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> - </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Nyatakan </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">volume urine dalam </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">gelas untuk </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">memudahkan persepsi klien</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> - </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">E</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">liminasi urine tentu sangat berhubungan erat</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">dengan keseimbangan air dan elektrolit tubuh</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">- B</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">ila dari hasil anamnesa adahal yang mengindikasikan voume urine berlebih, pertanyaan kita di arahkanlebih jauh ke kemungkinan klien kekurangan cairan, kaj</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">i</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> apakah klien</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">mengalami gejala kurang cairan dan bagaimana klien mengatasinya</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">. </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">- Tanyakanseberapa besar volume cairan yang dikonsumsi setiap hari</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">- Kaji pola sebelum</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">sakit untuk membandingkan pola sebelum sakit untuk membandingan pola</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">yang ada sekarang</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pertumbuhan dan perkembangan</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 39.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l2 level1 lfo3; text-align: justify; text-indent: -18.0pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">S</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">ecara langsung pertumbuhan dan perkembangan ada di bawah pengaruh GH,kelenjar tiroid dan kelenjar gonad</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 39.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l2 level1 lfo3; text-align: justify; text-indent: -18.0pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Gangguan pertumbuhan dan perkembangan</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">dapat saja terjadi semenjak di dalam kandungan bila hormon yang</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">mempengaruhi tumbang fetus kurang seperti hipotiroid pada ibu</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 39.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l2 level1 lfo3; text-align: justify; text-indent: -18.0pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kondisi ini</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">dapat pula terjadi setelah bayi lahir artinya selama proses tumbang terjadi<span style="letter-spacing: -.75pt;">disfungsi GH atau mungkin Gonad dan kelenjar tiroid</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 39.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l2 level1 lfo3; text-align: justify; text-indent: -18.0pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Perlu mengkajigangguan ini apakah terjadi semenjak bayi di lahirkan dengan tubuh yang</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">kerdil, atau terjadi selama proses pertumbuh</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">a</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">n dan bahkan tidak dapat diidentifikasi jelas kapan mulai tampak gejala tersebut</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 39.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l2 level1 lfo3; text-align: justify; text-indent: -18.0pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Mengkaji</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">secara lengkap</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">pertambahan ukuran tubuh dan fungsinya misalnya bagaimaa tingkat</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">intelegensia, kemampuan berkomunikasi, inisiatif dan rasa tanggung jawab</span></div> <span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">d. Kaji pula apakah perubahan fisik tersebut mempengaruhi kejiwaan klien</span><br />
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font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Fungsi seksual dan reproduksi sama penting untuk di kaji baik klien wanitamaupun pria</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pada</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">klien wanita, kaji siklus menstruasinya mencakup lama,volume, frekuensi dan perubahan fisik termasuk sensasi nyeri atau kramp</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">abdomen sebelum selama dan sesudah haid</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">- Untuk volume gunakan satuan</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">jumlah pembalut yang di gunakan, kaji pula pada umur berapa klien pertama</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">kali menstruasi</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">ila klien bersuami, kaji apakah pernah hamil, abortus, dan melahirkan</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Jumlah anak yang pernah di lahirkan dan apakah klien menggunakan carater</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">tentu</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">untuk</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">membatasi kelahiran atau cara untuk mendapatkan keturunan</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pada klien pria, kaji apakah klien mampu ereksi dan orgasme dan bagaimanaperasaan klien setelah melakukannya, adakah perasaan puas dan</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">menyenangkan</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> - </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tanyakan pula adakah perubahan bentuk dan ukuran alatgenitalnya</span></div><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--"/> <m:smallFrac m:val="off"/> <m:dispDef/> <m:lMargin m:val="0"/> <m:rMargin m:val="0"/> <m:defJc m:val="centerGroup"/> <m:wrapIndent m:val="1440"/> <m:intLim m:val="subSup"/> <m:naryLim m:val="undOvr"/> </m:mathPr></w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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UnhideWhenUsed="false" Name="Light Shading Accent 1"/> <w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 1"/> <w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 1"/> <w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 1"/> <w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 1"/> <w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 1"/> <w:LsdException Locked="false" UnhideWhenUsed="false" Name="Revision"/> <w:LsdException Locked="false" Priority="34" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="List Paragraph"/> <w:LsdException Locked="false" Priority="29" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Quote"/> <w:LsdException Locked="false" Priority="30" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Quote"/> <w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 1"/> <w:LsdException Locked="false" Priority="67" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 1 Accent 1"/> <w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 1"/> <w:LsdException Locked="false" Priority="69" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 3 Accent 1"/> <w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 1"/> <w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 1"/> <w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 1"/> <w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 1"/> <w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 2"/> <w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 2"/> <w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 2"/> <w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 2"/> <w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 2"/> <w:LsdException Locked="false" Priority="65" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 1 Accent 2"/> <w:LsdException Locked="false" Priority="66" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium List 2 Accent 2"/> <w:LsdException Locked="false" Priority="67" SemiHidden="false"
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UnhideWhenUsed="false" Name="Medium Grid 3 Accent 2"/> <w:LsdException Locked="false" Priority="70" SemiHidden="false"
UnhideWhenUsed="false" Name="Dark List Accent 2"/> <w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 2"/> <w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 2"/> <w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 2"/> <w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 3"/> <w:LsdException Locked="false" Priority="61" SemiHidden="false"
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UnhideWhenUsed="false" Name="Light Grid Accent 3"/> <w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 3"/> <w:LsdException Locked="false" Priority="64" SemiHidden="false"
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UnhideWhenUsed="false" Name="Dark List Accent 3"/> <w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 3"/> <w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 3"/> <w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 3"/> <w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 4"/> <w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 4"/> <w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 4"/> <w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 4"/> <w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 4"/> <w:LsdException Locked="false" Priority="65" SemiHidden="false"
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UnhideWhenUsed="false" Name="Colorful Shading Accent 4"/> <w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 4"/> <w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 4"/> <w:LsdException Locked="false" Priority="60" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Shading Accent 5"/> <w:LsdException Locked="false" Priority="61" SemiHidden="false"
UnhideWhenUsed="false" Name="Light List Accent 5"/> <w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 5"/> <w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 5"/> <w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 5"/> <w:LsdException Locked="false" Priority="65" SemiHidden="false"
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UnhideWhenUsed="false" Name="Medium Grid 1 Accent 5"/> <w:LsdException Locked="false" Priority="68" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Grid 2 Accent 5"/> <w:LsdException Locked="false" Priority="69" SemiHidden="false"
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UnhideWhenUsed="false" Name="Dark List Accent 5"/> <w:LsdException Locked="false" Priority="71" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Shading Accent 5"/> <w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 5"/> <w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 5"/> <w:LsdException Locked="false" Priority="60" SemiHidden="false"
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UnhideWhenUsed="false" Name="Light List Accent 6"/> <w:LsdException Locked="false" Priority="62" SemiHidden="false"
UnhideWhenUsed="false" Name="Light Grid Accent 6"/> <w:LsdException Locked="false" Priority="63" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 1 Accent 6"/> <w:LsdException Locked="false" Priority="64" SemiHidden="false"
UnhideWhenUsed="false" Name="Medium Shading 2 Accent 6"/> <w:LsdException Locked="false" Priority="65" SemiHidden="false"
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UnhideWhenUsed="false" Name="Medium List 2 Accent 6"/> <w:LsdException Locked="false" Priority="67" SemiHidden="false"
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UnhideWhenUsed="false" Name="Colorful Shading Accent 6"/> <w:LsdException Locked="false" Priority="72" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful List Accent 6"/> <w:LsdException Locked="false" Priority="73" SemiHidden="false"
UnhideWhenUsed="false" Name="Colorful Grid Accent 6"/> <w:LsdException Locked="false" Priority="19" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Emphasis"/> <w:LsdException Locked="false" Priority="21" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Emphasis"/> <w:LsdException Locked="false" Priority="31" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Subtle Reference"/> <w:LsdException Locked="false" Priority="32" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Intense Reference"/> <w:LsdException Locked="false" Priority="33" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Book Title"/> <w:LsdException Locked="false" Priority="37" Name="Bibliography"/> <w:LsdException Locked="false" Priority="39" QFormat="true" Name="TOC Heading"/> </w:LatentStyles> </xml><![endif]--><!--[if gte mso 10]> <style>
/* Style Definitions */
table.MsoNormalTable
{mso-style-name:"Table Normal";
mso-tstyle-rowband-size:0;
mso-tstyle-colband-size:0;
mso-style-noshow:yes;
mso-style-priority:99;
mso-style-qformat:yes;
mso-style-parent:"";
mso-padding-alt:0cm 5.4pt 0cm 5.4pt;
mso-para-margin-top:0cm;
mso-para-margin-right:0cm;
mso-para-margin-bottom:10.0pt;
mso-para-margin-left:0cm;
line-height:115%;
mso-pagination:widow-orphan;
font-size:11.0pt;
font-family:"Calibri","sans-serif";
mso-ascii-font-family:Calibri;
mso-ascii-theme-font:minor-latin;
mso-hansi-font-family:Calibri;
mso-hansi-theme-font:minor-latin;}
</style> <![endif]--> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kondisi kelenjar endokrin</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"></span></div><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.75pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kondisi jaringan atau organ sebagai dampak dari kondisi endokrin</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Pemeriksaan fisik terhadap kondisi kelenjar hanya dapat dilakukan terhadap</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">kelenjar tiroid dan kelenjar gomad pria (testes)</span> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Inspeksi :</span></i></b><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></i></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Disfungsi sistem endokrin :</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Menyebabkan perubahan fisik sebagai dampaknya terhadap tumbang, keseimbangan</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">cairan&elektrolit, seks&reproduksi, metabolisme dan energy</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Hal-hal y</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">an</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">g harus diamati :</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Penampilan umum :</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 32.2pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Apakah K tampak kelemahan berat, sedang dan ringan</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 32.2pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>Amati bentuk dan proporsi tubuh :</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 32.2pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Apakah terjadi kekerdilan atau seperti raksasa</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 32.2pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>Pemeriksaan Wajah :</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-US</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--"/> <m:smallFrac m:val="off"/> <m:dispDef/> <m:lMargin m:val="0"/> <m:rMargin m:val="0"/> <m:defJc m:val="centerGroup"/> <m:wrapIndent m:val="1440"/> <m:intLim m:val="subSup"/> <m:naryLim m:val="undOvr"/> </m:mathPr></w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
DefSemiHidden="true" DefQFormat="false" DefPriority="99"
LatentStyleCount="267"> <w:LsdException Locked="false" Priority="0" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="Normal"/> <w:LsdException Locked="false" Priority="9" SemiHidden="false"
UnhideWhenUsed="false" QFormat="true" Name="heading 1"/> <w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 2"/> <w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 3"/> <w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 4"/> <w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 5"/> <w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 6"/> <w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 7"/> <w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 8"/> <w:LsdException Locked="false" Priority="9" QFormat="true" Name="heading 9"/> <w:LsdException Locked="false" Priority="39" Name="toc 1"/> <w:LsdException Locked="false" Priority="39" Name="toc 2"/> <w:LsdException Locked="false" Priority="39" Name="toc 3"/> <w:LsdException Locked="false" Priority="39" Name="toc 4"/> <w:LsdException Locked="false" Priority="39" Name="toc 5"/> <w:LsdException Locked="false" Priority="39" Name="toc 6"/> <w:LsdException Locked="false" Priority="39" Name="toc 7"/> <w:LsdException Locked="false" Priority="39" Name="toc 8"/> <w:LsdException Locked="false" Priority="39" Name="toc 9"/> <w:LsdException Locked="false" Priority="35" QFormat="true" Name="caption"/> <w:LsdException Locked="false" Priority="10" SemiHidden="false"
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</style> <![endif]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Fokuskan pada abnormalitas struktur, bentuk dan ekspresi wajah seperti dahi, rahang dan bibir</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 32.2pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pada Mata :</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Amati adanya edema periorbital dan exopthalamus serta ekspresi wajah tampak datar atau tupul</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 32.2pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>Pada Daerah Leher :</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Amati bentuk leher apakah tampak membesar, asimetris, terdapat peningkatan JVP, warna kulit sekitar leher apakah terjadi hiper/hipopigmentasi dan amati apakah itu merata.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 32.2pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Apakah terjadi hiperpigmentasi pada jari, siku dan lutut :</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Biasanya dijumpai pada orang yg mengalami gangguan kel. Adrenal</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 32.2pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Apakah terjadi Vitiligo atau hipopigmentasi pada kulit :</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Biasanya tampak pada orang yg mengalami hipofungsi kelenjar adrenal sebagai akibat destruksi melanosit dikulit oleh proses autoimun</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 32.2pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Amati adanya penumpukan massa otot berlebihan pada leher bag. Belakang atau disebut</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">bufflow neck atau leher/punuk kerbau :</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 32.2pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>Terjadi pada K hiperfungsi adrenokortikal</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 32.2pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Amati keadaan rambut axilla dan dada :</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 32.2pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pertumbuhan rambut yg berlebihan pada dada dan wajah wanita disebut hirsutisme dan amati juga adanya striae pd buah dada atau abdomen biasanya dijumpai pada hiperfungsi adrenokortikal</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 32.2pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Palpas</span></i></b><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">i</span></i></b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 32.2pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Hanya kelenjar tiroid dan testis yg dapat diperiksa secara palpasi</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 32.2pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Auskultasi :</span></i></b><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></i></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Auskultasi pada daerah leher diata tiroid dapat mengidentifikasi bunyi " bruit ". 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</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>Mengkaji kemampuan koping K, dukungan Keluarga serta keyakinan K tentang sehat dan sakit.</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Perubahan fisik, fungsi seksual dan reproduksi serta perubahan2 lainnya yg disebabkan oleh gangguan sistem endokrin</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">. </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Akan berpengaruh terhadap konsep diri K</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pengkajian Diagnostik</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">PEMERIKSAAN KELENJAR HIPOFISE</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Foto Tengkorak (Kranium)</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>Dilakukan untuk melihat kondisi seila tursica (tumor atau atrofi)</span><span lang="IN" style="mso-ansi-language: IN;">. </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tidak di butuhkan persiapan fisik secara khusus</span><span lang="IN" style="mso-ansi-language: IN;"></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Foto Tulang (Osteo)</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>Untuk melihat kondisi tulang</span><span lang="IN" style="mso-ansi-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>Pada gigankisme – pertambahan ukuran dan panjang tulang</span><span lang="IN" style="mso-ansi-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pada akromegali – pertambahan kesamping tulang-tulang ferifer</span><span lang="IN" style="mso-ansi-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Persiapan fisik khusus tidak ada</span><span lang="IN" style="mso-ansi-language: IN;"></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="mso-ansi-language: IN; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>Ct Scan Otak</span><span lang="IN" style="mso-ansi-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Untuk melihat kemungkinan adanya tumor pada hipofisis atau hipotalamus</span><span lang="IN" style="mso-ansi-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Persiapan fisisk tidak ada.</span><span lang="IN" style="mso-ansi-language: IN;"></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="mso-ansi-language: IN; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pemeriksaan Darah dan Urine</span><span lang="IN" style="mso-ansi-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kadar Growth hoemone (GH)</span><span lang="IN" style="mso-ansi-language: IN;"></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"></span>Nilai normal 10 pg/ml</span><span lang="IN" style="mso-ansi-language: IN;"></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"></span>Meningkat pada bulan-bulan pertama kelahiran </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"></span>Spesimen darah vena 5 cc</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"></span>Tanpa persiapan khusus</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><span style="font-family: "Times New Roman","serif"; 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</style> <![endif]--> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"></span>Nilai normal 6-10 pg/ml</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"></span>Untuk menentukan apakah gangguan tiroid bersifat primer atau sekunder</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"></span>Spesimen vena 5 cc </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><br />
<span style="mso-spacerun: yes;"> </span>Tanpa persiapan khusus</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">. </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kadar adrenocotricotropine hormon (ACTH)<br />
<span style="mso-spacerun: yes;"> </span>Pengukuran dilakukan dengan tes supresi deksametason</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Spesimen darah vena kurang lebih 5 cc dan urine 24 jam</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span> <div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Persiapan :</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tidak ada pembatasan makanan dan minuman</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Bila klein menggunakan obat-obatan kortisol atau antagonisnya dihentikan dulu 24 jam sebelumnya</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>Bila obat harus diberikan lampirkan sejenis obat dan dosisnya pada lembaran pengiriman specimen</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Cegah stres fisik dan fisikologis</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pelaksanaan :</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l2 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Klien diberikan deksametason 4x0,5 ml/hari selama lamanya 2 hari</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l2 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Besok paginya darah vena diambil kurang lebih 5 cc</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l2 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Urine ditampung selama 24 jam </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l2 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Spesimen dikirim ke laboratorium</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Hasil :</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Normal bila</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo3; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kadar ACTH dalam darah menurun kortisol darah kurang dari 5 mg/dl</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo3; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">17-hydroxy-cortico-streroid (17 –OHCS) dalm urine kurang dari 2,5 mg<br />
Cara sederhana</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo3; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>Pemberian deksametason 1 mg per oral tengah malam</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo3; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>Pada pagi hari, darah vena diambil kurang lebih 5 cc</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo3; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Urine ditampung selama 5 hari</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><br />
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</style> <![endif]--> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l2 level1 lfo8; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Spesimen dikirim ke laboratorium</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Hasil :</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l13 level1 lfo9; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Normal bila kadar kortisol darah lebih kecil sama dengan 3 mg/dl</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l13 level1 lfo9; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Ekskresi 17 OHCS dalm urine kurang dari 2,5 mg</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">PEMERIKSAAN FISIK KELENJAR TIROID</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><br />
a. Uptake Radioaktif (Ray)</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>Tujuan : menukur kemampuan kelenjar tiroid dalam menangkap yodium<br />
<span style="mso-spacerun: yes;"> </span>Persiapan :</span><span lang="IN" style="mso-ansi-language: IN;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo10; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Klien puasa 6-8 jam </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l1 level1 lfo10; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Jelaskan tujuan dan prosedur</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Persiapan klien :</span><span lang="IN" style="mso-ansi-language: IN;"></span> <div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l3 level1 lfo11; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="mso-ansi-language: IN; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Klien diberikan yodium radioaktif 50 microcuri per oral</span><span lang="IN" style="mso-ansi-language: IN;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l3 level1 lfo11; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Dengan alat pengukur (di taruh di atas klenjer tiroid) di ukur radioaktif yang bertahan </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l3 level1 lfo11; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"></span>Dapat pula di ukur clearance yodium melalui ginjal dengan mengumpul kan urine selama 24jam dan di ukur kadar radioaktif yodium</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Hasil</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Banyak yodium yang ditahan oleh kalenjer tiroid di hitung dalam persentase<br />
1. Normal : 10-35%</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2. Menurun : < 10% (pada hipotiroidisme) 3. Meningkat > 35% (pada tirotoksis,pengobatan panjang hipertiroidisme)</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b. T3 dan T4 Serum</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pemeriksaan fisik secara khusus tidak ada</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Spesimen darah vena 5-10 cc</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Nilai normal pada dewasa: yodium bebas 0,1-0,6 mg/dl T3 0,2-0,3 mg/dl T4 6-12 mg/dl</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>Pada anak T3180-240 mg/dl</span><span lang="IN" style="mso-ansi-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><br />
c. Upatake T3 Resin</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 39.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l6 level1 lfo12; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tujuan mengukur jumlah hormon tiroid (T3) atau thyrcid binding globulin (TBG) tak jenuh</span><span lang="IN" style="mso-ansi-language: IN;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 39.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l6 level1 lfo12; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">TBG meningkat pada hippertirodisme menurun pada hipotiroidisme<br />
<span style="mso-spacerun: yes;"> </span>Spesimen darah vena 5cc</span><span lang="IN" style="mso-ansi-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>Persiapan: puasa 6-8 jam</span><span lang="IN" style="mso-ansi-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>Nilai normal</span><span lang="IN" style="mso-ansi-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">• Dewasa : 25-35% uptake oleh resin </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">• Anak : umur nya tidak ada</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">d. Protein Boun Iondine</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tujuan: mengukur yodium yg terikat dengan protein plasma</span><span lang="IN" style="mso-ansi-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Nilai normal 4-8 mg% dalam 100ml darah</span><span lang="IN" style="mso-ansi-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Spesimen darah vena 5-10 cc</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>Klien di puasakan 6-8jam sebelum pemeriksaan</span><span lang="IN" style="mso-ansi-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">e. Basal Metabolic Rate</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"></span>Tujuan: pengukuran secara tidak langsung jumlah oksigen yang dibutuhkan di bawah kondisi basal selama beberapa waktu</span><span lang="IN" style="mso-ansi-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Persiapan :</span><span lang="IN" style="mso-ansi-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1. Klien puasa 12jam</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2. Hindari kondisi yang menimbulkan kecemasan dan stress</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3. Klien harus tidur sedikit nya 8 jam</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4. Tidak mengkonsumsi analgetik & sedative</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">5. Jelaskan pada klien tujuan pemeriksaandan prosedur nya</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">6. Tidak boleh bangun dari tempat tidur sampai pemeriksaan di lakukan<br />
<span style="mso-spacerun: yes;"> </span>Penatalaksanaan<br />
Pengukuran kalorimetri dengan menggunakan metabolator<br />
<span style="mso-spacerun: yes;"> </span>nilai normal :</span><span lang="IN" style="mso-ansi-language: IN;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l7 level1 lfo13; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">pria 53 kalori perjam</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l7 level1 lfo13; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">wanita 60 kalori perjam</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>Metode Harris Benedict Untuk Mengukur BMR</span><span lang="IN" style="mso-ansi-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pria:BMR = 66 + (13,7 x BB(kg) ) + ( 5 x TB(cm) ) +(6,8 x U(thn) )<br />
Wanita</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">BMR = 665 + (9,6 x BB(kg) + (1,8 x TB (cm) ) + (4,7 x U (thn) )<br />
<br />
f. Scanning Thyroid</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Radio loding scanning</span><span lang="IN" style="mso-ansi-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Untuk menentukan apakah nodul tiroid tunggal atau majemuk dan berfungsi atau tidak berfungsi</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Uptake iodine</span><span lang="IN" style="mso-ansi-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">o Untuk menentukan pengambilan yodium dari plasma</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">o Nilai normal 10-30% dalam 24jam</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">PEMERIKSAAN DIAGNOSTIK KELENJER PARATIROID</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a. Percobaan Sulkowitch</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>Dilakukan untuk memeriksa perubahan jumlah kalsium dalam urine<br />
<span style="mso-spacerun: yes;"> </span>Menggunakan reagen sulkowitch</span><span lang="IN" style="mso-ansi-language: IN;">.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>Persiapan</span><span lang="IN" style="mso-ansi-language: IN;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l8 level1 lfo14; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Urine 24 jam ditapung</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l8 level1 lfo14; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="mso-ansi-language: IN; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>Diet rendah kalsium 2 hari berturut-turut.</span><span lang="IN" style="mso-ansi-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>Penatalaksanaan<br />
</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">1. </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Masukkan urin 3ml ke dalam tabung (2 tabung)</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2. Tabung pertama masukkan reagen sulkowitch, tabung kedua hanya sebagai kontrol.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pembacaan secara kuantitatif</span><span lang="IN" style="mso-ansi-language: IN;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l15 level1 lfo15; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Negatif ( - ) juka tidak terjadi keruhan</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l15 level1 lfo15; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>Positif ( + ) terjadi keruhan yang halus</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l15 level1 lfo15; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Positif (+ + ) kekeruhan sedang</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l15 level1 lfo15; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Positif ( + + + ) kekeruhan banyak timbul dalam waktu < 20 detik</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l15 level1 lfo15; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Positif ( + + + + ) kekeruhan hebat, terjadi seketika</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">b. Percobaan Ellwort-Howard</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>Percobaan didasarkan pada diuresis fosfat yang dipengaruhi oleh parathormon.</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pada hipoparatiroid, diuresis fosfor mencapai 5-6x nilai normal</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pada hiperparatiroid, diuresis tidak banyak berubah.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>Cara pemeriksaannya :</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l11 level1 lfo16; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Klien disuntikkan parathormon intravena</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l11 level1 lfo16; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Urin ditampung dan diukur kadar fosfatnya.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">c. Percobaan Kalsium Intravena</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Normal bila fosfor serum meningkat dan fosfor diuresis berkurang.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">PEMERIKSAAN DIAGNOSTIK KELENJAR PANKREAS</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span> </div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">a. Pemeriksaan Gula Darah (puasa)</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>Tujuannya untuk menilai kadar gula darah setelah puasa selama 8-10 jam.</span><span lang="IN" style="mso-ansi-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Nilai normal</span><span lang="IN" style="mso-ansi-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1. Dewasa : 70-110mg/dl</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2. Anak-anak : 60-100mg/dl</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3. Bayi : 50-80mg/dl</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>Persiapa</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">n</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><br />
1. Klien di puasakan 8-10 jam sebelum pemerksaan</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2. Jelaskan rtujuan dan prosedur tindakan</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>Pelaksanaan<br />
1. Spesimen adalah darah vena ± 5 cc</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2. Gunakan antikoagulasi bila pemeriksaan tidak dapat dilakukan</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">3. Pengobatan insulin atau oral hipoglikemi sementara dihentikan</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">4. Setelah pengambilan darah, klien diberi minum dan makan serta obat sesuai program.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo7; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Pemeriksaan Fisik </span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 39.7pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pemeriksaan fisik pada sistem endokrin mungkin dapat dilakukan hanya sebagian dari keseluruhan pengkajian. atau mungkin sebagian sudah dapat diatasi sendiri oleh klien dengan pengetahuan dan kecurigaan terhadap masalah fungsi endokrin. </span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Persiapan </span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 39.7pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Satu-satunya organ endokrin yang dapat dipalpasi adalah kelejar tiroid. Bagaimanapun pengkajian lainnya dapat memperlihatkan informasi mengenai masalah endokrin termasuk inspeksi pada kulit. rambut dan kuku. raut muka. refleks dan sistem muskuloskeletal. Pengukuran tinggi dan berat badan sangat penting seperti tanda-tanda vital yang juga memperlihatkan petunjuk terhadap ketidakmampuan fungsi sistem endokrin. </span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 39.7pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Klien mungkin duduk setelah melakukan latihan. Refleks hammer digunakan untuk tes refleks tendon bagian dalam. Utamakan latihan, perawat mengumpulkan peralatan penting dan menjelaskan teknik kepada. klien untuk mengurangi cemas. Penambahan teknik untuk mengkaji hipokalsemia, tetanus. Komplikasi terhadap kekacauan endokrin termasuk urutan latihan. </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Teknik Pemeriksaan </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kelainan Yang Mungkin Ditemukan Kulit </span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l4 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kulit </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Inspeksi warna kulit </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l9 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Hiperpigmentasi ditemukan pada klien Addison</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">desease atau cushing syndrom. </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l9 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Hipopigmentas</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">i </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">terlihat pada klien diabetes mellitus,</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">hipertiroidisme, hipotiroidisme.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Palpasi (tekstur. kelembaban. dan </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">adanya lesi. </span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kulit kasar. kering ditemukan pada klien dengan</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">hipotiroidisme. Dimana</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">kelembutan dan bilasan</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">kulit bisa menjadi tanda pada klien dengan</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">hipertiroidisme. Lesi pada ekstremitas bawah</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">mengindikasikan DM.</span></div><div class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l4 level1 lfo2; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Kuku dan Rambut </span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Peningkatan pigmentasi pada kuku diperlihatkan</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">oleh klien dengan penyakit addison desease,</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">kering, . tebal. dan rapuh terdapat pada penyakit<br />
hipotiroidisme, rambut lembut</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">. </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">hipertyroidisme.</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Hirsutisme terdapat pada penyakit cushing</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">syndrom</span></div><div class="MsoListParagraph" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l4 level1 lfo2; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Muka(inspeksi bentuk dan kesimetrisan </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">wajah), inspeksi posisi mata </span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Variasi dan bentuk dan struktur muka mungkin</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">dapat diindikasikan dengan</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">penyakit akromegali</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">mata.</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l4 level1 lfo2; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Kelenjar Thyroid </span></div><div class="MsoListParagraphCxSpLast" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Palpasi kelenjar tyroid terhadap ukuran </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">dan konsistensinya. Tidak membesar pada klien dengan penyakit </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">graves atau goiter. Minta klien</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">untuk miringkan kepala ke kanan Minta</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">klien untuk menelan. Setelah klien</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">menelan. pindahkan pada sebelah kiri.</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">selama palpasi pada dada kiri bawah</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">metabolik. seperti yang ditunjukkan hanya pada nodul yang bisa diindikasi bisul, tumor malignan dan. benigna. </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l4 level1 lfo2; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Fungsi Motorik </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-add-space: auto; mso-list: l14 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Mengkaji tendon dalam-tendon reflex</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; mso-add-space: auto; mso-list: l14 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Refleks tendon dalam disesuaikan</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">dengan tahap perkembangan biceps,<br />
brachioradialis,triceps, Patellar, achilles.</span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Peningkatan refleks dapat terlihat pada penvakit hipcrtiroidisme penurunan refleks dapat terlihat pada penvakit hipotiroidisnie </span></div><div class="MsoListParagraphCxSpFirst" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l4 level1 lfo2; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Fungsi sensorik </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-add-space: auto; mso-list: l5 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Mengkaji fungsi sensorik</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-add-space: auto; mso-list: l5 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tes sensitivitas klien terhadap nyeri,</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">temperature, vibrasi, sentuhan, lembut.</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Stereognosis. Bandingkan kesimetrisan</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">area pada kedua sisi dan tubuh. Dan</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">bandingkan bagian distal dan proksimal</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">dan ekstremitas. minta klien untuk</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">menutup mata. Untuk mengetes nyeri</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">gunakan jarum yang tajam dan tumpul.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-add-space: auto; mso-list: l5 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Untuk tes temperature. gunakan botol</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">yang berisi air hangat dan dingin. </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-add-space: auto; mso-list: l5 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Untuk</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">mengetes rasa getar gunakan penala</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">garpu tala.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-add-space: auto; mso-list: l5 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>Untuk mengetes stereognosis.</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">tempatkan objek (bola kapas, pembalut<br />
karet) pada tangan klien. kemudian minta</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">klien mengidentifikasi objek tersebut.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-add-space: auto; mso-list: l5 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Neuropati periperal dan parastesia dapat terjadi pada diabetes, hipotiroidisme dan akromegali. </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-add-space: auto; mso-list: l5 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Struktur Muskuloskeletal </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">. </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Inspeksi ukuran dan proporsional struktur tubuh klien Orang jangkung, yang disebabkan karena</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">insufisiensi growth hormon. Tulang yang sangat</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">besar, bisa merupakan indikasi akromegali.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-add-space: auto; mso-list: l5 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Hipokalsemi Tetani </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-add-space: auto; mso-list: l5 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pengkajian tanda trousseaus dan tanda </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">chvoteks </span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo5; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Peningkatan kadar kalsium</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">, </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>tangan dan jari-jari </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">klien kontraksi (spasme karpal) </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo5; text-align: justify; text-indent: -18.0pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pengkajian Untuk Lanjut Usia. </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Efek dan usia pada sistem endokrin sedikit lebih sulit untuk mendeteksi dengan organ tubuh lain</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Walaupun demikian gangguan endokrin lebih banyak pada usia 40 tahun. Pada wanita, produksi hormon meningkat dibanding dengan menopause. Dari pria dan wanita, output anterior pituitary mengalami penurunan. </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Umur yang relative terjadi perubahan pada struktur dan fungsi dan kelenjar endokrin adalah sebagai berikut : </span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo6; text-align: justify; text-indent: -18.0pt;"><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kelenjar tiroid mengalami derajat yang sama dengan atropfi, fibrosis and nodularity </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo6; text-align: justify; text-indent: -18.0pt;"><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Hormon tiroid mengalami level penurunan dan hypoparatiroidisme biasanya sering pada </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">orang dewasa. </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo6; text-align: justify; text-indent: -18.0pt;"><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kelenjar adrenal kehilangan beberapa berat badan dan menjadi makin buruk, fibrotik </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo6; text-align: justify; text-indent: -18.0pt;"><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pada bagian anterior, kelenjar pituitary mengalami penurunan ukuran dan menjadi </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">mati/fibrotik. </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l10 level1 lfo6; text-align: justify; text-indent: -18.0pt;"><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">§<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Beberapa variasi yang normal dibandingkan dengan yang tidak, dapat menjadi bingung </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">dengan penemuan abnormal pada endokrin adalah sebagai berikut : </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo5; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pikun, beberapa kecil coklat, flat macula dapal dilihat pada lengan dan dorsal pada tangan. </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo5; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Seboroik, keratosis, penebalan pada area pigmentasi, dapat dilihat pada wajah dan tangan. </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo5; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pertumbuhan rambut yang lambat </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo5; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kuku semakin tebal, brittle dan kuning </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo5; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kulit wajah menjadi louggar dan tulang menjadi lebih menonjol. Penurunan terhadap sensasi perabaan </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo5; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Penurunan refleks tendon </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo5; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">-<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">P</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">enurunan tinggi badan </span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">Referensi</span></div><div class="MsoNormal" style="line-height: 150%;"><a href="http://www.scribd.com/doc/48494338/Anatomi-Fisiologi-Dan-Pengkajian-Umum-Sistem-Endokrin"><span style="font-family: "Times New Roman","serif";">http://www.scribd.com/doc/48494338/Anatomi-Fisiologi-Dan-Pengkajian-Umum-Sistem-Endokrin</span></a><span lang="IN" style="font-family: "Times New Roman","serif"; mso-ansi-language: IN;">.</span></div><div class="MsoNormal"><a href="http://dhielani.blogspot.com/2009/03/pengkajian-sistem-endokrin.html"><span style="font-family: "Times New Roman","serif";">http://dhielani.blogspot.com/2009/03/pengkajian-sistem-endokrin.html</span></a><span lang="IN" style="font-family: "Times New Roman","serif"; mso-ansi-language: IN;"></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal" style="line-height: 150%;"><span lang="IN" style="font-family: "Times New Roman","serif"; mso-ansi-language: IN;">Di postingkan oleh :</span></div><div class="MsoNormal" style="line-height: 150%;"><span lang="IN" style="font-family: "Times New Roman","serif"; mso-ansi-language: IN;">Ita Nurmalitasari (05200ID09017).</span></div><div class="MsoNormal" style="line-height: 150%;"><span lang="IN" style="font-family: "Times New Roman","serif"; mso-ansi-language: IN;">IIA AKPER PEMDA GARUT</span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><br />
</div>ita_2A_SISTEM_ENDOKRINhttp://www.blogger.com/profile/01283161728267260485noreply@blogger.com0tag:blogger.com,1999:blog-2572653943791789476.post-49899250453108139942011-05-19T02:46:00.000-07:002011-05-19T22:46:10.175-07:00ANATOMI FISIOLOGI SISTEM ENDOKRIN<link href="file:///C:%5CUsers%5Cintan%5CAppData%5CLocal%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_filelist.xml" rel="File-List"></link><link href="file:///C:%5CUsers%5Cintan%5CAppData%5CLocal%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_themedata.thmx" rel="themeData"></link><link href="file:///C:%5CUsers%5Cintan%5CAppData%5CLocal%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_colorschememapping.xml" rel="colorSchemeMapping"></link> <m:smallfrac m:val="off"> <m:dispdef> <m:lmargin m:val="0"> <m:rmargin m:val="0"> <m:defjc m:val="centerGroup"> <m:wrapindent m:val="1440"> <m:intlim m:val="subSup"> <m:narylim m:val="undOvr"> </m:narylim></m:intlim> </m:wrapindent><style>
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<div style="line-height: 150%; text-align: justify; text-indent: 0.5in;">Sistem endokrin adalah sistem kontrol kelenjar<a href="http://id.wikipedia.org/wiki/Kelenjar" title="Kelenjar"><span style="color: black; text-decoration: none;"></span></a> tanpa saluran (<i>ductless</i>) yang menghasilkanhormon<a href="http://id.wikipedia.org/wiki/Hormon" title="Hormon"><span style="color: black; text-decoration: none;"></span></a> yang tersirkulasi di tubuh melalui aliran darah<a href="http://id.wikipedia.org/wiki/Darah" title="Darah"><span style="color: black; text-decoration: none;"></span></a> untuk memengaruhi organ <a href="http://id.wikipedia.org/wiki/Organ_%28anatomi%29" title="Organ (anatomi)"><span style="color: black; text-decoration: none;"></span></a>lain. Hormon bertindak sebagai "pembawa pesan" dan dibawa oleh aliran darah ke berbagai sel dalam tubuh, yang selanjutnya akan menerjemahkan "pesan" tersebut menjadi suatu tindakan. </div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjd5L8FbeHdWRabOBhu05KS4c2qFUCxr9tNrW1CvjjMGW_ItNdS_tmp7ExZrKHX0Uyd8Qmtxp_eycSwiTRHvIKzrglcH_PT1r4l_PAGUZqvLycRidp44gMd068Dc8JLzR-Xew6jgHKsMBbo/s1600/endocrines.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjd5L8FbeHdWRabOBhu05KS4c2qFUCxr9tNrW1CvjjMGW_ItNdS_tmp7ExZrKHX0Uyd8Qmtxp_eycSwiTRHvIKzrglcH_PT1r4l_PAGUZqvLycRidp44gMd068Dc8JLzR-Xew6jgHKsMBbo/s320/endocrines.gif" width="281" /></a></div><div style="line-height: 150%; text-align: justify; text-indent: 0.5in;"><br />
</div><div class="MsoNormal" style="line-height: normal;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Anatomi Hipofisis</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt;">.<o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hypofisis cerebri atau glandula pituitari adalah struktur lonjong kecil yang melekat pada permukaan bawah otak melalui infundibulum. Lokasinya sangat terlindungi baik yaitu terletak pada sella turcica ossis sphenoidalis. Disebut master endocrine gland karena hormon yang dihasilkan kelenjar ini banyak mempengaruhi kelenjar endokrin lainya.</span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjl80Qc6ILSaeV4FnfKoiz3PGlb9Sze2ZdBKyiM04a2wI-MjYF9DbJE4uoeBRr0fmKqBWpwBt14a8SRVVwBQN5jh5sZMcRACGZJq_9gZ7yu7aFrY-y6dDGGYNj_mWjldn1pQVURxVaqlId7/s1600/hipofise-2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjl80Qc6ILSaeV4FnfKoiz3PGlb9Sze2ZdBKyiM04a2wI-MjYF9DbJE4uoeBRr0fmKqBWpwBt14a8SRVVwBQN5jh5sZMcRACGZJq_9gZ7yu7aFrY-y6dDGGYNj_mWjldn1pQVURxVaqlId7/s1600/hipofise-2.jpg" /></a></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 0.5in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Dibagi menjadi 2 lobus :</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">1. Lobus anterior ( adenohypofisis)</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">, dibagi lagi menjadi:</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">a. Pars anterior ( pars distalis )</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">b. Pars intermedia</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dipisahkan oleh suatu celah, sisa kantong embrional.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Juluran dari pars anterior yaitu pars tuberalis meluas keatas sepanjang permukaan anterioar dan lateral tangkai hypofisis.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">2. Lobus posterior (neurohypofisis)</span></i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Vascularisasi<br />
<i>Arteri </i>carotis interna bercabang a. Hypophysialis superior dan inferior.<i>Vena</i> bermuara kedalam sinus intercavernosus.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adeno hypophysis</span></u></b><b><u><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></u></b></div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 0.75in; text-align: justify; text-indent: -0.25in;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pars distalis</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Bagian utama dari kelenjar hypofisis k</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">r</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">e</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">n</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> meliputi 75% dari seluruh kelenjar</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
• Dengan sedian yang diberi pewarnaan HE dapat dibedakan menjadi 2 macam sel :<o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sel chromophobe (Sel utama)</span></i><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></i></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sitoplasma tidak menyerap bahan warna sehingga tampak intinya saja, ukuran selnya kecil. Sel ini biasanya berkelompok dibagian tengah dari lempengan sel chromofil sehingga ada dugaan bahwa sel ini merupakan sel yang sedang tidak aktif dan nantinya dapat berubah menjadi sel acidofil atau sel basofil pada saat diperlukan</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Sel Acidophil </span></i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ukuranya lebih besar dengan batas yang jelas dan dengan pewarnaan HE rutin sitoplasmanya berwarna merah muda. Berdasakan reaksinya terhadap bahan cat, dapat dibedakan menjadi 2 sel:</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 0.75in; text-align: justify; text-indent: -0.25in;"><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sel orangeophil (alpha acidophil = sel somatrotope)</span></i><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></i></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sel ini dapat dicat dengan orange-G, menghasilkan hormon GH</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 0.75in; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sel carminophil (epsilon acidhophil = sel mammotrope)</span></i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sel ini bereaksi baik terhapat cat azocarmin. Jumlah sel ii meningkat selama dan setelah kehamilan. Hormon yang dihasilkan hormon prolaktin.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sel Basophil</span></i><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></i></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sel ini memiliki inti lebih besar dari sel acidiphil dan dengan pewarnaan HE sitoplasmanya tampak berwarna merah ungu atau biru. Bila memakai pengecatan khusus aldehyde – fuchsin, dapat dibedakan 2 macam sel :</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 39.3pt; text-align: justify; text-indent: -0.25in;"><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sel beta basophil (sel thyrotrophic)</span></i><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></i></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sel ini tercat baik dengan aldehyde – fuchsin dan menghsilkan hormon thyrotropic hormone</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 39.3pt; text-align: justify; text-indent: -0.25in;"><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sel delta basophil</span></i><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></i></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
Dengan perwarnaan aldehyde – fuchsin tidak tercat dengan baik. Berdasarkan hormon yang dibentuk, diduga sel ini ada 3 macam:</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sel gonadotrophin type 1</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sel ini menghasilkan FSH</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sel gonadotropin type 2</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sel ini menghasilkan LH</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Sel corticotrophic</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sel ini menghasilkan hormon ACTH, pada manusia sel ini membentuk melanocyte stimulating hormone ( MSH)</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 0.75in; text-align: justify; text-indent: -0.25in;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pars intermedia</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagian hypophysis ini pada manusia mengalami rudimenter, dan tersusun dari suatu lapisan sel tipis yang berupa lempengan – lempengan yang tidak teratur dan gelembung yang berisi koloid. Pada manusia diduga membentuk melanocyte stimulating hormon ( MSH ) yang akan </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">merangsang kerja sel melanocyte untuk membentuk pigmen lbh bnyk. Tetapi hal ini masih dlm penelitian l</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">e</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">i</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">h lanjut.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Neura hypophyse</span></u></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terdiri dari 2 macam struktur :</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pars nervosa : </span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">infundibular processus</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Infundibulum : </span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">neural stalk ( merupakan tangkai yang menghubungkan neuro hypophyse dengan hypotalamus )</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagian ini tersusun dari :</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a. Sabut saraf tak bermyelin</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> yang berasal dari neuro secretory cell hypotalamus yang dihubungkan melalui hypotalamo – hypophyseal tract</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b. Sel pituicyte :</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> sel ini menyerupai neuroglia yaitu selnya kecil dan mempunyai pelanjutan- pelanjutan sitoplasma yang pendek.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ciri khas yang terdapat dalam neuro – hipophyse ini adalah adanya suatu struktur yang disebut herring’s bodies yang merupakan neurosekret dari neuro-secretory cell dari hypotalamus yang kemudian dialirkan melalui axon dan ditimbun dalam neuro hypophyse sebagai granul. Hormon – hormon yang dihasilkan oleh bagian ini adalah : ADH ( vasopressin ), oxytocin.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Fisiologi Hipofisis</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Kelenjar hipofisis serta hubungannya dengan hipotalamus</span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelenjar hipofisis merupakan kelenjar kecil-kecil diameternya kira-kira 1 cm dan beratnya 0,5-1 gram yang terletak di sela tursika, rongga tulang basis otak, dan dihubungkan dengan hipotalamus oleh tungkai hipofisis atau hipofisial.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dipandang dari sudut fisiologi, kelenjar hipofisis dibagi menjadi:</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hipofisis Anterior (Adenohipofisis)</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hormon yang dikeluarkan oleh hipofisis anterior berperan utama dalam pengaturan fungsi metabolisme di seluruh tubuh. Hormon-hormonnya yaitu:</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hormon Pertumbuhan</span></i><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></i></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Meningkatkan pertumbuhan seluruh tubuh dengan cara mempengaruhi pembentukan</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> protein</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">, pembelahan sel, dan deferensiasi sel.</span><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></i></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adrenokortikotropin (Kortikotropin)</span></i><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></i></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengatur sekresi beberapa hormon adrenokortikal, yang selanjutnya akan mempengaruhi metabolism glukosa, protein dan lemak.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hormon perangsang Tiroid (Tirotropin)</span></i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengatur kecepatan sekresi tiroksin dan triiodotironin oleh kelenjar tiroid, dan selanjutnya mengatur kecepatan sebagian besar reaksi kimia diseluruh tubuh.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">d)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Prolaktin</span></i><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></i></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
Meningkatkan pertunbuhan kelenjar payudara dan produksi air susu.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">e)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hormon Perangsang Folikel dan Hormon Lutein</span></i><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></i></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengatur pertumbuhan gonad sesuai dengan aktivitas reproduksinya.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hipofisis Posterior (Neurohipofisis)</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ada 2 jenis hormon:</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a) Hormon Antideuretik (disebit juga vasopresin)</span></i><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></i></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengatur kecepatan ekskresi air ke dalam urin dan dengan cara ini akan membantu mengatur konsentrasi air dalam cairan tubuh.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b) Oksitosin</span></i><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></i></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Membantu menyalurkan air susu dari kelenjar payudara ke putting susu selama pengisapan dan mungkin membantu melahirkan bayi pada saat akhir masa kehamilan.<o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pars Intermedia</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Daerah kecil diantara hipofisis anterior dan posterior yang relative avaskular, yang pada manusia hamper tidak ada sedangkan pada bebrapa jenis binatang rendah ukurannya jauh lebih besar dan lebih berfungsi.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pembuluh darah yang menghubungkan hipotalamus dengan sel- sel kelenjar hipofisis anterior. Pembuluh darah ini berkhir sebagai kapiler pada kedua ujungnya, dan makanya disebut system portal.dalam hal ini system yang menghubungkan hipotalamus dengan kelenjar hipofisis disebut juga system portal hipotalamus – hipofisis. System portal merupakan saluran vascular yang penting karena memungkinkan pergerakan hormone pelepasan dari hypothalamus ke kelenjar hipofisis , sehingga memungkinkan hypothalamus mengatur fungsi hipofisis. Rangsangan yang berasal dari tak mengaktifkan neuron dalam nucleus hypothalamus yang menyintesis dan menyekresi protein degan berat molekul yang rendah. Protein atau neuro hormone ini dikenal sebagai hormone pelepas dan penghambat. Hormon –hormon ini dilepaska kedalam pembuluh darah system portal dan akhirnya mencapai sel – sel dalam kelenjar hipofisis. Dalam rangkaian kejadian tersebut hormon- hormon yang dilepaskan oleh kelenjar hipofisis diangkt bersama darah dan merangsang kelenjar-kelenjar lain ,menyebabkan pelepasan hormon – hormon kelenjar sasaran. Akhirnya hormon – hormon kelenjar sasaran bekerja pada hipothalamus dan sel – sel hipofisis yang memodifikasi sekresi hormone.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Sistem porta hipothalamus – hipofisis</span></u></b><b><u><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></u></b></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sekresi hormon pelepas hipothalamus dan hormon penghambat ke eminensia mediana.</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
Neuron-neuron khusus di dalam hypothalamus mensintesis dan mensekresi hormone pelepas hypothalamus dan hormone penghambat yang mengatur sekresi hormone hipofisis anterior. Neuron –neuron ini berasal dari berbagai bagian hypothalamus dan mengirimkan serat – serat sarafnya nenuju ke eminensia mediana da tuber sinerum , jaringan hypothalamus yang menyebar menuju tangkai hipofisis. Bagian ujung serat – serat saraf ini berbeda dengan ujung- ujung serat saraf umum yang ada di dalam system saraf pusat.dimana funsi serat ini tidak menghantarkan sinyal – sinyal yang berasal dari neuron ke neuron yang lain namun hanya mensekresi hormone pelepas dan hormone penghambat hypothalamus saja ke dalam cairan jaringan. Hormone- hormone ini segera diabsorbsi ke dalam kapiler system porta hypothalamus dan hipofisis dan langsung diangkut ke sinu kelenjar hipofisis anterior.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Fungsi hormon pelepas dan hormon penghambat dalam hipofisis anterior.</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
Hormone –hormon pelepas dan hormone – hormone pnghambat berfungsi mengatur sekresi hormone hipofisis anterior. Untuk sebagian besar hormone hipofisis , yang penting adalah hormone pelepas ,tetapi untuk prolaktin ,mungkin sebagian besar hormone penghambat yang mempunyai pengaruh paling banyak terhadap pengaturan hormone. Hormone – hormone pelepas dan penghambat hypothalamus yang terpenting adalah :<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• TRH :</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> hormone pelepas tiroid yang menyebabkab pelepasan hormone perangsang tiroid.<br />
<i>• Hormone pelepaS kortikotropin(CRH) :</i> menyebabkan pelepasan adenokortikotropin.<br />
<i>• Hormone pelepas hormone pertumbuhan (GHRH) : </i>menyebabkan pelepasan hormone pertumbuhan dan hormone penghambat hormone pertumbuhan (GHIH) yang mirip dengan hormone somatostatin dan menghambat pelepasan hormone pertumbuhan.<br />
<i>• Hormone pelepas gonadotropin(GnRH) </i>: menyebabkan pelepasan dari dua hormone gonadotropik, hormone lutein dan hormone perangsang folikel.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">• Hormone penghambat prolaktin (PIH)</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> : menghambat sekresi prolaktin.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Daerah –daerah spesifik dalam hipothalamus yang mengatur sekresi faktor pelepas dan faktor penghambat hipothalamus yang spesifik.</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sebelum diangkut ke kelenjar hipofisis anterior , semua atau hamper semua hormone hypothalamus disekresi ke ujung serat saraf yang terletak di dalam eminensia mediana. Perangsangan listrik pada daerah ini merangsang ujung- ujung saraf dan oleh karena itu pada dasarnya menyebabkan pelepasan semua hormone hypothalamus. Akan tetapi badan sel neuron yang menyebar ke eminensia mediana ini terletak di daerah khusus dalam hypothalamus atau pada daerah yang berdekatan dengan bagian basal otak.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anatomi Pankreas</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgTRvsxfBD8dXOUhfX47FwZb1vfS4o84LTAHrGz9QY5K1cbra5b1V1GdghACFMIDb_dyJjXZAVsZi_9l4hwKivwGd67vb7u_c_vOLFS2N-8-flh2By3Zdm7xOevrlrWyYnyGQMs5j2JNs9-/s1600/pankrease71.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgTRvsxfBD8dXOUhfX47FwZb1vfS4o84LTAHrGz9QY5K1cbra5b1V1GdghACFMIDb_dyJjXZAVsZi_9l4hwKivwGd67vb7u_c_vOLFS2N-8-flh2By3Zdm7xOevrlrWyYnyGQMs5j2JNs9-/s320/pankrease71.jpg" width="301" /></a></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pancreas merupakan organ yang memanjang dan terletak pada epigastrium dan kuadran kiri atas. Strukturnya lunak, berlobulus, dan terletak pada dinding posterior abdomen di belakang peritoneum sehingga termasuk organ retroperitonial kecuali bagian kecil caudanya yang terletak dalam ligamentum lienorenalis.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 0.25in; text-align: justify; text-indent: -0.25in;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagian pancreas</span></u></b><b><u><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></u></b></div><div class="MsoNormal" style="line-height: 150%; margin-left: 0.25in; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pancreas dapat dibagi dalam:</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Caput Pancreatis</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> berbentuk seperti cakram dan terletak di dalam bagian cekung duodenum. Sebagian caput meluas ke kiri di belakang arteria san vena mesenterica superior serta dinamakan Processus Uncinatus.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Collum Pancreatis</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> merupakan bagian pancreas yang mengecil dan menghubungkan caput dan corpus pancreatis. Collum pancreatis terletak di depan pangkal vena portae hepatis dan tempat dipercabangkannya arteria mesenterica superior dari aorta.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Corpus Pancreatis</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> berjalan ke atas dan kiri, menyilang garis tengah. Pada potongan melintang sedikit berbentuk segitiga.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Cauda Pancreatis</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> berjalan ke depan menuju ligamentum lienorenalis dan mengadakan hubungan dengan hilum lienale.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0.25in; text-align: justify; text-indent: -0.25in;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hubungan</span></u></b><b><u><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></u></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ke anterior:</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Dari kanan ke kiri: colon transversum dan perlekatan mesocolon transversum, bursa omentalis, dan gaster.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Ke posterior:</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Dari kanan ke kiri: ductus choledochus, vena portae hepatis dan vena lienalis, vena cava inferior, aorta, pangkal arteria mesenterica superior, musculus psoas major sinistra, glandula suprarenalis sinistra, ren sinister, dan hilum lienale.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0.25in; text-align: justify; text-indent: -0.25in;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Vaskularisasi</span></u></b><b><u><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></u></b></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Arteriae</span></i><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></i></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a) pancreaticoduodenalis superior (cabang a.gastroduodenalis )</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b) pancreaticoduodenalis inferior (cabang a.mesenterica cranialis)</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c) pancreatica magna dan a.pancretica caudalis dan inferior cabang a.lienalis</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 0.25in; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2. Venae</span></i><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></i></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Venae yang sesuai dengan arteriaenya mengalirkan darah ke sistem porta.</span><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></i></div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 0.25in; text-align: justify; text-indent: -0.25in;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Aliran Limfatik</span></u></b><b><u><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></u></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelenjar limf terletak di sepanjang arteria yang mendarahi kelenjar. Pembuluh eferen akhirnya mengalirkan cairan limf ke nodi limf coeliaci dan mesenterica superiores.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 0.25in; text-align: justify; text-indent: -0.25in;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Inervasi</span></u></b><b><u><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></u></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berasal dari serabut-serabut saraf simpatis (ganglion seliaca) dan parasimpatis (vagus).<br />
<b><u><br />
f. Ductus Pancreaticus</u></b></span><b><u><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></u></b></div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 39pt; text-align: justify; text-indent: -39pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>i.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ductus Pancreaticus Mayor ( W I R S U N G I )</span></i><b><u><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></u></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
Mulai dari cauda dan berjalan di sepanjang kelenjar menuju ke caput, menerima banyak cabang pada perjalanannya. Ductus ini bermuara ke pars desendens duodenum di sekitar pertengahannya bergabung dengan ductus choledochus membentuk papilla duodeni mayor Vateri. Kadang-kadang muara ductus pancreaticus di duodenum terpisah dari ductus choledochus.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 39pt; text-align: justify; text-indent: -39pt;"><b><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>ii.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></i></b><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ductus Pancreaticus Minor ( S AN T O R I N I )</span></i><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></i></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengalirkan getah pancreas dari bagian atas caput pancreas dan kemudian bermuara ke duodenum sedikit di atas muara ductus pancreaticus pada papilla duodeni minor.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Fisiologi Pankreas</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Eksokrin</span></u></b><b><u><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></u></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sel – sel asini menghasilkan beberapa enzim yang disekresikan melalui ductus pankreas yang bermuara ke duodenum.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Enzim – enzim tersebut berfungsi untuk mencerna 3 jenis makanan utama = karbohidrat, protein, dan lemak.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sekresi ini juga mengandung sejumlah besar ion bikarbonat menetralkan asam kimus dari lambung.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Enzim proteolitik = tripsin, kimotripsin, dan karboksipolipeptidase.<br />
Tripsin dan kimotripsin : memisahkan protein yang dicerna menjadi peptida, tapi tidak menyebabkan pelepasan asam – asam amino tunggal.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Karboksipolipeptidase : memecah beberapa peptida menadi asam – asam amino bentuk tunggal.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Enzim proteolitik yang kurang penting = elastase dan nuklease.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Enzim proteolitik disintesis di pankreas dalam bentuk tidak aktif berupa = tripsinogen, kimotripsinogen, dan prokarboksipolipeptidase = menjadi aktif jika disekresikan di tractus intestinal.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tripsinogen diaktifkan oleh enzim enterokinase yang disekresi mukosa usus ketika kimus berkontak dengan mukosa. Kimotripsinogen dan prokarboksipolipeptidase diaktifkan oleh tripsin.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Enzim pankreas untuk mencerna karbohidrat = amilase pankreas : menghidrolisis serat, glikogen, dan sebagian besar karbohidrat (kecuali selulosa) untuk membentuk trisakaridan dan disakarida.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Enzim pencerna lemak = lipase pankreas : menghidrolisis lemak netral menjadi asam lemak dan monogliserida.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolesterol esterase : hidrolisis ester kolesterol.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Fosfolipase : memecah asam lemak dan fosfolipid.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tiga rangsangan dasar yang menyebabkan sekresi pankreatik :<br />
1. Asetikolin : disekresikan ujung n. vagus parasimpatis dan saraf2 kolinergenik.<br />
2. Kolesistokinin : disekresikan mukosa duodenum dan jejunum rangsangan asam.<br />
3. Sekretin : disekresikan mukosa duodenum dan jejunum rangsangan asam.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Endokrin </span></u></b><b><u><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></u></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 57pt; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Fungsi endokrin kelenjar pankreas diperankan oleh pulau langerhans sel α, sel β, sel δ, dan sel F.</span><span style="font-family: Symbol;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">terdiri atas 4 sel </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 57pt; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sekresi sel – sel ini berupa hormon yang akan langsug diangkut melalui pembuluh darah.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sel Hormon Target Utama Efek Hormonal Regulasi</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">α (Glukagon)</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Target : Hati, jaringan adipose</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Efek : merombak cadangan lipid, merangsang sintesis glukosa dan pemecahan glikogen di hati, menaikan kadar glukosa.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Distimulasi oleh kadar glukosa darah yang rendah, dihambat oleh somatostatin.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">β (Insulin)</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Target : Sebagian besar sel</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Efek : membantu pengambilan glukosa oleh sel, menstimulasi pembentukan dan penyimpanan glikogen dan lipid, menurunkan kadar glukosa darah.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Distimulasi oleh kadar glukosa darah yang tinggi, dihambat oleh somatostatin.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">δ (Somatostatin)</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Target : Sel langerhans lain, epitel saluran pencernaan</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Efek : menghambat sekresi insulin dan glukagon, menghambat absorbsi usus dan sekresi enzim pencernaan.Distimulasi oleh makanan tinggi-protein, mekanismenya belum jelas.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">.F (Polipeptida pankreas)</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Target : Organ pencernaan</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Efek : menghambat kontraksi kantong empedu, mengatur produksi enzim pankreas, mempengaruhi absorbsi nutrisi oleh saluran pencernaan.<br />
Distimulasi oleh makanan tinggi-protein dan rangsang parasimpatis.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pancreas merupakan kelenjar eksokrin dan endokrin. Kedua fungsi tersebut dilakukan oleh sel-sel yang berbeda.<o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagian Eksokrin</span></u></b><b><u><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></u></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pancreas dapat digolongkan sebagai kelenjar besar, berlobulus, tubuloasinosa kompleks.<br />
<i>ASINUS</i></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Asinus berbentuk tubular, dikelilingi lamina basal dan terdiri atas 5-8 sel berbentuk piramid yang tersusun mengelilingi lumen sempit. Tidak terdapat sel mioepitel. Di antara asini, terdapat jaringan ikat halus mengandung pembuluh darah, pembuluh limf, saraf dan saluran keluar.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sebuah asinus pancreas terdiri dari sel-sel zimogen (penghasil protein). Ductus ekskretorius meluas ke dalam setiap asinus dan tampak sebagai sel sentroasinar yang terpulas pucat di dalam lumennya. Produksi sekresi asini dikeluarkan melalui ductus interkalaris (intralobular) yang kemudian berlanjut sebagai ductus interlobular.<o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></b><b><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagian Endokrin</span></u></b><b><u><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></u></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagian endokrin pancreas, yaitu PULAU LANGERHANS, tersebar di seluruh pancreas dan tampak sebagai massa bundar, tidak teratur, terdiri atas sel pucat dengan banyak pembuluh darah. Pulau ini dipisahkan oleh jaringan retikular tipis dari jaringan eksokrin di sekitarnya dengan sedikit serat-serat retikulin di dalam pulau.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dengan cara pulasan khusus dapat dibedakan menjadi:</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -0.5in;"><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>i.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Sel A = penghasil glucagon</span></i><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></i></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terletak di tepi pulau.</span> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengandung gelembung sekretoris dengan ukuran 250nm.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Batas inti kadang tidak teratur.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -0.5in;"><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>ii.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sel B = penghasil insulin</span></i><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></i></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terletak di bagian lebih dalam atau lebih di pusat pulau.</span> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengandung kristaloid romboid atau poligonal di tengah.</span> <span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mitokondria kecil bundar dan banyak.</span><span lang="IN"><o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -0.5in;"><span lang="IN"><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>iii.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Sel D = penghasil somatostatin</span></i><span lang="IN"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terletak di bagian mana saja dari pulau, umumnya berdekatan dengan</span><span style="font-family: Symbol;">-</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> sel A.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengandung gelembung sekretoris ukuran 300-350 nm dengan granula</span><span style="font-family: Symbol;">-</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> homogen.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -0.5in;"><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span>iv.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Sel C</span></i><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></i></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terlihat pucat, umumnya tidak bergranula dan terletak di tengah di</span><span style="font-family: Symbol;">-</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> antara sel B. Fungsinya tidak diketahui.</span><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></i></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pankreas-Insulin</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Insulin merupakan protein kecil; insulin terdiri dari dua rantai asam amino, yang satu sama lainnya dihubungkan oleh ikatan disulfide. Bila kedua rantai asam amino dipisahkan, maka aktivitas fungsional dari insulin akan hilang.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Translasi RNA insulin oleh ribosom yang melekat pada reticulum endoplasma — membentuk preprohormon insulin — melekat erat pada reticulum endoplasma — membentuk proinsulin — melekat erat pada alat golgi — membentuk insulin — terbungkus granula sekretorik dan sekitar seperenam lainnya tetap menjadi proinsulin yang tidak mempunyai aktivitas insulin.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Insulin dalam darah beredar dalam bentuk yang tidak terikat dan memilki waktu paruh 6 menit. Dalam waktu 10 sampai 15 menit akan dibersihkan dari sirkulasi. Kecuali sebagian insulin yang berikatan dengan reseptor yang ada pada sel target, sisa insulin didegradasi oleh enzim insulinase dalam hati, ginjal, otot, dan dalam jaringan yang lain.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Reseptor insulin merupakan kombinasi dari empat subunit yang saling berikatan bersama oleh ikatan disulfide, 2 subunit alfa ( terletak seluruhnya di luar membrane sel ) dan 2 subunit beta ( menembus membrane, menonjol ke dalam sitoplasma ). Insulin berikatan dengan subunit alfa — subunit beta mengalami autofosforilasi — protein kinase — fosforilasi dari banyak enzim intraselular lainnya.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Efek perangsangan insulin :</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Setelah insulin berikatan dengan membrane reseptornya — sel tubuh sangat permeable terhadap glukosa — glukosa masuk dengan cepat dalam sel — di dalam sel, glukosa dengan cepat difosforilasi — menjadi zat yang diperlukan untuk fungsi metabolisme karbohidrat. Peningkatan transport glukosa — karena penyatuan berbagai vesikel intraselular dengan membrane sel — vesikel ini sendiri membawa molekul membrane protein transport glukosanya .Hal ini terutama terjadi pada sel otot dan sel lemak tetapi tidak terjadi pada sebagian besar sel neuron dalam otak. Bila tidak ada insulin, vesikel ini terpisah dari membrane sel — bergerak kembali ke dalam sel.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">membrane sel lebih permeable terhadap asam amino, ion kalium, ion fosfat — meningkatkan permeabilitas membrane terhadap glukosa.<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perubahan kecepatan translasi mRNA pada ribosom dan perubahan kecepatan transkripsi DNA dalam inti sel.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Efek Insulin Terhadap Metabolisme Karbohidrat</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jaringan otot bergantung pada asam lemak untuk energinya karena membrane otot istirahat yang normal sedikit permeable terhadap glukosa kecuali dirangsang oleh insulin.</span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Otot akan menggunakan sejumlah glukosa selama kerja fisik sedang atau berat dan selama beberapa jam setelah makan karena sejumlah besar insulin disekresikan.</span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Setelah makan — glukosa darah naik — insulin naik — penyimpanan glukosa dalam bentuk glikogen dalam hati, otot, dan sel jaringan lainnya.</span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Glikogen ini dapat digunakan untuk menghasilkan energi yang besar dan singkat dalam rangka menyediakan ledakan energi anaerobic melalui pemecahan glikolitik dari glikogen menjadi asam laktat dalam keadaan tidak ada oksigen.</span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Insulin meningkatkan kecepatan transport glukosa dalam sel otot yang sedang istirahat paling sedikit 15 kali lipat.</span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Insulin menyebabkan sebagian besar glukosa diabsorbsi sesudah makan — kemudian disimpan dalam hati dalam bentuk glikogen — sehingga konsentrasi glukosa darah menurun — sekresi insulin menurun — glikogen dalam hati dipecah menjadi glukosa — dilepaskan kembali dalam darah — untuk menjaga konsentrasi glukosa darah tidak terlalu rendah.</span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Insulin menghambat fosforilase hati — sehingga mencegah pemecahan glikogen dalam sel hati.</span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Insulin meningkatkan pemasukan glukosa dari darah oleh sel hati — meningkatkan aktivitas enzim glukokinase — glukosa terjerat sementara dalam sel hati.</span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Insulin meningkatkan aktivitas enzim yang meningkatkan sintesis glikogen ( enzim glikogen sintetase ).</span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kadar glukosa darah turun — insulin turun — menghentikan sintesis glikogen dalam hati, mencegah ambilan glukosa oleh hati dari darah — enzim fosforilase aktif — pemecahan glikogen menjadi glukosa fosfat — oleh enzim glukosa fosfat, radikal fosfat lepas dari glukosa — glukosa masuk darah.</span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bila jumlah glukosa yang masuk dalam hati hati lebih banyak daripada jumlah yang dapat disimpan sebagai glikogen / digunakan untuk metabolisme sel hepatosit setempat — insulin memacu pengubahan semua kelebihan glukosa menjadi asam lemak yang dibentuk sebagai trigliserida dalam bentuk LDL dan ditranspor dalam bentuk LDL melalui darah menuju jaringan adipose –yang ditimbun sebagai lemak.</span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Insulin menghambat glukoneogenesis — dengan menurunkan jumlah dan aktivitas enzim hati yang dibutuhkan untuk glukoneogenesis — hal ini disebabkan oleh kerja insulin yang menurunkan pelepasan asam amino dari otot dan jaringan ekstra hepatic lainnya.</span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sel otak bersifat permeable terhadap glukosa walaupun tanpa insulin</span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jika kadar glukosa rendah — terjadi renjatan hipoglikemik — ditandai dengan iritabilitas saraf progresif — penderita pingsan, kejang, koma.</span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Efek Insulin Terhadap Metabolisme Protein</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Insulin menyebabkan pengangkutan secara aktif asam amino dalam sel. Insulin bersama GH meningkatkan pemasukan asam amino dalam sel. Akan tetapi, asam amino yang dipengaruhi bukanlah asam amino yang sama.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Insulin meningkatkan translasi mRNA pada ribosom — terbentuk protein baru. Insulin dapat “menyalakan” mesin ribosom.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Insulin meningkatkan kecepatan transkripsi DNA dalam inti sel — jumlah RNA naik — sintesis protein.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Insulin menghambat proses katabolisme protein — mengurangi pelepasan asam amino dari sel dan mengurangi pemecahan protein oleh lisosom sel.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Insulin menekan kecepatan glukoneogenesis — dengan mengurangi aktivitas enzim.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tidak ada insulin — penyimpanan protein terhenti — katabolisme protein meningkat — sintesis protein terhenti — asam amino tertimbun dalam plasma — konsentrasi asam amino plasma naik <o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Digunakan sebagai sumber energi dalam proses glukoneogenesis. Pemecahan asam amino ini meningkatkan eskresi ureum dalam urin.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Efek Insulin Terhadap Metabolisme Lemak</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengaruh jangka panjang kekurangan insulin menyebabkan aterosklerosis hebat, serangan jantung, stroke, penyakit vascular lainnya.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Insulin meningkatkan pemakaian glukosa dan mengurangi pemakaian lemak, sehingga berfungsi sebagai penghemat lemak.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Insulin meningkatkan pembentukan asam lemak. Sintesis lemak dalam sel hati dan ditranspor dari hati melalui darah dalam bentuk lipoprotein menuju jaringan adipose untuk disimpan.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Factor yang mengarah pada peningkatan sintesis asam lemak dalam hati meliputi:<br />
o Insulin meningkatkan pengangkutan glukosa dalam hati. Sesudah konsentrasi glikogen dalam hati meningkat 5 sampai 6 persen, glikogen ini akan menghambat sintesisnya sendiri. Seluruh glukosa tambahan dipakai untuk membentuk lemak. Glukosa dipecah menjadi piruvat melalui jalur glkolisis, dan piruvat ini selanjutnya diubah menjadi asetil ko-A, merupakan substrat asal untuk sintesis asam lemak.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelebihan ion sitrat dan ion isositrat terbentuk oleh siklus asam sitrat bila pemakaian glukosa untuk energi ini berlebihan. Ion ini mempunyai efek langsung dalam mengaktifkan asetil ko-A karboksilase, yang dibutuhkan untuk proses karboksilasi asetil ko-A untuk membentuk malonil ko-A, tahap pertama sintesis asam lemak.<br />
membentuk trigliserida </span><span style="font-family: Symbol;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">o Asam lemak disintesis dalam hati sendiri dilepaskan dari sel hati dalam darah dalam bentuk lipoprotein. Insulin mengaktifkan lipoprotein lipase yang memecah trigliserida menjadi asam lemak yang kemudian diabsorbsi dalam sel lemak dan diubah kembali menjadi trigliserida untuk disimpan.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Insulin mempunyai 2 efek penting untuk menyimpan lemak dalam sel lemak:<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">o Insulin menghambat kerja lipase sensitive hormone sehingga pelepasan asam lemak dari jaringan adipose ke dlaam sirkulasi darah terhambat.<br />
o Insulin meningkatkan pengangkutan glukosa melalui membrane sel dalam sel lemak. Glukosa ini dipakai untuk sintesis sedikit asam lemak. Yang lebih penting, glukosa dipakai untuk membentuk alfa gliserol fosfat. Bahan ini menyediakan gliserol berikatan dengan asam lemak membentuk trigliserida yang disimpan dalam sel lemak. Jika tidak ada insulin, penyimpanan asam lemak yang diangkut dari hati dalam bentuk lipoprotein hampir dihambat.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 39.3pt; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tidak ada insulin — enzim lipase sensitive hormone aktif — hidrolisis trigliserida yang disimpan dalam hati — melepaskan asam lemak+gliserol dalam darah — konsentrasi asam lemak dalam darah naik — dijadikan sumber energi utama bagi seluruh jaringan tubuh selain otak. Asam lemak yang berlebihan dalam plasma meningkatan pengubahan asam lemak menjadi fosfolipid+kolesterol. Konsentrasi kolesterol yang tinggi inilah yang mempercepat perkembangan aterosklerosis pada penderita diabetes yang parah.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 39.3pt; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;">·<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tidak ada insulin — kelebihan asam lemak dalam sel hati — mekanisme pengangkutan karnitin –mengangkut asam lemak dalam mitokondria sangat aktif — dalam mitokondria, asam lemak melapas asetil ko-A — asam asetoasetat — dilepaskan dalam sirkulasi darah – sel perifer –asetil ko-A — energi. Perlu diingat, tidak semua asam asetoasetat dapat dimetabolisme di jaringan perifer karena jumlahnya yang banyak. Keadaan ini menyebabkan keadaan asidosis cairan tubuh yang berat. Asam asetoasetat diubah menjadi asam beta hidroksibutirat dan aseton. Ketiganya merupakan badan keton yang dapat menimbulkan ketosis. Sedangkan, asam aetoasetat dan asam beta hidroksibutirat menyebabkan asidosis — koma — kematian.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pengaturan Sekresi Insulin</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perangsangan sekresi insulin oleh glukosa darah</span></i><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></i></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Konsentrasi glukosa dalam darah meningkat menyebabkan sekresi insulin meningkat.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Arial Unicode MS","sans-serif"; font-size: 12pt; line-height: 150%;">❀<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dalam waktu 3 sampai 5 menit sesudah terjadi peningkatan segera kadar glukosa darah, insulin meningkat sampai hampir 10 kali lipat. Keadaan ini disebabkan oleh pengeluaran insulin yang sudah terbentuk lebih dahulu oleh sel beta pulau langerhans pancreas. Akan tetapi, kecepatan sekresi awal yang tinggi ini tidak dapat dipertahankan, sebaliknya, dalam waktu 5 sampai 10 menit kemudian kecepatan sekresi insulin akan berkurang sampai kira-kira setengah dari kadar normal.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Arial Unicode MS","sans-serif"; font-size: 12pt; line-height: 150%;">❀<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Kira-kira 15 menit kemudian, sekresi insulin meningkat untuk kedua kalinya, sehingga dalam waktu 2 sampai 3 jam akan mencapai gambaran seperti dataran yang baru, biasanya pada saat ini kecepatan sekresinya bahkan lebih besar daripada kecepatan sekresi pada tahap awal. Sekresi ini disebabkan oleh adanya tambahan pelepasan insulin yang sudah lebih dahulu terbentuk dan oleh adanya aktivasi system enzim yang mensintesis dan melepaskan insulin baru dari sel.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Arial Unicode MS","sans-serif"; font-size: 12pt; line-height: 150%;">❀<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Naiknya sekresi insulin akibat stimulus glukosa menyebabkan meningkatnya kecepatan dan sekresi secara dramatis. Selanjutnya, penghentian sekresi insulin hampir sama cepatnya, terjadi dalam waktu 3 sampai 5 menit setelah pengurangan konsentrasi glukosa kembali ke kadar puasa.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Arial Unicode MS","sans-serif"; font-size: 12pt; line-height: 150%;">❀<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Peningkatan glukosa darah meningkatkan sekresi insulin dan insulin selanjutnya meningkatkan transport glukosa ke dalam hati, otot, dan sel lain, sehingga mengurangi konsentrasi glukosa darah kembali ke nilai normal.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 0.25in; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2. Asam amino ( arginin dan lisin )</span></i><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></i></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 39.3pt; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Arial Unicode MS","sans-serif"; font-size: 12pt; line-height: 150%;">❀<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Pemberian asam amino sewaktu tidak ada peningkatan kadar glukosa peningkatan sekresi insulin sedikit saja.</span><span style="font-family: Symbol;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">darah </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: Symbol;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b. Bila pemberian insulin pada saat terjadi peningkatan glukosa darah sekresi insulin yang diinduksi oleh glukosa dapat berlipat ganda saat kelebihan asam amino.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 39.3pt; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Arial Unicode MS","sans-serif"; font-size: 12pt; line-height: 150%;">❀<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jadi, asam amino sangat memperkuat rangsangan glukosa terhadap sekresi insulin. Tampaknya perangsangan sekresi insulin oleh asam amino merupakan respons yang sangat bermakna sebab insulin sendiri sebaliknya meningkatkan pengangkutan asam amino ke dalam sel jaringan demikian juga meningkatkan pembentukan protein intraselular. Sehingga hal ini menyebabkan insulin sangat berguna untuk pemakaian asam amino yang berlebihan.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3. Hormon gastrointestinal</span></i><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></i></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Campuran gastrin, sekretin, kolesistokinin, dan peptide penghambat asam lambung ( hormone terkuat dari seluruh hormone kelenjar pencernaan ) akan meningkatkan sekresi insulin ( peningkatan “antisipasi” insulin persiapan agar glukosa dan asam amino dapat diabsorbsi</span><span style="font-family: Symbol;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dalam darah dari makanan tersebut ). Hormone ini dilepaskan sesudah seseorang makan.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">4. Hormon – hormone lain dan system saraf</span></i><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></i></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a. Glukagon, GH, kortisol, progesteron, dan estrogen.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemanjangan sekresi salah satu jenis hormone ini mengakibatkan sel beta pulau langerhans pancreas menjadi lelah dan akibatnya timbullah diabetes. Memang, diabetes sering terjadi pada orang yang menggunakan dosis farmasi tinggi dari beberapa hormone ini.<br />
b. Perangsangan saraf parasimpatis atau saraf simpatis terhadap pancreas juga meningkatkan sekresi insulin.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Faktor lain yang dapat merangsang sekresi insulin</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Asam amino</span></i><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></i></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Yang paling berpengaruh arginin dan lisin. Apabila pemberian asam amino dilakukan pada tidak ada peningkata glukosa darah, hanya menyebabkan peningkatan sekresi insulin sedikit saja. Apabila pemberian ini dilakukan ketika terjadi peningkatan glukosa darah maka terja hipersekresi dari insulin.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tampaknya perangsangan insulin oleh asam amino merupakan respon yang sangat bermakna sebab insulin sendiri sebaliknya meningkatkan pengangkutan asam amino kedalam sel-sel jaringan demikian juga meningkatkan pembentukan protein intraselular. Jadi insulin sangat berguna untuk pemakaian asam amino yang berlebih dalam cara yang sama bahwa insulin penting bagi penggunaan karbohidrat.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jadi asam amino ini dapat memperkuat rangsangan glukosa terhadap sekresi insulin.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Hormon gastrointestinal</span></i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Campuran beberapa hormon yang pencernaan yang penting gastrin,sekretin, kolesistokinin, dan peptida penghambat asam lambung (yang tampaknya merupakan hormon terkuat yang dikeluarkan oleh kelenjar pencernaan) akan meningkatkan sekresi insulin dalam jumlah banyak. Hormon ini dilepaska ketika setelah makan. Selanjutnya hormon ini akan menyebabkan antisipasi insulin dalam darah yang merupakan suatu persiapan agar glukosa dan asam amino dapat diabsorbsi. Hormon ini bekerja sama dengan asam amino yaitu meningkatkan sensitivitas respon insulin untuk meningkatkan glukosa darah, yang hampir mengdakan kecepatan sekresi insulin bersamaan dengan naiknya glukosa darah.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hormon lain dan sistem saraf otonom</span></i><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></i></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hormon-hormon yang dapat meningkatkan sekresi insulin : glukagon, hormon pertumbuhan, kortisol, dan yang lebih lemah adalah progesteron dan estrogen .pemanjangan sekresi hormon insulindalam jumlah besar kadang dapat menyebabkan sel beta mengalami kelelahan dan dapat menyebabkan diabetes.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada beberapa keadaan, perangsangan saraf parasimpatis dan saraf simpatis terhadap pankreas juga meningkatkan sekresi insulin.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Peran Insulin ( Dan Hormone Lain ) Dalam “Pengalihan” Antara Metabolisme Karbohidrat Dan Metabolisme Lipid</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span style="font-family: "Arial Unicode MS","sans-serif"; font-size: 12pt; line-height: 150%;">❀<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Insulin meningkatkan pemakain karbohidrat sebagai sumber energi dan menekan pemakaian lemak.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span style="font-family: "Arial Unicode MS","sans-serif"; font-size: 12pt; line-height: 150%;">❀<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Glukosa darah tinggi — insulin keluar — karbohidrat lebih dipakai daripada lemak — kelebihan glukosa darah disimpan dalam bentuk glikogen hati, lemak hati, dan glikogen otot.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span style="font-family: "Arial Unicode MS","sans-serif"; font-size: 12pt; line-height: 150%;">❀<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hormone yang mempengaruhi sekresi insulin<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">oGH, sekresi hormon ini merupakan respons terhadap hipoglikemia<br />
oKortisol, sekresi hormon ini merupakan respons terhadap hipoglikemia<br />
oEpinefrin, meningkatkan konsentrasi glukosa dalam plasma selama stress yakni bila system saraf simpatis dirangsang, meningkatkan konsentrasi asam lemak dalam plasma, menyebabkan timbulnya proses glikogenolisis banyak glukosa dalam darah, mempunyai efek lipolitik</span><span style="font-family: Symbol;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dalam hati mengaktifkan hormone jaringan lemak yang sensitive</span><span style="font-family: Symbol;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">terhadap sel lemak lipase, meningkatkan pemakaian lemak saat stress, saat kerja fisik, syok sirkulasi, kecemasan.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pankreas-Glukagon<o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Glukagon merupakan polipeptida besar. Hormon ini memiliki berat molekul 3485 dan terdiri dari rantai yang tersusun atas 29 asam amino. Hanya 1 mikrogram/kg glukagon dalam waktu kira-kira 20 menit dapat meningkatkan konsentrasi glukosa darah kira-kira 20 mg/dl darah (25%) karena alasan inilah glukagon disebut sebagai hormon hiperglikemik.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Efek Terhadap Metabolisme</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Glikogenolisis dan Peningkatan Konsentrasi Glukosa Darah</span></i><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></i></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Disebabkan oleh rentetan peristiwa sbb:</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 39pt; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Wingdings; font-size: 12pt; line-height: 150%;">§<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Glukagon mengaktifkan adenil siklase</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 39pt; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Wingdings; font-size: 12pt; line-height: 150%;">§<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terbentuk siklik adenosin monofosfat</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 39pt; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Wingdings; font-size: 12pt; line-height: 150%;">§<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengaktifkan protein pengatur protein kinase</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 39pt; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Wingdings; font-size: 12pt; line-height: 150%;">§<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengaktifkan protein kinase</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 39pt; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Wingdings; font-size: 12pt; line-height: 150%;">§<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengaktifkan fosforilase b kinase</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 39pt; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Wingdings; font-size: 12pt; line-height: 150%;">§<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mengubah fosforilase b à fosforilase a</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 39pt; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Wingdings; font-size: 12pt; line-height: 150%;">§<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Meningkatkan pemecahan glikogen menjadi glukosa-1-fosfat</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 39pt; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Wingdings; font-size: 12pt; line-height: 150%;">§<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Defosforilasi</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 39pt; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: Wingdings; font-size: 12pt; line-height: 150%;">§<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Glukosa dilepaskan dari sel-sel hati</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rangkaian peristiwa ini sangat penting karena :</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Merupakan salah satu peristiwa yang telah diteliti paling menyeluruh dari semua fungsi second messenger dari siklik adenosin monofosfat.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menggambarkan adanya sistem menyeluruh dimana setiap produk yang berikutnya dihasilkan lebih banyak daripada produk sebelumnya.<o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
<i>2. Peningkatan Glukoneogenesis </i></span><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></i></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Glukagon dapat meningkatkan kecepatan ambilan asam amino oleh sel-sel hati, kemudian mengubah asam amino menjadi glukosa melalui glukoneogenesis. Proses ini dapat dicapai melalui pengaktifan berbagai enzim yang dibutuhkan untuk transpor asam amino dan glukoneogenesis, terutama aktivasi dari sistem enzim untuk mengubah piruvat menjadi fosfoenolpiruvat, suatu lankah kecepatan terbatas (rate-limiting step) dalam glukoneogenesis.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Efek lain dari Glukagon </span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">mengaktifkan lipase sel lemak</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">, sehingga meningkatkan persediaan asam lemak yang dipakai sebagai sumber energi tubuh.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Menghambat penyimpanan trigliserida di dalam hati</span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">, sehingga mencegah hati membuang asam lemak dari darah yang juga membantu menambah jumlah persediaan asam lemak yang nantinya dapat dipergunakan oleh jaringan tubuh lain.<o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Glukagon dalam konsentrasi abnormal yang sangat besar juga <i>(1) meningkatkan kekuatan jantung,(2) meningkatkan sekresi empedu, (3) menghambat sekresi asam lambung.</i><o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: normal;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Anatomi Tiroid<o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelenjar tiroid merupakan kelenjar berwarna merah kecoklatan dan sangat vascular. Terletak di anterior cartilago thyroidea di bawah laring setinggi vertebra cervicalis 5 sampai vertebra thorakalis 1.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelenjar ini terselubungi lapisan pretracheal dari fascia cervicalis dan terdiri atas 2 lobus, lobus dextra dan sinistra, yang dihubungkan oleh isthmus. Beratnya kira2 25 gr tetapi bervariasi pada tiap individu. Kelenjar tiroid sedikit lebih berat pada wanita terutama saat menstruasi dan hamil.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Lobus kelenjar tiroid seperti kerucut. Ujung apikalnya menyimpang ke lateral ke garis oblique pada lamina cartilago thyroidea dan basisnya setinggi cartilago trachea 4-5. Setiap lobus berukutan 5x3x2 cm</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Isthmus menghubungkan bagian bawah kedua lobus, walaupun terkadang pada beberapa orang tidak ada. Panjang dan lebarnya kira2 1,25 cm dan biasanya anterior dari cartilgo trachea walaupun terkadang lebih tinggi atau rendah karena kedudukan dan ukurannya berubah.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Vaskularisasi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
Kelenjar tiroid disuplai oleh <i>arteri tiroid superior, inferior, dan terkadang juga arteri tiroidea ima dari a. brachiocephalica atau cabang aorta</i>. Arterinya banyak dan cabangnya beranastomose pada permukaan dan dalam kelenjar, baik ipsilateral maupun kontralateral.<br />
a. tiroid superior menembus fascia tiroid dan kemudian bercabang menjadi cabang anterior dan posterior. Cabang anterior mensuplai permukaan anterior kelenjar dan cabang posterior mensuplai permukaan lateral dan medial. a. tiroid inferior mensupali basis kelenjar dan bercabang ke superior (ascenden) dan inferior yang mensuplai permukaan inferior dan posterior kelenjar.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sistem venanya berasal dari pleksus perifolikular yang menyatu di permukaan membentuk <i>vena tiroidea superior, lateral dan inferior. </i><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sistem Limfatik</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pembuluh limfe tiroid terhubung dengan plexus tracheal dan menjalar sampai nodus prelaringeal di atas isthmus tiroid dan ke nodus pretracheal serta paratracheal. Beberapa bahkan juga mengalir ke nodus brachiocephal yang terhubung dengan tymus pada mediastinum superior.</span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Innervasi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
Kelenjar tiroid diinnervasi oleh superior, middle, dan inferior cervical symphathetic ganglia</span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: normal;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt;">Fisiologi T</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">iroid</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 18pt;"><o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hormon tiroid dihasilkan oleh kelenjar tiroid. Kelenjar tiroid memiliki dua buah lobus, dihubungkan oleh isthmus, terletak di kartilago krokoidea di leher pada cincin trakea ke dua dan tiga. Kelenjar tiroid berfungsi untuk pertumbuhan dan mempercepat metabolisme. Kelenjar tiroid menghasilkan dua hormon yang penting yaitu tiroksin (T4) dan triiodotironin (T3). Karakteristik triioditironin adalah berjumlah lebih sedikit dalam serum karena reseptornya lebih sedikit dalam protein pengikat plasma di serum tetapi ia lebih kuat karena memiliki banyak resptor pada jaringan. Tiroksin memiliki banyak reseptor pada protein pengikat plasma di serum yang mengakibatkan banyaknya jumlah hormon ini di serum, tetapi ia kurang kuat berikatan pada jaringan karena jumlah reseptornya sedikit. (Guyton. 1997)</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Proses pembentukan hormon tiroid adalah:</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">(1)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Proses penjeratan ion iodida dengan mekanisme pompa iodida. Pompa ini dapat memekatkan iodida kira-kira 30 kali konsentrasinya di dalam darah;</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">(2)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Proses pembentukan tiroglobulin. Tiroglobulin adalah glikoprotein besar yang nantinya akan mensekresi hormon tiroid;</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">(3)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Proses pengoksidasian ion iodida menjadi iodium. Proses ini dibantu oleh enzim peroksidase dan hidrogen peroksidase.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">(4)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Proses iodinasi asam amino tirosin. Pada proses ini iodium (I) akan menggantikan hidrogen (H) pada cincin benzena tirosin. Hal ini dapat terjadi karena afinitas iodium terhadap oksigen (O) pada cincin benzena lebih besar daripada hidrogen. Proses ini dibantu oleh enzim iodinase agar lebih cepat.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">(5)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Proses organifikasi tiroid. Pada proses ini tirosin yang sudah teriodinasi (jika teriodinasi oleh satu unsur I dinamakan monoiodotirosin dan jika dua unsur I menjadi diiodotirosin)</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">(6)<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Proses coupling (penggandengan tirosin yang sudah teriodinasi). Jika monoiodotirosin bergabung dengan diiodotirosin maka akan menjadi triiodotironin. Jika dua diiodotirosin bergabung akan menjadi tetraiodotironin atau yang lebih sering disebut tiroksin. Hormon tiroid tidak larut dalam air jadi untuk diedarkan dalam darah harus dibungkus oleh senyawa lain, dalam hal ini tiroglobulin. Tiroglobulin ini juga sering disebut protein pengikat plasma. Ikatan protein pengikat plasma dengan hormon tiroid terutama tiroksin sangat kuat jadi tiroksin lama keluar dari protein ini. Sedangkan triiodotironin lebih mudah dilepas karena ikatannya lebih lemah. (Guyton. 1997)</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Anatomi Paratiroid</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelenjar paratiroid kecil, kuning kecoklatan oval, biasanya terletak antara garis lobus posterior dari kelenjar tiroid dan kapsulnya. Ukurannya kira2 6x3x2 mm. Beratnya 50 mg.<br />
Biasanya 2 pada tiap sisi, superior dan inferior. Normalnya paratiroid posterior bergeser hanya pada kutub paratiroid posterior, tapi bisa juga turun bersama timus ke thorax atau pada bifurcation karotis.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelenjar paratiroid superior letaknya lebih konstan daripada inferior dan biasanya terlihat di tengah garis posterior kelenjar tiroid walaupun bisa lebih tinggi. Bagian inferior sangat bervariasi pada beberapa situasi (tergantung perkembangan embriologisnya) dan bias tanpa selubung fascia tiroid, di bawah arteri tiroid, atau pada kelenjar tiroid dekat kutub inferior. </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Vascularisasi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
Kelenjar paratiroid divaskularisasi oleh a. tiroid inferior atau dari anastomose antara pembuluh darah superior dan inferior. Kira2 1/3 kelenjar paratiroid pada orang2 punya 2 atau lebih arteri paratiroid<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sistem Limfatik</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pembuluh limfe ada banyak dan diasosiasikan dengan kelenjar tiroid dan tymus.<br />
<b>Innervasi</b><br />
a. Symphathetic — dari ganglia cervical superior atau middle atau oleh plexus pada fascia lobus posterior.<br />
b. Aktivitas paratiroid — dikontrol oleh level Ca dalam darah<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelenjar Paratiroid</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
Kelenjar ini terdiri dari 4 bentukan kecil yang berwarna kuning kecoklatan, berbentuk ovoid dan melekat pada baian posterior dari kelenjar thyroid.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sepasang dari kelenjar ini menempati kutub atas dari kelenjar thyroid dan terbungkus oleh fascia yang sama dengan fascia kelenjar thyroid.<br />
Sedang sepasang kelenjar lainnya biasanya menempati kutub bawah kelenjar thyroid, tetapi letaknya bisa di dalam atau di luar fascia kelenjar thyroid.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Masing-masing kelenjar ini terbungkus oleh kapsul jaringan ikat kendor yang kaya dengan pembuluh darah, dan kapsul ini memebentuk septa yang masuk ke dalam kelenjar.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelenjar ini tersusun dari 2 macam sel :</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Chieff cell (principal cell) :</span></i><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></i></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sel ini sudah ada sejak lahir dan akan terus bertahan, dan merupakan sel yang terbanyak dalam kelenjar ini.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ukuran sel ini kecil dengan inti di tengah, dan sitoplasma bersifat sedikit asidofilik, sehingga dengan pewarnaan H.E tampak berwarna merah muda. Tetapi kadang-kadang ada beberapa sel yang sitoplasmanya lebih pucat karena mengandung banyak glikogen, tetapi sebaian lain mempunyai sitoplasma lebih gelap karena glikogennya hanya sedikit.<br />
Sel ini mengandung granula yang diduga menghasilkan parathyroid hormon (parath hormone)</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></i><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Oxyphiel cell</span></i><i><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></i></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sel ini timbulny mulai umur sekitar 7 tahun atau pada saat pubertas.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terdiri dari sel yang ukurannya lebih besar dari chief sel, tersebar diantara chief cell tersebut dan sitoplasmanya merah muda pucat.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Fungsi sel ini belum diketahui.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Fisiologi Paratiroid</span></b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hormone paratiroid (PTH) merupakan regulator mayor homeostatis serum kalsium dan fosfat. PTH baru disekresi jika terdapat penurunan serum kalsium. PTH merupakan hormone peptide yang tersusun atas 84 asam amino yang disekresikan oleh kelenjar paratiroid. Pada kelenjar paratiroid terdapat sensor Ca2+ yang meregulasi sintesis PTH dan sekresinya dalam responnya terhadap perubahan kadar kalsium yang terionisasi dalam konsentrasi plasma. Saat kadar kalsium meningkat, kalsium yang banyak terikat dengan reseptor membrane pada sel di kelenjar paratiroid akan menghambat sintesis PTH dan sekresi dari PTH seperti gambar dibawah ini.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sebaliknya jika kadar kalsium turun — kalsium yang berikatan dengan CaR (Calcium Receptor) akan turun — meningkatkan sintesis dan sekresi dari PTH. Efek dari PTH terutama dalam mengembalikan kadar kalsium yang turun menjadi normal antara lain:</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Secara cepat dan langsung mempengaruhi ginjal untuk mereabsorpsi kalsium pada tubulus distal dan lengkung Henle asending tebal sehingga dengan cepat meningkatkan kadar kalsium serum.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Secara tidak langsung mempengaruhi usus untuk mengabsorpsi secara cepat ion-ion kalsium dengan jalan PTH mempengaruhi ginkal untuk meningkatkan sintesis 1,25-(OH)2D, merupakan calcitriol (bentuk aktif dari Vitamin D), yang akan menstimulasi usus halus untuk mengabsorpsi kalsium dan fosfat dengan cepat.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PTH secara langsung menginhibisi osteoblas untuk membentuk tulang. Selain itu dikarenakan penurunan kadar calcitonin yang berperan menghambat kerja osteoklas, terjadi peningkatan aktivitas dari osteoklast dalam memecah tulang dan melepaskan kalsium tulang ke dalam darah sehingga akan meningkatkan kadar kalsium menjadi normal.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anatomi Adrenal</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 0.5in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelenjar adrenal adalah sepasang organ yang terletak dekat kutub atas ginjal, terbenam dalam jaringan lemak. Kelenjar ini ada 2 buah, berwarna kekuningan serta berada di luar (ekstra) peritoneal. Bagian yang sebelah kanan berbentuk pyramid dan membentuk topi (melekat) pada kutub atas ginjal kanan. Sedangkan yang sebelah kiri berbentuk seperti bulan sabit, menempel pada bagian tengah ginjal mulai dari kutub atas sampai daerah hilus ginjal kiri. </span><span lang="PT-BR" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelenjar adrenal pada manusia panjangnya 4-6 cm, lebar 1-2 cm, dan tebal 4-6 mm. Bersama-sama kelenjar adrenal mempunyai berat lebih kurang 8 g, tetapi berat dan ukurannya bervariasi bergantung umur dan keadaan fisiologi perorangan. Kelenjar ini dikelilingi oleh jaringan ikat padat kolagen yang mengandung jaringan lemak. Selain itu masing-masing kelenjar ini dibungkus oleh kapsul jaringan ikat yang cukup tebal dan membentuk sekat/septa ke dalam kelenjar</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Vaskularisasi </span></b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelenjar adrenal disuplai oleh sejumlah arteri yang masuk pada beberapa tempat di sekitar bagian tepinya. Ketiga kelompok utama arteri adalah <b>arteri suprarenalis superior</b>, berasal dari arteri frenika inferior; <b>arteri suprarenalis media</b>, berasal dari aorta ; dan <b>arteri suprarenalis inferior</b>, berasal dari arteri renalis. Berbagai cabang arteri membentuk pleksus subkapsularis yang mencabangkan tiga kelompok pembuluh: arteri dari simpai; arteri dari kortex, yang banyak bercabang membentuk jalinan kapiler diantara sel-sel parenkim (kapiler ini mengalir ke dalam kapiler medulla); dan arteri dari medulla, yang melintasi kortex sebelum pecah membentuk bagian dari jalinan kapiler luas dari medulla. Suplai vaskuler ganda ini memberikan medulla dengan darah arteri (melalui <b>arteri medularis</b>) dan darah vena (melalui <b>arteri kortikalis</b>). Endotel kapiler ini sangat tipis dan diselingi lubang-lubang kecil yang ditutupi diafragma tipis. Di bawah endotel terdapat lamina basal utuh. Kapiler dari medulla bersama dengan kapiler yang mensuplai kortex membentuk vena medularis, yang bergabung membentuk <b>vena adrenal</b> atau <b>suprarenalis.</b></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adrenal</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terbagi atas korteks dan medula.</span><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 18pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Korteks</span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> dibagi zona :</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><ul type="disc"><li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Glomerulosa : paling luar.</span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></li>
<ul type="circle"><li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tepat dibawah simpai</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sel polihedralkecil berkelompok membentuk bulatan . inti gelap, sitoplasma basofilik. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada manusia tidak begitu berkembang</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penghasil mineralokortikoid(aldosteron yang terkuat)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></li>
</ul><li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Zona fasikulata</span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></li>
<ul type="circle"><li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Lebil tebal </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">terdiri atas sel polihedral besar dengan sitoplasmanya basofilik.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Selnya tersusun berderet lurus setebal 2 sel, dengan sinusoid venosa bertingkap yang jalannya berjajar dan diantara deretan itu. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="NO-BOK" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sel-sel mengandung banyak tetes lipid, fosfolipid , asam lemak , lemak dan kolesterol.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sel ini juga banyak mengandung vitamin C dan mensekresikan kortikosteroid.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></li>
</ul><li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Zona retikularis </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></li>
<ul type="circle"><li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">`Lapisan ini terdiri atas deretan sel bulat bercabang – cabang berkesinambungan.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sel-selnya penghasil hormon kelamin (progesteron , estrogen & androgen).</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sel ini juga mengandung vitamin C.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></li>
</ul></ul><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Medula </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><ul type="disc"><li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terdiri atas deretan sel kromafin, dengan sinusoid venosa lebar diantaranya.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Terdapat sekelompok – kelompok kecil sel saraf</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menghasilkan adrenalin & nor adrenalin </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sitoplasmanya mengandung banyak vesikel berisikan sekret ini.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></li>
</ul><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sel tersusun dalam deretan setebal satu sel pada tepi sinusoid venosa.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Fisiologi Adrenal</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagian Korteks</span></b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">SINTESIS HORMON KORTEK ADRENAL</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 0.25in; text-align: justify; text-indent: -0.25in;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;">§<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"> </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kortek adrenal mensintesis molekul steroid yang dipilah menjadi tiga kelompok hormon yaitu glukokortikoid, mineralkortikoid dan androgen dengan zona/lapisan penghasil yang berbeda-beda</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 0.25in; text-align: justify; text-indent: -0.25in;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;">§<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Seperti kita ketahui, kortek adrenal mempunyai 3 lapisan/zona yaitu :</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 1in; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a. Zona glomerulosa </span><span lang="IN" style="font-family: Wingdings; font-size: 12pt; line-height: 150%;">à</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> memproduksi hormon mineralkortikoid</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 1in; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b. Zona fasikulata </span><span lang="IN" style="font-family: Wingdings; font-size: 12pt; line-height: 150%;">à</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> memproduksi hormon glukokortikoid (bersama dengan zona reticularis)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 1in; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c. Zona reticularis </span><span lang="IN" style="font-family: Wingdings; font-size: 12pt; line-height: 150%;">à</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> memproduksi homon androgen </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 0.25in; text-align: justify; text-indent: -0.25in;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;">§<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"> </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolesterol, yang didapatkan dari makanan dan sintesis endogen adalah bahan untuk steroidogenesis. Uptake kolesterol dilakukan oleh LDL receptor. Dengan stimulasi dari ACTH, jumlah receptor LDL meningkat</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 0.25in; text-align: justify; text-indent: -0.25in;"><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;">§<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Di bawah ini, adalah skema jalanya sintesis dari hormon steroid adrenal :</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Keterangan :</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 1in; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">o Sisntesis mineralkokrtikoid </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pregnenolon diubah menjadi progesterone oleh dua buah enzim reticulum endoplasma halus yaitu <b>3β-hidroksisteroid dehidrogenase dan Δ<sup>5,4</sup> isomerase.</b> Progesterone mengalami hidroksilase pada posisi C<sub>21</sub> untuk membentuk 11-deoksikotrikosteron, yang merupakan mineralkortikoid yang aktif (menahan ion Na<sup>+</sup>). Hidroksilase berikutnya, pada C<sub>11</sub>, menghasilkan kortikosteron. Enzim 18-hidroksilase bekerja pada kortikosteron membentuk 18 hidroksikortikosteron yang diubah menjadi aldosteron oleh konversi 18-alkohol menjadi aldehid</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 1in; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">o Sintesis glukokortikoid</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sintesis kortisol memerlukan tiga enzim hidroksilase yang bekerja secara berurutan pada posisi C<sub>17</sub>, C<sub>21</sub>, C<sub>11</sub>. Dua reaksi pertama berlangsung cepat , sementara hidroksilasi C<sub>11</sub> berlangsung lambat. 17α-hidroksilase merupakan enzim reticulum endoplasma halus yang bekerja pada pregnenolon. 17α-hidroksiprogesteron mengalami hidroksilase pada posisi C<sub>21</sub> oleh 21-hidroksilase hingga membentuk 11-deoksikortisol yang kemudian juga dihidroksilasi oleh 11β-hidroksilase pada posisi C<sub>11</sub> untuk membentuk kortisol. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 1in; text-align: justify; text-indent: -0.25in;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">o Sintesis androgen</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hormon androgen yang utama yang dihasilkan oleh korteks adrenal adalah dehidroepiandrosteron (DHEA). DHEA sebenarnya adalah sebuah prehormon karena kerjanya 3β-OHSD dan Δ<sup>5,4</sup> isomerase akan mengubah DHEA androgen yang lemah menjadi androstenedion yang lebih poten. Reduksi androstenesion pada posisi C<sub>17</sub> mengakibatkan pembentukan testosterone </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">TRANSPORT HORMON STEROID<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 0.25in; text-align: justify; text-indent: -0.25in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1. Kortisol bersirkulasi dalam plasma sebagai :<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1. Kortisol bebas </span><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;">à</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> merupakan bentuk hormon yang aktif dan tidak terikat dengan protein dan mereka dapat secara lagsung bereaksi ke organ target. Normalnya <5%><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2. Kortisol terikat protein<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="PT-BR" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Plasma mempunyai dua macam pengikat kortisol. Yang pertama mempunyai affinitas yang tinggi yaitu kortisol binding globulin (CBG) dan yang lainya mempunyai affinitas yang rendah, kadar protein yang tinggi yaitu albumin. Kortisol terikat CBG mengurangi efek dari inflamasi, dengan peningkatan konsentrasi kortisol bebas secara local. Ketika konsentrasi kortisol >700nmol, sebagian terikat pada albumin dan sebagian yang lebih besar beredar secara bebas. CBG meningkat pada kadar estrogen yang tinggi (kehamilan, pemakai obat kontrasepsi). Peningkatan CBG disertai juga dengan peningkatan protein terikat kortisol, dengan demikian kadar total kortisol dalam plasma meningkat. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3. Kortisol metabolit<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 0.5in; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adalah suatu respon biologis yang tidak aktif dan terikat lemah pada protein plasma<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">METABOLISME DAN EKSRESI STEROID<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 0.25in; text-align: justify; text-indent: -0.25in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1. GLUKOKORTIKOID<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sekresi kortisol tiap harinya berkisar antara 40-80 μmol, yang disekresi dengan irama sirkadian. Kadar kortisol dalam plasma ditentukan oleh sekresinya, inaktivasinya dan eksresinya. Hati adalah organ utama untuk penginaktivan steroid. Enzim utama yang meregulasi metabolism kortisol adalah 11β-hydroxysteroid dehydrogenase (11β-HSD). Ada dua isoforms : 11β-HSD 1 diekspresikan terutama di hati dan bertindak sebagai reductase, mengkonversi inactive kortison ke dalam bentuk glukokortikoid yang aktif yaitu kortisol. 11β-HSD 2 diekspresikan di sejumlah jaringan dan mengkonversi kortisol dalam bentuk yang tidak aktif, kortison.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 0.25in; text-align: justify; text-indent: -0.25in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2. MINERALKORTIKOID<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada individu yang mempunyai kadar garam yang normal, sekresi tiap harinya berkisar 0,1 dan 0,7 μmol. Selama perjalanannya lewat hati, >75% dari aldosterone diinaktivkan oleh konyugasi dengan asam glukoronik. Bagaimanapun juga pada kondisi tertentu, seperti pada gagal jantung, penginaktifanya berkurang<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 0.25in; text-align: justify; text-indent: -0.25in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3. ADRENAL ANDROGENS<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Androgen terutama disekresi oleh adrenal dalam bentuk DHEA dan DHEAS. Kira-kira 15-30 mg dari senyawa ini disekresikan tiap harinya. Dalam jumlah yang lebih kecil androstenedione, 11β-hydroxyandrostenedione dan testosterone disekresikan. DHEA merupakan prekusor utama dari urinary 17-ketosteroid. 2/3 dari urinary 17-ketosteroid pada laki-laki derivate dari metabolism adrenal, dan sisanya berasal dari testicular androgen. Sedangkan pada wanita, hampir semua urinary 17-ketosteroid derivate dari adrenal<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 4.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">MEKANISME AKSI HORMON STEROID<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="IT" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Steroid berdifusi secara pasif melewati membrane sel dan terikat pada protein intraselular. Glukokortikoid dan mineralkortikoid terikat dengan reseptor yang afinitasnya hampir sama dengan reseptor mineralkortikoid. Bagaimanapun juga, hanya glukokortikoid yang terikat pada reseptor glukokortikoid. Setelah steroid terikat pada reseptor, komplek steroid-reseptor berjalan ke nucleus, dimana steroid akan melakukan transkripsi RNA. Karena kortisol terikat pada mineralkortikoid dikarenakan afinitas yang sama dengan aldosterone, spesifitas mineralkortikoid dicapai dengan metabolism local dari kortisol untuk menginaktivkan senyawa cortisone dengan 11</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">β</span><span lang="IT" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">-HSD2</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">REGULASI HORMON STEROID<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 0.25in; text-align: justify; text-indent: -0.25in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1. GLUKOKORTIKOID<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">· </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ACTH diproses dari precursor POMC. POMC dibuat di berbagai jaringan termasuk otak, hipofisis anterior dan posterior dan limfocyte<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">· </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ACTH (adrenocortiko tropic hormon) disintesis dan disimpan dalam sel basophil di hipofisis anterior<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">· </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sekresi ACTH dari hipofisis anterior diatur oleh corticotrophin releasing hormon (CRH) yang diproduksi di eminens medianan di hipotalamus.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><span style="font-family: Symbol; font-size: 12pt; line-height: 150%;">· </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Factor utama yang mengontrol ACTH dan juga CRH tentunya adalah :<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 0.75in; text-align: justify; text-indent: -0.25in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a. Kadar kortisol dalam plasma<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kortisol mempunyai efek umpan balik negative terhadap (1) hipotalamus untuk menurunkan pembentukan CRF dan (2) kelenjar hipofisis anterior untuk menurunkan pembentukan ACTH. Kedua umpan balik ini membantu mengatur konsentrasi kortisol dalam plasma. Jadi, bila konsentrasi kortisol menjadi sangat tinggi, maka umpan balik ini secara otomatis akan mengurangi jumlah ACTH sehingga kembali ke keadaan normalnya<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 0.75in; text-align: justify; text-indent: -0.25in;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b. Stress<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Stress baik fisik, emosional atau hipoglikemia menyebabkan terjadinya sekresi CRH dan arginin vasopressin dan aktivasi dari system saraf simpatis. Hal ini akan meningkatkan sekresi ACTH.<o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 0.75in; text-align: justify; text-indent: -0.25in;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c. Siklus istirahat atau aktivitas tiap orang </span><span style="font-family: Wingdings; font-size: 12pt; line-height: 150%;">à</span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> berhubungan dengan irama sirkadian</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p></o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ACTH dalam plasma bervariasi sesuai dengan sekresi dan mengikuti pola sirkadian yang mana mencapai puncak saat kita bangun (pagi hari) dan mencapai titik terendah saat malam hari (akan tidur). </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jika pola istirahat kita berubah, maka irama sirkadian ini juga akan berubah mengikuti pola baru.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><o:p>referensi </o:p></span></div><div class="MsoNormal">http://4uliedz.wordpress.com/2009/02/05/sistem-endokrin/Aulia</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="IN" style="font-size: 12pt; line-height: 150%;"><o:p> dipostingkan oleh :</o:p></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="IN" style="font-size: 12pt; line-height: 150%;"><o:p>ita nurmalitasari 2A 05200ID09017</o:p></span></div>ita_2A_SISTEM_ENDOKRINhttp://www.blogger.com/profile/01283161728267260485noreply@blogger.com1