difteri bing

8/18/2019 Difteri Bing

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KAJIAN TEORI

2.1 Definisi Difteri

• Difteria adalah suatu penyakit infeksi mendadak yang disebabkan oleh kuman

Corynebacterium diphteriae. Mudah menular dan yang diserang terutama traktusrespiratorius bagian atas dan ditandai dengan terbentuknya pseudomembran dan

dilepaskannya eksotoksin yang dapat menimbulkan gejala umum dan lokal. (Ilmu

Kesehatan Anak FK UI: 2!"

• Difteri adalah suatu infeksi akut yang disebabkan oleh bakteri penghasil toksik

(racun) Corynebacterium diphteriae. (2#".

• Difteri adalah infeksi saluran pernafasan yang disebabkan oleh Corynebacterium

diphteriae dengan bentuk basil batang gram positif (Jauhari$nuru%in. 2#".

2.2 Klasifikasi

Berdasarkan tingkat keparahannya, Staff lmu !esehatan "nak #!$ membagi penyakit ini

menjadi % tingkat yaitu &

'. nfeksi ringan & bila pseudomembran hanya terdapat pada mukosa hidung dengan

gejala hanya nyeri menelan.

. nfeksi sedang & bila pseudomembran telah menyaring sampai faring (dinding

belakang rongga mulut), sampai menimbulkan pembengkakan pada laring.

%. nfeksi berat & bila terjadi sumbatan nafas yang berat disertai dengan gejala

komplikasi seperti miokarditis (radang otot jantung), paralysis (kelemahan anggota

gerak) dan nefritis (radang ginjal).

Berdasarkan letaknya, digolongkan sebagai berikut &

• Difteri hidung

ejala paling ringan dan paling jarang (*). Mula+mula tampak pilek, kemudian secret yang

keluar tercampur darah sedikit yang berasal dari pseudomembran. enyebaran

pseudomembran dapat mencapai faring dan laring.

• Difteri faring dan tonsil ( Difteri #ausial ).

Difteri jenis ini merupakan difteri paling berat karena bisa mengancam nya-a penderita

akibat gagal nafas. aling sering dijumpai ( /*). ejala mungkin ringan tanpa pembentukan

pseudomembran. Dapat sembuh sendiri dan memberikan imunitas pada penderita.ada

kondisi yang lebih berat dia-ali dengan radang tenggorokan dengan peningkatan suhu tubuh

yang tidak terlalu tinggi, pseudomembran a-alnya hanya berupa bercak putih keabu+abuan

yang cepat meluas ke nasofaring atau ke laring, nafas berbau, dan ada pembengkakan

regional leher tampak seperti leher sapi (bull’s neck). Dapat terjadi sakit menelan, dan suara

serak serta stridor inspirasi -alaupun belum terjadi sumbatan laring.

• Difteri laring dan trakea


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0ebih sering merupakan penjalaran difteri faring dan tonsil, daripada yang primer. ejala

gangguan nafas berupa suara serak dan stridor inspirasi jelas dan bila lebih berat timbul sesak

nafas hebat, sianosis, dan tampak retraksi suprasternal serta epigastrium. "da bull1s neck,

laring tampak kemerahan dan sembab, banyak sekret, dan permukaan ditutupi oleh

pseudomembran. Bila anak terlihat sesak dan payah sekali perlu dilakukan trakeostomi

sebagai pertolongan pertama.

• Difteri kutaneus dan 2aginal

Dengan gejala berupa luka mirip saria-an pada kulit dan 2agina dengan pembentukan

membrane diatasnya. 3amun tidak seperti saria-an yang sangat nyeri, pada difteri, luka yang

terjadi justru tidak terasa apa+apa. Difteri dapat pula timbul pada daerah konjungti2a dan

umbilikus.

• Diphtheria !ulit, !onjungti2a, 4elinga

Diphtheria kulit berupa tukak di kulit, tepi jelas dan terdapat membran pada dasarnya.

!elainan cenderung menahun. Diphtheria pada mata dengan lesi pada konjungti2a berupa

kemerahan, edema dan membran pada konjungti2a palpebra. ada telinga berupa otitis

eksterna dengan sekret purulen dan berbau.

2.& Anat'mi %an Fisi'l'i

• Anat'mi )istem *erna*asan

Saluran pernapasan terdiri dari rongga hidung, faring, laring, trakea, broncus dan paru.

(3elson, 5'5)

• Saluran pernafasan bagian atas &

• 6ongga hidung

7idung berfungsi sebagai penyaring kotoran, melembabkan serta menghangatkan udara yang

dihirup ke dalam paru 8 paru

• #aring

#aring adalah struktur yang menghubungkan hidung dengan rongga mulut ke laring.. #ungsi

utamanya adalah untuk menyediakan saluran pada traktus respiratoriun dan digestif.

• 0aring

0aring adalah struktur epitel kartilago yang menghubungkan faring dan trakhea. #ungsi

utamanya adalah untuk memungkinkan terjadinya lokalisasi. 0aring juga melindungi jalan

nafas ba-ah dari obstruksi benda asing dan memudahkan batuk.

) Saluran pernafasan bagian ba-ah &

• 4rakhea


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Disokong oleh cincin tulang ra-an yang berbentuk seperti sepatu kuda yang panjangnya

kurang lebih / inci, tempat dimana trakea bercabang menjadi bronkus utama kiri dan kanan

dikenal sebagai karina.

• Bronkus

4erdiri atas bagian yaitu broncus kanan dan kiri. Bronkus kanan lebih pendek dan lebar,

merupakan kelanjutan dari trakhea yang arahnya hampir 2ertikal. Bronchus kiri lebih panjang

dan lebih sempit, merupakan kelanjutan dari trakhea dengan sudut yang lebih tajam.

• "l2eoli

aru terbentuk oleh sekitar %55 juta al2eoli. 4erdapat tiga jenis sel 8 sel al2eolar, sel al2eolar

tipe adalah sel epitel yang membentuk dinding al2eolar. Sel al2eolar tipe

sel8sel yang aktif secara metabolik, mensekresi surfactan, suatu fosfolipid yang melapisi

permukaan dalam dan mencegah al2eolar agar tidak kolaps. Sel al2eolar tipe adalah

makrofag yang merupakan sel 8 sel fagositosis yang besar yang memakan benda asing dan

bekerja sebagai mekanisme pertahanan penting.

• aru

aru+paru merupakan organ elastic berbentuk kerucut yang terletak dalam rongga torak atau

dada. !edua paru+paru saling terpisah oleh mediasinum central yang mengandung jantung

pembulu+pembulu darah besar.

0etak paru+paru dirongga dada dibungkus oleh selaput yang bernama pleura.

leura dibagi menjadi dua&

'). leura 9isceral (selaput dada pembungkus) yaitu selaput paru yang langsung

membungkus paru+paru:

). leura arietal yaitu selaput yang melapisi rongga dada sebelah luar. "ntara kedua pleura

ini terdapat rongga (ka2um) yang disebut ka2um pleura.

ada keadaan normal, ka2um pleura ini 2akum (hampa udara) sehingga paru+paru dapat

berkembang kempis dan juga terdapat sedikit cairan (eksudat) yang berguna untukmeminyaki permukaannya (pleura), menghindarkan gesekan antara paru+paru dan dinding

dada se-aktu ada gerakan bernafas.

• Fisi'l'i)istem +ernafasan

!etika udara atmosfer mencapai al2eoli, oksigen akan bergerak dari al2eoli melintasi

membran al2eolar kapiler dan menuju sel darah merah. Sistem sirkulasi kemudian akan

memba-a oksigen yang telah berikatan dengan sel darah merah menuju jaringan tubuh,

dimana oksigen akan digunakan sebagai bahan bakar dalam proses metabolisme. ertukaran

oksigen dan karbon dioksida pada membran al2eolar kapiler dikenal dengan istilah difusi

pulmonal. Setelah proses pertukaran gas selesai (kadar karbondioksida yang rendah) akanmenuju sisi kiri jantung, dan akan dipompakan ke seluruh sel dalam tubuh.


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Saat mencapai jaringan, sel darah merah yang teroksigenasi ini akan melepaskan ikatannya

dengan oksigen dan oksigen tersebut digunakan untuk bahan bakar metabolisme. ;uga

karbondioksida akan masuk sel darah merah. Sel darah merah yang rendah oksigen dan tinggi

karbondioksida akan menuju sisi kanan jantung untuk kemudian dipompakan ke paru+paru.

7al yang sangat penting dalam proses ini adalah bah-a al2eoli harus terus menerus

mengalami pengisian dengan udara segar yang mengandung oksigen dalam jumlah yangcukup.

( Sumber & http&


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• Sakit dan pembengkakan pada tenggorokan

• Mual, muntah , sakit kepala.

• "danya pembentukan selaput di tenggorokan ber-arna putih ke abu abuan kotor.

• !aku leher

!eluhan a-al yang paling sering adalah nyeri tenggorokan, nausea, muntah, dan disfagia.

Selain itu ditandai dengan adanya membran semu di tonsil dan di sekitarnya, serta pelepasan

eksotoksin, yang dapat menimbulkan gejala umum (seperti penyakit infeksi) atau local

(seperti tampak keluhan nyeri)

2.3 +at'fisi'l'i

Biasanya bakteri berkembang biak pada atau di sekitar permukaan selaput lendir mulut atau

tenggorokan dan menyebabkan peradangan. Bila bakteri sampai ke hidung, maka hidung

akan berair. eradangan bisa menyebar dari tenggorokan ke pita suara (laring) dan

menyebabkan pembengkakan sehingga saluran udara menyempit dan terjadi gangguan

pernafasan.

Bakteri ini ditularkan melalui percikan ludah dari batuk penderita atau benda maupun

makanan yang telah terkontaminasi oleh bakteri. !etika telah masuk dalam tubuh, bakteri

melepaskan toksin atau racun. 4oksin ini akan menyebar melalui darah dan bisa

menyebabkan kerusakan jaringan di seluruh tubuh, terutama jantung dan saraf.

"kibat yang ditimbulkan oleh penyakit ini banyak bergantung pada efek eksotoksin yang

diproduksi. 4oksin menghambat pembuatan protein sel sehingga sel mati. 3ekrosis jaringan pada tempat menempelnya kuman akan menunjang perkembang+biakan kuman dan produksi

toksin selanjutnya, serta pembentukan membran yang melekat erat pada dasarnya.

Basil hidup dan berkembang biak pada traktus respiratorius bagian atas, terlebih bila terdapat

peradangan kronis pada tonsil, sinus dan lain+lain. 4etapi -alaupun jarang, basil dapat pula

hidup pada daerah 2ul2a, telinga dan kulit.

ada tempat ini basil membentuk pseudomembran dan melepaskan eksotoksin.

seudomembran dapat timbul lokal atau kemudian menyebar dari faring atau tonsil ke laring

dan seluruh traktus respiratorius bagian atas sehingga menimbulkan gejala yang lebih berat.

!elenjar getah bening sekitarnya akan mengalami hiperplasia dan mengandung toksin.

2.! K'm*likasi

!omplikasi yang timbul pada pasien difteri &

'. Miokarditis

• biasanya timbul akhir minggu kedua atau a-al minggu ketiga perjalanan penyakit

• emerikasaan #isik & rama derap, bunyi jantung melemah atau meredup, kadang+

kadang ditemukan tanda+tanda payah jantung.


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. !olaps perifer

%. bstruksi jalan nafas dengan segala akibatnya, bronkopneumonia dan atelektasis

=. $rogenital & dapat terjadi nefritis

enderita difteri ('5*) akan mengalami komplikasi yg mengenai sistem susunan saraf

terutama sistem motorik. 4erjadi pada akhir minggu pertama perjalanan penyakit.

2.# +enatalaksanaan

• engobatan $mum (Buku kuliah ilmu kesehatan anak #!$, 'AAA) &

• "nti Diphteri Serum ("DS) diberikan sebanyak 5.555$


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• ada urine terdapatnya albuminuria ringan

6A6 II

A)U7AN KE+ERA8ATAN TEORITI)

&.1 +enka5ian

&.1.1 I%entitas Klien

Meliputi nama, umur, no M6, pekerjaan, alamat, agama, cara masuk, ri-ayat alergi, tanggal

masuk 6S dan lain+lain.

&.1.2 Ri9aat Kesehatan

'. 6i-ayat !esehatan Dahulu

Biasanya klien mengalami peradangan kronis pada tonsil, sinus, faring, laring, dan saluran

nafas atas dan mengalami pilek dengan sekret bercampur darah yang disebabkan oleh bakteri

Corynebacterium diphteriae.

. 6i-ayat !esehatan Sekarang

• Biasanya klien mengalami demam yang tidak terlalu tinggi, lesu, pucat, sakit kepala,

anoreksia

• Biasanya klien mengeluh sakit menelan, menggigil, malaise, sakit tenggorokan, batuk.

%. 6i-ayat !esehatan !eluarga

Biasanya ada keluarga yang mengalami difteri jadi ada kemungkinan besar anaknya akan

menderita penyakit yang sama.

=. 6i-ayat erinatal dan 3eonatal

E 7amil

$ntuk mengetahui !ondisi ibu selama hamil, periksa kehamilan dimana dan berapa kali,

serta mendapatkan apa saja dari petugas kesehatan selama hamil.

E ersalinan

• $ntuk mengetahui cara persalinan, ditolong oleh siapa, adakah penyulit selama

melahirkan seperti perdarahan.

• !aji dimana klien dilahirkan, berat badan, panjang badan bayi.

E 3eonatal


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$ntuk mengetahui apakah bayi minum "S atau asi, berapa BB 0ahir, B lahir, apakah saat

lahir bayi langsung menangis. 6i-ayat imunisasi anak dan kesehatan keluarga.

"pakah ri-ayat imunisasi pada anak lengkap


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ntegumen& bersih


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efektif b


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8 ain le2el

8 ain control

4ujuan & nyeri berkurang atau

hilang.

!riteria hasil &

o asien dapat mengatakan nyeri

yang dirasakan

o 3yeri berkurang

o Hajah tidak meringis.

o Skala nyeri berkurang.( 5+ )

o 449 normal

"ktifitas !epera-atan &

8 0akukan pengkajian nyeri secara

menyeluruh meliputi lokasi, durasi,

frekuensi, kualitas, keparahan nyari danfactor pencetus nyeri

8 bser2asi ketidaknyamanan non

2erbal

. ain control

"kiti2itas !epera-atan &

8 "jarkan untuk menggunakan teknik

non farmakologi misal relaksasi, guided

imageri, terapi musik dan distraksi

8 !endalikan factor lingkungan yang

dapat mempengaruhi respon pasien

terhadap ketidaknyamanan misal suhu,

lingkungan, cahaya, kegaduhan.

8 !olaborasi& pemberian analgetik

sesuai indikasi

Sumber & ( Buku saku diagnosa dengan inter2ensi 3C dan criteria hasil 3C< ;udith M.

Hilkinson & ahli bahasa, Hidya-ati.. Ket al.L & editor edisi Bahasa ndonesia, ny Meiliya,

Monica ster. 8 d. . 8 ;akarta & C, 55>.)

&., Im*lementasi

N' D; Ke*era9atan Im*lementasi Ke*era9atan

'ola nafas napas tidak efektif

b


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b


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2.1 Definiti'n Di*htheria

• Diphtheria is an infectious disease caused by the bacteria suddenly Corynebacterium

diphteriae. Contagious and attacked mainly the upper respiratory tract and is

characteriIed by the formation and release of pseudomembranous eGotoGin can cause

local and general symptoms. (+e%iatri0s FK UI: 2!"

•

Diphtheria is an acute infection caused by bacteria producing toGic (poison)Corynebacterium diphteriae. (2#".

• Diphtheria is a respiratory infection caused by Corynebacterium diphteriae -ith stem

gram+positi2e bacilli form (Jauhari$ nuru%in. 2#".

2.2 -lassifi0ati'n

Based on the se2erity, Staff ediatrics #aculty of medicine di2ide the disease into three

le2els, namely&

'. Mild infections& -hen pseudomembranous only found in the nasal mucosa -ithsymptoms only painful s-allo-ing.

. nfection -as& -hen pseudomembranous has filtered through the pharynG (the back

-all of the oral ca2ity), to cause s-elling of the larynG.

%. Se2ere infections& in case of blockage by hea2y breathing accompanied by symptoms

of complications such as myocarditis (inflammation of the heart muscle), paralysis

(limb -eakness) and nephritis (kidney inflammation).

Based on its location, are classified as follo-s&

• diphtheria nose

Symptoms lightest and most rarely (*). "t first look cold, then the secret is out miGed -ith

a little blood coming from pseudomembranous. seudomembranous deployment can reach

the pharynG and larynG.

• Diphtheria pharynG and tonsils (diphtheria #ausial).

Diphtheria Diphtheria of this type is the most serious because it could threaten the li2es of

patients due to respiratory failure. 4he most freJuent (/*). Symptoms may be mild -ithout

pseudomembrane formation. Can heal itself and pro2ide immunity to the more se2ereconditions penderita.ada begins -ith a sore throat -ith increased body temperature is not


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too high, pseudomembranous originally just a grayish+-hite spots that Juickly eGpanded into

the nasopharynG or larynG, halitosis, and there regional s-elling of the neck looks like the

neck of a co- (bull's neck). 4here may be pain in s-allo-ing, and hoarseness, and

inspiratory stridor laryngeal obstruction although it has not happened yet.

• Diphtheria of the larynG and trachea

More often the propagation of diphtheria pharynG and tonsils, rather than the primary. Breath

disorder symptoms such as hoarseness and stridor ob2ious inspirations and -hen more se2ere

shortness of breath arise terrific, cyanosis, and appear retraction suprasternal and epigastric.

3o bulls neck, larynG appear red and s-ollen, a lot of secretions, and the surface is co2ered

by pseudomembranous. Hhen children look cro-ded and chi2ied need to do a tracheostomy

as first aid.

• Diphtheria cutaneous and 2aginal

Hith symptoms such as thrush+like sores on the skin and 2agina -ith the formation of

membrane thereon. But unlike canker sores are painful, the diphtheria, -ounds that happened

just do not feel anything. Diphtheria can also occur on areas of the conjuncti2a and the

umbilicus.

• Diphtheria skin, conjuncti2a, ar

Diphtheria form of skin ulcers on the skin, clear edges and there membrane basically. 4he

disorder tends to chronic. Diphtheria in the eye -ith conjuncti2al lesion in the form of

redness, edema and palpebral conjuncti2a membrane on. n the form of otitis eGterna ear -ith

purulent secretions and smell.

2.& Anat'm an% +hsi'l'

• The anat'm 'f the res*irat'r stem

6espiratory tract consists of the nasal ca2ity, pharynG, larynG, trachea, and lungs broncus.

(3elson, 5'5)

• $pper respiratory tract&

• nasal ca2ity

4he nose acts as a filter dirt, moisten and -arm the air that is inhaled into the lungs + lungs

• faring

4he pharynG is the structure that connects the mouth to the nasal ca2ity larynG .. ts main

function is to pro2ide a channel on respiratoriun and digesti2e tract.

• larynG

4he larynG is the epithelial structure of cartilage that connects the pharynG and trachea. ts

main function is to allo- localiIation. 4he larynG also protect the lo-er air-ay obstruction

foreign body and eases cough.


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) lo-er respiratory Channels&

• trachea

Supported by a ring of cartilage that is shaped like a horseshoe that is less than / inches,

-here the trachea branches into a left and right main bronchus kno-n as !arina.

• bronchi

Consisting of t-o parts, namely broncus right and left. 6ight bronchus is shorter and -ider, is

a continuation of the trachea, -hich is directed almost 2ertically. 0eft bronchus is longer and

narro-er, a continuation of the trachea -ith a sharper angle.

• al2eoli

0ung formed by about %55 million al2eoli. 4here are three types of cells + al2eolar cells,

al2eolar type cells are epithelial cells that form the al2eolar -all. 4ype al2eolar cells

cells that are metabolically acti2e, secreting surfactan, a phospholipid that lines the inner

surface and in order not to pre2ent al2eolar collapse. "l2eolar type cells are macrophages,

-hich are cells + the cells that eat phagocytosis large foreign objects and -orks as an

important defense mechanism.

• lung

4he lungs are elastic cone+shaped organ located in the piston ca2ity or chest. Both lungs

separated from each other by a central mediasinum containing heart+pembulu large blood2essels.

4he layout of the lungs chest ca2ity co2ered by a membrane called the pleura.

4he pleura is di2ided into t-o&

'). 9isceral pleura (the lining of the chest -rapper) -hich are immediately -rapped pleura

lungs:

). arietal pleura is the membrane that lines the chest ca2ity outside. 4here are bet-een the

t-o pleural ca2ity (ca2ity) is called pleural ca2ity.

n normal circumstances, the pleural ca2ity is a 2acuum (2acuum) so that the lungs can

de2elop flat and there is also a bit of fluid (eGudates) are useful to lubricate the surface

(pleura), to a2oid friction bet-een the lung and the chest -all -hen there is a mo2ement to

breathe.

• +hsi'l' Res*irat'r )stem

Hhen the atmospheric air reaches the al2eoli, oGygen mo2es from the al2eoli across the

al2eolar capillary membrane and into the red blood cells. 4he circulatory system -ould then

carry the oGygen that has been bound to red blood cells to the tissues of the body, -hereoGygen is used as fuel in the process of metabolism. 4he eGchange of oGygen and carbon


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dioGide in the al2eolar capillary membrane kno-n as pulmonary diffusion. "fter the gas

eGchange process is complete (lo-er carbon dioGide le2els) going to-ards the left side of the

heart, and -ill be pumped to the rest of the cells in the body.

Hhen it reaches the net-ork, oGygenated red blood cells -ill be untied -ith oGygen and the

oGygen used to fuel metabolism. "lso carbon dioGide -ill enter the red blood cells. 6ed blood cells are lo- in oGygen and high in carbon dioGide going to-ards the right side of the

heart and then pumped to the lungs. t is 2ery important in this process is that the al2eoli must

continue to ha2e filling -ith fresh air containing oGygen in sufficient Juantities.

(Source& http&5? C for '5 minutes, lasting se2eral -eeks in ice,

-ater, milk and mucus had dried up. 4here are three types of basil that forms gra2is, mitis,

intermedius and on the basis of differences in the colonies form blood agar cultures

containing potassium telurit.

Diphtheria bacillus has the properties&

• sedomembran perilous formed at sides, bleed easily, and canescent co2ering areas

terkena.terdiri of fibrin, leukocytes, necrotic tissue and bacteria.

• GotoGin issued a highly malignant and can be toGic to the net-ork after a fe- hours

absorbed and pro2ides an o2er2ie- of net-ork changes are typical, especially in the

heart muscle, kidney and ner2e tissue.

2. -lini0al anifestati'ns

• #e2er, increased body temperature to %@.A degrees Celsius,

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• Coughs and colds are mild.

• ain and s-elling in the throat

• 3ausea, 2omiting, headache.

• 4he formation of membranes in the throat is -hite to grayish ash dirty.

• stiff neck

4he most common early complaint is sore throat, nausea, 2omiting, and dysphagia.

"dditionally characteriIed by a pseudo membrane on the tonsils and in the 2icinity, as -ell as

the release of eGotoGin, -hich can cause general symptoms (such as infectious diseases) or

local (as seen complaints of pain)

2.3 +ath'*hsi'l'

$sually the bacteria multiply on or near the surface of the mucous membranes of the mouthor throat and cause inflammation. Hhen bacteria get into the nose, the nose -ill be runny.

4he inflammation can spread from the throat to the 2oice boG (larynG) and cause s-elling

that narro-s air-ays and respiratory disorders occur.

4he bacteria are spread through sali2a splashes of coughing patients or objects or food that

has been contaminated by bacteria. Hhen it has entered the body, the bacteria release toGins

or poisons. 4his toGin -ill spread through the blood and can cause tissue damage throughout

the body, especially the heart and ner2es.

4he impact caused by this disease depend a lot on the effects of eGotoGin produced. 4oGininhibits protein production of cells so that the cells die. 4issue necrosis at the site of

attachment of the bacteria -ill support the proliferation of germs and subseJuent toGin

production, as -ell as the formation of membrane firmly attached to its base.

Basil li2e and breed in the upper respiratory tract, especially -hen there is a chronic

inflammation of the tonsils, sinus and others. But rarely, basil can also li2e on the 2ul2a, ears

and skin.

"t this point basil pseudomembranous form and releases an eGotoGin. seudomembranous

may arise locally or later spread from the pharynG or larynG and tonsil to the entire upper

respiratory tract, causing more se2ere symptoms. Surrounding lymph nodes -ill undergohyperplasia and contain toGins.

2.! -'m*li0ati'ns

Complications arise in patients -ith diphtheria&

'. myocarditis

• usually arises end of the second -eek or the beginning of the third -eek of the course

of disease


18/24

• hysical eGamination& galloping rhythm, heart sounds -eak or dimmed, sometimes

found signs of heart trouble.

. collapsed peripheral

%. "ir-ay obstruction -ith all its conseJuences, bronchopneumonia and atelectasis

=. $rogenital& nephritis can occur

Diphtheria patients ('5*) -ill de2elop complications that the ner2ous system, especially the

motor system. ccurs at the end of the first -eek of the course of disease.

2.# Treatment

• eneral Medicine (Books college of pediatrics faculty of medicine, 'AAA)&

•

"nti Diphteri Serum ("DS) is gi2en 5.555$ < day di2e days in a ro-, -ith the pre2iously tested the skin and eyes.

• "ntibiotics, procaine penicillin /5.555$ < kg < day to % days free of heat. n patients

-ho do trach, added chloramphenicol / mg < kg < day, di2ided four doses.

• Corticosteroids, intended to pre2ent complications of myocarditis is 2ery dangerous.

May be gi2en prednisone mg < kg < day for % -eeks and then discontinued gradually

• "ccording 3gastiyah ('AA)& Management of nursing patients in -hich patients

treated -ith diphtheria dikamar insulation co2ered. ersonnel should -ear a skort

(aprons) and the mask must be replaced e2ery turn of duty or -hen dirty. Should also be a2ailable supplies of hand -ashing, disinfectant soap, -ashcloth or to-el dry. "lso

the place to soak cutlery filled -ith disinfectant.

2.4 Inestiati'ns

'. Schick test

4he skin test is used to determine the immune status of patients. #or this eGamination in use a

dose '


19/24

-7A+TER II

NUR)IN< T7EORETI-A=

&.1 Assessment

&.1.1 -lient I%entit

ncludes the name, age, no M6, occupation, address, religion, logging in, and allergy history,

date of admission and others.

&.1.2 7ealth 7ist'r

'. #ormerly 7ealth 7istory

$sually the client is eGperiencing a chronic inflammation of the tonsils, sinuses, pharynG,

larynG, and upper respiratory tract and colds -ith secretions miGed -ith blood -hich is

caused by the bacterium Corynebacterium diphteriae.

. 7ealth 7istory 3o-

• $sually clients ha2e a fe2er that is not too high, lethargy, pale, headache, anoreGia

• $sually clients complain of pain in s-allo-ing, chills, malaise, sore throat, cough.

%. #amily 7ealth 7istory

$sually there are families -ho ha2e diphtheria so no child -ill likely suffer from the same

disease.

=. erinatal and 3eonatal 7istory

E regnant

4o determine the condition of the mother during pregnancy, pregnancy check -here and ho-

many times, as -ell as get any health -orker during pregnancy.

E Childbirth

• 4o determine the mode of deli2ery, helped by -hom, is there any complications

during childbirth, such as bleeding.

• "ssess -here the client -as born, -eight, body length baby.

E 3eonatal

4o find out if the baby drinks milk or asi, ho- birth -eight, birth B, -hether at birth the

baby started to cry < no.


20/24

/. " history of gro-th and de2elopment

ro-th and de2elopment of motor, sensory clients -ith diphtheria usually interrupted

breathing so hard to s-allo-, accompanied by fe2er, chills, malaise, sore throat, cough.

>. Childs immuniIation history and family health.

s the childs immuniIation history in full < no.

&.1.& +hsi0al E;aminati'n

n 449 obtained&

'. Body temperature F%@.A N C

. 6espiratory& > G < min (increase)

%. Blood pressure& '55


21/24

. palpation:

7ead& palpable lump abnormal < no

3eck& tyorid palpable enlarged glands, glands and enlargement of 2eins lymfe jugolaris < no.

Chest& symmetric < no, looks lump abnormal < no, irregular breath < no.

Stomach& palpable lump abnormal < not ..

ntegumentary& dry < damp, ugly turgor < no

%. auscultation:

Chest& 6onchi and -heeIing sound < no

"bdomen& audible bo-el < no

=. percussion:

atellar refleG left < right positi2e < no

Stomach& 3o bloating < no

&.2 Nursin Dian'sis

#rom some data in dapatka in diphtheria patients, -e conclude that the diagnosis can arise&

'. Breath breathing pattern ineffecti2e b < d edema of the larynG.

. 4he imbalance in nutrition less than body reJuirements b < d anoreGia.

%. "cute pain b < d the inflammatory process.

Source& (3ursing Diagnosis& defiisi and Classification 55A+5'' < editor, 4. 7eather

7erdman: linguists, Made Surma-ati, D-i Hidiatri, stu 4iar: editor of the ndonesian

edition, Monica sther + ;akarta& C 5'5)

Nursin Interenti'ns &.&

Nursin %; Nursin *lan

O/5e0ties An% -riteria Results Interenti'n

'.ola breath breathing is

effecti2e b < d edema of

the larynG.

3C&

+ 6espiratory status& "ir-ay

patency.

+ 9ital sign status

bjecti2e& patient breathing pattern back to normal.

'. 6espiratory status& "ir-ay patency

"cti2ity, 3ursing&

+ bser2ation of signs + 2ital signs.

+ osition the patient semi+#o-ler.

+ nstruct the patient not to mo2e too


22/24

Gpected outcomes&

o 4he freJuency of respiratory dlm

normal range

o 4he rhythm of the breath as

eGpected.

o Spending sputum in the air-ay

o 3o additional breath sounds

o Breathing easy

o 3o dyspnea

much.

+ 4each the patient to cough effecti2ely

+ Collaboration -ith the medical team in

the deli2ery of Gygen therapy

. mbalance nutrition

less than body

reJuirements b < danoreGia.

3C&

+ 3utritional status& "deJuacy of

nutrient

+ 3utritioal status& food and fluid

intake

bjecti2e& 3utrition clients can be

met.

Gpected outcomes&

o Clients can find out about her

illness.

o 4here is an interest and appetite.

o ating as needed

o BB increased.

'. 3utritional status& food and fluid

intake

3ursing "cti2ities&

+ Monitor caloric intake and the Juality

of food consumption.

+ i2e small portions and the food issoft < mushy.

+ i2e the meal according to taste.

+ Heigh BB e2ery day

%. "cute pain b < d theinflammatory process

3C&

+ ain le2el

+ ain control

bjecti2e& pain diminished or

disappeared.

Gpected outcomes&

'. ain le2el

3ursing "cti2ity&

+ erform a thorough assessment of pain

include the location, duration,

freJuency, Juality, se2erity of pain nyari

and trigger factor

+ bser2ation of non+2erbal discomfort


23/24

atients can say the pain felt

o ain is reduced

o face not to grimace.

o Scale pain -as reduced. (5+)

o 449 normal

. ain control

"kiti2itas 3ursing&

+ 4each for using non+pharmacologicaltechniJues eg relaGation, guided

imageri, music therapy and distraction

+ Control of en2ironmental factors that

can influence patient response to

discomfort eg temperature, en2ironment,

light, noise.

+ Collaboration& analgetik according to

indications

Source& (ocket Books diagnosis -ith inter2ention criteria 3C and 3C results < ;udith M.

Hilkinson& linguists, Hidya-ati .. Ket al.L& ndonesian edition editor, ny Meiliya, Monica

sther. + d. . + ;akarta& C, 55>.)

&., Im*lementati'n

N'. Nursin %; im*lementati'n 'f Nursin

'

Breath breathing pattern

ineffecti2e b < d edema of the

larynG.

+ bser2e signs + 2ital signs.

+ ositioning the patient semi+#o-ler.

+ "d2ise the patient not to mo2e too much.

+ 4each the patient to cough effecti2ely

+ Mengkolaborasi -ith another medical team, Gygen

therapy deli2ery

4he imbalance in nutrition

less than body reJuirements

b < d anoreGia.

+ Monitor the caloric intake and the Juality of food

consumption.

+ ro2ide small ser2ings and soft foods < mushy.

+ ro2ides meal according to taste.

+ Considering BB e2ery day

% "cute pain b < d the

inflammatory process

+ Conduct a thorough assessment of pain include the

location, duration, freJuency, Juality, se2erity of pain

nyari and trigger factor


24/24

+ bser2ing non+2erbal discomfort

+ 4each you to use non+pharmacological techniJues eg

relaGation, guided imageri, music therapy and

distraction

+ Controlling en2ironmental factors that can influence

patient response to discomfort eg temperature,

en2ironment, light, noise.

+ Mengkolaborasi& pro2iding analgesic according to

indications

&. Ealuati'n

Do after the implementation, the e2aluation of our patients, namely&

• atient breathing pattern back to normal, and the patient does not eGperience anymore

dypnea

• 3utrition of patients can be met, and the -eight can be increased

• Gperienced pain in patients can be reduced, and also the pain -ill disappear

6I6=IO

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