tag:blogger.com,1999:blog-12457292855415432552024-03-21T16:18:24.867-07:00Team_One KMB 2A Akpem GarutTEAM_ONE KMB 2A AKPEM GARUThttp://www.blogger.com/profile/01719877433346227735noreply@blogger.comBlogger16125tag:blogger.com,1999:blog-1245729285541543255.post-26902943122978579782011-04-08T05:20:00.000-07:002011-04-08T05:20:28.414-07:00tugas KMB III ke-13 (trauma ginjal )<!--[if !mso]> <style>
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<div align="center" class="MsoNormalCxSpFirst" style="line-height: 200%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 17pt; line-height: 200%;">TRAUMA GINJAL</span></b></div><div align="center" class="MsoNormalCxSpMiddle" style="line-height: 200%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Disusun untuk memenuhi salah satu tugas mata kuliah KMB III</span></b></div><div align="center" class="MsoNormalCxSpMiddle" style="line-height: 200%; text-align: center;"><br />
</div><div align="center" class="MsoNormalCxSpMiddle" style="line-height: 200%; text-align: center;"><br />
</div><div align="center" class="MsoNormalCxSpMiddle" style="line-height: 200%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><img height="188" src="file:///C:/DOCUME%7E1/aDvika_4/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image002.jpg" width="200" /></span></b></div><div align="center" class="MsoNormalCxSpMiddle" style="line-height: 200%; text-align: center;"><br />
</div><div align="center" class="MsoNormalCxSpMiddle" style="line-height: 200%; text-align: center;"><br />
</div><div align="center" class="MsoNormalCxSpMiddle" style="line-height: 200%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Disusun oleh :</span></b></div><div align="center" class="MsoNormalCxSpMiddle" style="line-height: 200%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Asep DIki Permana</span></b></div><div align="center" class="MsoNormalCxSpMiddle" style="line-height: 200%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">05200ID09006</span></b></div><div align="center" class="MsoNormalCxSpMiddle" style="line-height: 200%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Tingkat II A</span></b></div><div align="center" class="MsoNormalCxSpMiddle" style="line-height: 200%; text-align: center;"><br />
</div><div align="center" class="MsoNormalCxSpMiddle" style="line-height: 200%; text-align: center;"><br />
</div><div align="center" class="MsoNormalCxSpMiddle" style="line-height: 200%; text-align: center;"><br />
</div><div align="center" class="MsoNormalCxSpMiddle" style="line-height: 200%; text-align: center;"><br />
</div><div align="center" class="MsoNormalCxSpMiddle" style="line-height: 200%; text-align: center;"><br />
</div><div align="center" class="MsoNormalCxSpMiddle" style="line-height: 200%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 15pt; line-height: 200%;">AKADEMI KEPERAWATAN</span></b></div><div align="center" class="MsoNormalCxSpMiddle" style="line-height: 200%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 15pt; line-height: 200%;">PEMERINTAHAN DAERAH GARUT</span></b></div><div align="center" class="MsoNormalCxSpMiddle" style="line-height: 200%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 15pt; line-height: 200%;">2011</span></b></div><div align="center" class="MsoNormalCxSpMiddle" style="line-height: 200%; text-align: center;"><br />
</div><div align="center" class="MsoNormalCxSpMiddle" style="line-height: 200%; text-align: center;"><br />
</div><div align="center" class="MsoNormalCxSpMiddle" style="line-height: 200%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">BAB I</span></b></div><div align="center" class="MsoNormalCxSpLast" style="line-height: 200%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">PENDAHULUAN</span></b></div><div class="MsoListParagraphCxSpFirst" 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%;"><span>A.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Latar Belakang</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin: 2.25pt 0in 2.25pt 0.5in; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ginjal adalah sepasang organ pada setiap sisi dari tulang belakang (spine) didalam perut bagian bawah. Setiap ginjal adalah kira-kira seukuran kepalan tangan. Melekat pada puncak dari setiap ginjal adalah suatu kelenjar adrenal. Suatu massa dari jaringan yang berlemak dan suatu lapisan luar dari jaringan yang berserat (Gerota's fascia) menyelubungi ginjal-ginjal dan kelenjar-kelenjar adrenal.</span></div><div class="pj" style="line-height: 200%; margin-left: 0.5in; text-align: justify; text-indent: 41.9pt;">Ginjal terletak di rongga retroperitonium dan terlindung oleh otot-otot punggung di sebelah posterior dan oleh organ-organ intraperitoneal di sebelah anteriornya. Karena itu cedera ginjal tidak jarang diikuti oleh cedera organ-organ yang mengitarinya. trauma ginjal merupakan trauma terbanyak pada sistem urogenital, lebih kurang 10% dari trauma pada abdomen mencederai ginjal. Abdominal trauma merupakan cedera ke bagian perut. Mungkin tumpul atau tajam dan mungkin melibatkan kerusakan pada Abdominal organ. Tanda-tanda dan gejala meliputi nyeri pada perut, kesakitan, kaku, dan lebam dari perut eksternal. Abdominal trauma menyajikan risiko berat kehilangan darah dan infeksi. Diagnosa mungkin melibatkan ultrasonography, Computed Tomography, dan Peritoneal lavage, dan mungkin memerlukan perawatan operasi. </div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 2.25pt 0in 2.25pt 0.5in;"><br />
</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%;"><span>B.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rumusan Masalah</span></div><div class="MsoListParagraphCxSpMiddle" 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%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagaimana<span> </span>traumatic pada ginjal ?</span></div><div class="MsoListParagraphCxSpMiddle" 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%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Apakah<span> </span>pengertian traumatic ginjal ?</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" 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%;"><span>3.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagaimana patologi trauma ginjal ?</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" 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%;"><span>4.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagaimana<span> </span>mekanisme trauma ginjal ?</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" 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%;"><span>5.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagaimana<span> </span>klasifikasi patologi trauma ginjal ?</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" 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%;"><span>6.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagaimana<span> </span>grading trauma ginjal ?</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" 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%;"><span>7.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagaimana<span> </span>diagnosis trauma ginjal ?</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" 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%;"><span>8.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagaimana<span> </span>gejala trauma ginjal ?</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" 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%;"><span>9.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagaimana<span> </span>tanda trauma ginjal ?</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" 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%;"><span>10.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagaimana<span> </span>laboratorium trauma ginjal ?</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" 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%;"><span>11.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagaimana imaging trauma ginjal ?</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" 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%;"><span>12.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagaimana<span> </span>penatalaksanaan trauma ginjal ?</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0.75in; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0.75in; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0.75in; text-align: justify;"><br />
</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%;"><span>C.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan Penulisan</span></div><div class="MsoListParagraphCxSpMiddle" 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%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui tentang traumatic pada ginjal.</span></div><div class="MsoListParagraphCxSpMiddle" 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%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui tentang </span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">patologi trauma ginjal.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" 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%;"><span>3.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui tentang </span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">mekanisme trauma ginjal </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" 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%;"><span>4.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui tentang </span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">klasifikasi patologi trauma ginjal </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" 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%;"><span>5.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui tentang </span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">grading trauma ginjal </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" 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%;"><span>6.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui tentang </span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">diagnosis trauma ginjal </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" 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%;"><span>7.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui tentang </span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">gejala trauma ginjal </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" 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%;"><span>8.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui tentang </span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tanda trauma ginjal </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" 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%;"><span>9.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui tentang </span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">laboratorium trauma ginjal </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" 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%;"><span>10.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui tentang </span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">imaging trauma ginjal </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" 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%;"><span>11.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui tentang </span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">penatalaksanaan trauma ginjal </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0.75in; text-align: justify;"><br />
</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%;"><span>D.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sistematika Penulisan</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%;">BAB I PENDAHULUAN</span></div><div class="MsoListParagraphCxSpMiddle" 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%;"><span>A.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Latar Belakang</span></div><div class="MsoListParagraphCxSpMiddle" 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%;"><span>B.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rumusan Masalah</span></div><div class="MsoListParagraphCxSpMiddle" 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%;"><span>C.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan Penulisan</span></div><div class="MsoListParagraphCxSpLast" 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%;"><span>D.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sistematika Penulisan</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%;">BAB II TINJAUAN TEORITIS</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 28.35pt; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>A.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">pengertian traumatic ginjal </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 28.35pt; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>B.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">patologi trauma ginjal </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 28.35pt; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>C.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">mekanisme trauma ginjal </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 28.35pt; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>D.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">klasifikasi patologi trauma ginjal </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 28.35pt; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>E.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">grading trauma ginjal </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 28.35pt; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>F.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">diagnosis trauma ginjal </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 28.35pt; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>G.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">gejala trauma ginjal </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 28.35pt; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>H.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">tanda trauma ginjal </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 28.35pt; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>I.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">laboratorium trauma ginjal </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 28.35pt; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>J.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">imaging trauma ginjal </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 28.35pt; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>K.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">penatalaksanaan trauma ginjal </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></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%;">BAB III KESIMPULAN DAN SARAN</span></div><div class="MsoListParagraphCxSpFirst" 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%;"><span>A.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kesimpulan </span></div><div class="MsoListParagraphCxSpLast" 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%;"><span>B.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Saran</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%;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span></div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><br />
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</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB II</span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">TINJAUAN TEORITIS</span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><br />
</div><div class="MsoListParagraph" style="line-height: 200%; margin-left: 28.35pt; text-indent: -28.35pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>A.<span style="font: 7pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Pengertian </span></b></div><div class="MsoNormal" style="line-height: 200%; margin: 0in 0in 0.0001pt 0.5in; text-align: justify; text-indent: 27.8pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Trauma ginjal adalah cedera pada ginjal yang disebabkan oleh berbagai macam rudapaksa baik tumpul maupun tajam</span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 28.35pt; text-align: justify; text-indent: 35.45pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Trauma ginjal terjadi sekitar 3% dari seluruh trauma yamg ada(Geehan,2003), bahkan mencapai 5% pada daerah urban(Brandes,2003). Trauma ginjal terjadi sekitar 10% dari seluruh trauma abdomen( Geehan,2003., Seidman,2003). Dari seluruh trauma sistem genitourinaria, trauma ginjal menduduki angka tertinggi sekitar 50% tidak membedakan ginjal kiri atau kanan(Brandes,2003). Trauma biasanya disebabkan oleh karena jatuh, kecelakaan lalu lintas, pukulan, olah raga, tusukan atau senjata api.(dos Santos Vieira, 2003).</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraph" style="line-height: 200%; margin-left: 28.35pt; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>B.<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Patologi Trauma ginjal</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 28.35pt; text-align: justify; text-indent: 35.45pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Ginjal yang terletak pada rongga retroperitoneal bagian atas hanya terfiksasi oleh pedikel pembuluh darah serta ureter, sementara masa ginjal melayang bebas dalam bantalan lemak yang berada dalam fascia Gerota. Fascia Gerota sendiri yang efektif dalam mengatasi sejumlah kecil hematom , tidak sempurna dalam perkembangannnya. Kantong fascia ini meluas kebawah sepanjang ureter ,meskipun menyatu pada dinding anterior aorta serta vena cava inferior, namun mudah untuk sobek oleh adanya perdarahan hebat sehingga perdarahan melewati garis tengah dan mengisi rongga retroperitoneal.(Guerriero, 1984).</span></div><table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable"><tbody>
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</tbody></table><div class="MsoNormal" style="line-height: 200%; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Gambar 3. Fasia Gerota, proyeksi anterior-posterior. (Guerriero, 1984)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 28.35pt; text-align: justify; text-indent: 35.45pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Karena miskinnya fiksasi, ginjal mudah mengalami dislokasi oleh adanya akselerasi maupun deselerasi mendadak, yang bisa menyebabkan trauma seperti avulsi collecting system atau sobekan pada intima arteri renalis sehingga terjadi oklusi parsial maupun komplet pembuluh darah. Sejumlah darah besar dapat terperangkap didalam rongga retroperitoneal sebelum dilakukan stabilisasi. Keadaan ekstrem ini sering terjadi pada pasien yang datang di ruang gawat darurat dengan kondisi stabil sementara terdapat perdarahan retroperitoneal. Korteks ginjal ditutupi kapsul tipis yang cukup kuat.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 28.35pt; text-align: justify; text-indent: 35.45pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Trauma yang menyebabkan robekan kapsul sehingga menimbulkan perdarahan pada kantong gerota perlu lebih mendapat perhatian dibanding trauma yang tidak menyebabkan robekan pada kapsul.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 28.35pt; text-align: justify; text-indent: 35.45pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Vena renalis kiri terletak ventral aorta sehingga luka penetrans didaerah ini bisa menyebabkan trauma pada kedua struktur. Karena letaknya yang berdekatan antara pankreas dan pole atas ginjal kiri serta duodenum dengan tepi medial ginjal kanan bisa menyebabkan trauma kombinasi pada pankreas, duodenum dan ginjal.. Anatomi ginjal yang mengalami kelainan seperti hidronefrosis atau tumor maligna lebih mudah mengalami ruptur hanya oleh adanya trauma ringan.(McAninch,2000).</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraph" style="line-height: 200%; margin-left: 28.35pt; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>C.<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Mekanisme Trauma</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 28.35pt; text-align: justify; text-indent: 35.45pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Mekanisme trauma pada ginjal perlu diperhatikan benar oleh klinisi. Berikut adalah mekanisme yang umumnya terjadi pada trauma ginjal.( Geehan,2003)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 200%; margin-left: 56.7pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Trauma tembus</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 200%; margin-left: 56.7pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Trauma tumpul</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 200%; margin-left: 56.7pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>3.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Iatrogenik</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 200%; margin-left: 56.7pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>4.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Intraoperatif</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 200%; margin-left: 56.7pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>5.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Lain-lain</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 28.35pt; text-align: justify; text-indent: 35.45pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">80-85% trauma ginjal disebabkan trauma tumpul yang secara langsung mengenai abdomen, pinggang atau punggung. Trauma tersebut disebabkan karena kecelakaan lalu lintas, perkelahian, jatuh dan olahraga kontak. Tabrakan kendaraan pada kecepatan tinggi bisa menyebabkan trauma pambuluh darah utama karena deselerasi cepat. Luka karena senjata api dan pisau merupakan luka tembus terbanyak yang mengenai ginjal sehingga bila terdapat luka pada pinggang harus dipikirkan trauma ginjal sampai terbukti sebaliknya. Pada luka tembus ginjal, 80% berhubungan dengan trauma viscera abdomen. (Geehan , 2003; McAninch , 2000).</span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 28.35pt; text-align: justify; text-indent: 35.45pt;"><br />
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</div><div class="MsoNormal" style="line-height: 200%; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Gambar 4. Trauma tumpul yang merusak ginjal sering menyebabkan fraktur iga bawah dan prosesus transverses vertebra lumbal. (Blandy,1985)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable"><tbody>
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</tbody></table><div class="MsoNormal" style="line-height: 200%; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Gambar 5.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 28.35pt; text-align: justify; text-indent: 35.45pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Mekanisme trauma ginjal. Kiri: Hantaman langsung pada abdomen. Gambar kecil menunjukkan gaya yang berjalan dari hilus renalis. Kanan: Jatuh terduduk dari ketinggian (contrecoup of kidney). Gambar kecil memperlihatkan gayadari arah cranial merobek pedikel ginjal.(McAninch, 2000)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable"><tbody>
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</tbody></table><div class="MsoNormal" style="line-height: 200%; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Gambar 6.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 56.7pt; text-align: justify; text-indent: -28.35pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">A.Luka tembus peluru.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 56.7pt; text-align: justify; text-indent: -28.35pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">B.Luka tusuk. (Guerriero, 1984)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 28.35pt; text-align: justify; text-indent: 35.45pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Iatrogenik disebabkan oleh prosedur endourologi, Extracorporeal Shock Wave Lithotripsy(ESWL), biopsi renal dan prosedur ginjal perkutan. Pada intraoperatif terjadi pada Diagnostic Peritoneal Lavage(DPL). Penyebab lain trauma ginjal adalah karena rejeksi transplantasi ginjal serta proses kelahiran.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraph" style="line-height: 200%; margin-left: 28.35pt; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>D.<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Klasifikasi Patologi trauma Ginjal</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 28.35pt; text-align: justify; text-indent: 35.45pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Menurut Moore et al , trauma ginjal dibagi menjadi:(McAninch,2000)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraph" style="line-height: 200%; margin-left: 56.7pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Trauma minor</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 56.7pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Merupakan 85% kasus. Kontusio maupun ekskoriasi renal paling sering terjadi. Kontusio renal kadang diikuti hematom subkapsuler. Laserasi korteks superfisial juga merupakan trauma minor.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraph" style="line-height: 200%; margin-left: 56.7pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Trauma mayor</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 56.7pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Merupakan 15% kasus.Terjadi laserasi kortikomeduler yang dalam sampai collecting system menyebabkan ekstravasasi urine kedalam ruang perirenal. Hematom perirenal dan retroperitoneal sering menyertai laserasi dalam ini. Laserasi multiple mungkin menyebabkan destruksi komplit jaringan ginjal. Jarang terjadi laserasi pelvis renalis tanpa laserasi parenkim pada trauma tumpul.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraph" style="line-height: 200%; margin-left: 56.7pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>3.<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Trauma vaskuler</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 56.7pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Terjadi sekitar 1% dari seluruh trauma ginjal. Trauma vaskuler pada pedikel ginjal ini memang sangat jarang dan biasanya karena trauma tumpul. Bisa terjadi total avulsi arteri dan vena atau avulsi parsial dari cabang segmental vasa ini. Regangan pada arteri renalis utama tanpa avulsi menyebabkan trombosis arteri renalis.</span></div><div class="MsoListParagraph" style="line-height: 200%; margin-left: 28.35pt; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>E.<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Grading Trauma Ginjal</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 28.35pt; text-align: justify; text-indent: 35.45pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Untuk mengelola trauma ginjal dengan baik perlu terlebih dahulu menetapkan grading secara akurat. The American Association for the surgery of Trauma membagi trauma ginjal menjadi 5 grade:(Brandes , 2003)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 200%; margin-left: 56.7pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">derajat I : kontusio ginjal atau hematom subkapsuler yang tidak meluas tanpa disertai laserasi parenkim.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 200%; margin-left: 56.7pt; text-align: justify; text-indent: -28.35pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">derajat II : hematom perirenal yang tidak meluas atau laserasi korteks < 1 cm tanpa ekstravasasi urine.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 200%; margin-left: 56.7pt; text-align: justify; text-indent: -28.35pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>3.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">derajat III : laserasi korteks > 1 cm tanpa ekstra vasasi urine</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 200%; margin-left: 56.7pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>4.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">derajat IV: laserasi korteks meluas ke collecting system( terlihat adanya ekstravasasi kontras ), atau cedera arteri atau vena segmental(terlihat adanya infark parenkim segmental) atau cedera arteri atau vena utama yang tertutup oleh hematom</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 200%; margin-left: 56.7pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>5.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">derajat V : shattered kidney, avulsi pedikel ginjal atau trombosis arteri utama.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable"><tbody>
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</tbody></table><div class="MsoNormal" style="line-height: 200%; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Gambar 7. Klasifikasi trauma ginjal. A.grade I: hematuria gross atau mikroskopik, gambaran radilogis normal, kontusio atau hematom subkapsuler terlokalisisr tanpa laserasi parenkim. B.Grade II: hematom perirenal tak meluas atau laserasi korteks kurang dari 1 cm dalamnya tanpa disertai ekstravasasi urine. (McAninch, 2000)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable"><tbody>
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</tbody></table><div class="MsoNormal" style="line-height: 200%; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Gambar 8. Klasifikasi trauma ginjal. C: Grade III, laserasi parenkim > 1 cm kedalam korteks tanpa ekstravasasi urine. D: grade Iv, laserasi meluas ke corticomedullary junction dan ke dalam collecting system. (McAninch, 2000)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable"><tbody>
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<tr> <td style="padding: 0in;"> <div class="MsoNormal" style="line-height: 200%; margin-bottom: 0.0001pt;"><span lang="IN" style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><img alt="http://www.bedahugm.net/images/Trauma%20Ginjal/image007.jpg" height="210" src="file:///C:/DOCUME%7E1/aDvika_4/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image008.jpg" width="265" /></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div></td> </tr>
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</tbody></table><div class="MsoNormal" style="line-height: 200%; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Gambar 9. E: grade IV, trombosis arteri renalis segmental tanpa laserasi parenkim. Tampak adanya daerah iskemia segmental. F: gradeV, trombosis arteri renalis utama. (McAninch, 2000)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable"><tbody>
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<tr> <td style="padding: 0in;"> <div class="MsoNormal" style="line-height: 200%; margin-bottom: 0.0001pt;"><span lang="IN" style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><img alt="http://www.bedahugm.net/images/Trauma%20Ginjal/image008.jpg" height="186" src="file:///C:/DOCUME%7E1/aDvika_4/LOCALS%7E1/Temp/msohtmlclip1/01/clip_image009.jpg" width="218" /></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div></td> </tr>
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</tbody></table><div class="MsoNormal" style="line-height: 200%; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Gambar 10. G: grade V, laserasi multiple mayor menyebabkan suatu shattered kidney. H: grade V, avulsi vasa utama. (McAninch, 2000)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraph" style="line-height: 200%; margin-left: 28.35pt; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>F.<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Diagnosis</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 28.35pt; text-align: justify; text-indent: 35.45pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Kecurigaan adanya trauma ginjal patut dicermati pada keadaan dibawah ini:</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 28.35pt; text-align: justify; text-indent: 35.45pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Trauma didaerah </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">pinggang<span style="color: black;">, punggung, dada sebelah bawah, dan perut bagian atas dengan disertai nyeri atau didapatkan adanya jejas pada daerah tersebut.</span></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 28.35pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Hematuri</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 28.35pt; text-align: justify; text-indent: 42.55pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">fraktur kosta sebelah bawah (T8-T12) atau fraktur prosesus transversus vertebra.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 28.35pt; text-align: justify; text-indent: 42.55pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Trauma tembus pada daerah pinggang dan abdomen.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 28.35pt; text-align: justify; text-indent: 42.55pt;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Cedera deselerasi yang berat akibat jatuh dari ketinggian atau kecelakaan lalu lintas.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 28.35pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Derajat trauma ginjal tidak berhubungan dengan derajat hematuri, karena gross hematuria bisa terjadi pada trauma ginjal minor sedangkan hematuria ringan terjadi pada trauma ginjal mayor.(Purnomo,2003)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraph" style="line-height: 200%; margin-left: 28.35pt; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>G.<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Gejala</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 28.35pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Nyeri terlokalisasi pada satu pinggang atau seluruh perut. Trauma lain seperti ruptur visera abdomen atau fraktur pelvis multiple juga menyebabkan nyeri abdomen akut sehingga mengaburkan adanya trauma ginjal. Kateterisasi biasanya menunjukkan adanya hematuria. Perdarahan retroperitoneal bisa menyebabkan distensi abdomen, ileus, nausea serta vomitus.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraph" style="line-height: 200%; margin-left: 28.35pt; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>H.<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Tanda</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 28.35pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Perlu diperhatikan adanya syok atau tanda-tanda kehilangan darah masiv karena perdarahan retroperitoneal. Cermati adanya ekimosis pada pinggang atau kuadran atas abdomen. Juga adanya patah tulang iga bagian bawah. Mungkin ditemukan nyeri abdomen difus pada palpasi yang merupakan tanda akut abdomen karena adanya darah pada cavum peritonei. Distensi abdomen mungkin ditemukan dengan bising usus yang menghilang. Masa yang palpable menandakan adanya hematom retroperitoneal besar atau suatu ekstravasasi urin. Namun jika retroperitoneum robek, darah bebas masuk ke cavum peritonei tanpa ditemukan masa palpable pada pinggang.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraph" style="line-height: 200%; margin-left: 28.35pt; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>I.<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Laboratorium</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 28.35pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Biasanya didapatkan adanya hematuri baik gross maupun mikroskopis. Beratnya hematuri tidak berbanding lurus dengan beratnya kerusakan ginjal. Pada trauma minor bisa ditemukan hematuri yang berat, sementara pada trauma mayor bisa hanya hematuri mikroskopis. Sedangkan pada avulsi total vasa renalis bahkan tidak ditemukan hematuri. Awalnya hematokrit normal namun kemudian terjadi ppenurunan pada pemeriksaan serial. Temuan ini menandakan adanya perdarahan retroperitoneal persisten yang menyebabkan terjadinya hematom retroperitoneal yang besar. Perdarahan yang persisten jelas memerlukan tindakan operasi. .(McAninch ,2000)</span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 28.35pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 200%; margin-left: 28.35pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: 200%; margin-left: 28.35pt; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>J.<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Imaging</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 200%; margin-left: 56.7pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Plain Photo</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 56.7pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Adanya obliterasi psoas shadow menunjukkan hematom retroperitoneaal atau ekstravasasi urin. Udara usus pindah dari posisinya. Pada tulang tampak fraktur prosesus transversalis vertebra atau fraktur iga.(Donovan , 1994)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraph" style="line-height: 200%; margin-left: 56.7pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Intravenous Urography(IVU)</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 56.7pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Pada trauma ginjal, semua semua trauma tembus atau trauma tumpul dengan hemodinamik tidak stabil yang membutuhkan eksplorasi segera harus dilakukan single shot high dose intravenous urography(IVU) sebelum eksplorasi ginjal. Single shot IVU ini bersisi 2 ml/kgBB kontras standar 60% ionic atau non ionic yang disuntikkan intra vena, diikuti satu pengambilan gambar abdomen 10 menit kemudian. Untuk hasil yang baik sistol dipertahankan diatas 90 mmHg. Untuk menghemat waktu kontras dapat disuntikkan pada saat resusitasi awal. Keterbatasan pemeriksaan IVU adalah tak bisa mengetahui luasnya trauma. Dengan IVU bisa dilihat fungsi kedua ginjal, adanya serya luasnya ekstravasasi urin dan pada trauma tembus bisa mengetahui arah perjalanan peluru pada ginjal. IVU sangat akurat dalam mengetahui ada tidaknya trauma ginjal. Namun untuk staging trauma parenkim, IVU tidak spesifik dan tidak sensitive. Pada pasien dengan hemodinamik stabil, apabila gambaran IVU abnormal dibutuhkan pemeriksaa lanjutan dengan Computed Tomography (CT) scan.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 56.7pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Bagi pasien hemodinamik tak stabil, dengan adanya IVU abnormal memerlukan tindakan eksplorasi.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraph" style="line-height: 200%; margin-left: 56.7pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>3.<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">CT Scan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 56.7pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Staging trauma ginjal paling akurat dilakukan dengan sarana CT scan. Teknik noninvasiv ini secara jelas memperlihatkan laserasi parenkim dan ekstravasasi urin, mengetahui infark parenkim segmental, mengetahui ukuran dan lokasi hematom retroperitoneal, identifikasi jaringan nonviable serta cedera terhadap organ sekitar seperti lien, hepar, pancreas dan kolon.(Geehan , 2003; Brandes , 2003) CT scan telah menggantikan pemakaian IVU dan arteriogram.Pada kondisi akut, IVU menggantikan arteriografi karena secara akurat dapat memperlihatkan cedera arteri baik arteri utama atau segmental. Saat ini telah diperkenalkan suatu helical CT scanner yang mampu melakukan imaging dalam waktu 10 menit pada trauma abdomen. .(Brandes , 2003)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraph" style="line-height: 200%; margin-left: 56.7pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>4.<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Arteriografi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 56.7pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Bila pada pemeriksaan sebelumnya tidak semuanya dikerjakan, maka arteriografi bisa memperlihatkan cedera parenkim dan arteri utama. Trombosis arteri dan avulsi pedikel ginjal terbaik didiagnosis dengan arteriografi terutama pada ginjal yang nonvisualized dengan IVU. Penyebab utama ginjal nonvisualized pada IVU adalah avulsi total pedikel, trombosis arteri, kontusio parenkim berat yang menyebabkan spasme vaskuler. Penyebab lain adalah memang tidak adanya ginjal baik karena kongenital atau operasi sebelumnya.(MC Aninch , 2000)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraph" style="line-height: 200%; margin-left: 56.7pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>5.<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Ultra Sonography(USG)</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 56.7pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Pemeriksa yang terlatih dan berpengalaman dapat mengidentifikasi adanya laserasi ginjal maupun hematom. Keterbatasan USG adalah ketidakmampuan untuk membedakan darah segar dengan ekstravasasi urin, serta ketidakmampuan mengidentifikasi cedera pedikel dan infark segmental. Hanya dengan Doppler berwarna maka cedera vaskuler dapat didiagnosis. Adanya fraktur iga , balutan, ileus intestinal, luka terbuka serta obesitas membatasi visualisasi ginjal.(Brandes SB, 2003)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 200%; margin-left: 28.35pt; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>K.<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Penatalaksanaan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 200%; margin-left: 56.7pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Konservatif</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 56.7pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Tindakan konservatif ditujukan pada trauma minor. Pada keadaan ini dilakukan observasi tanda-tanda vital (tensi, nadi, suhu tubuh), kemungkinan adanya penambahan masa di pinggang, adanya pembesaran lingkar perut, penurunan kadar hemoglombin dan perubahan warna urin pada pemeriksaan urin serial.(Purnomo , 2003) Trauma ginjal minor 85% dengan hematuri akan berhenti dan sembuh secara spontan. Bed rest dilakukan sampai hematuri berhenti.(McAninch, 2000)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 200%; margin-left: 56.7pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Eksplorsi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 200%; margin-left: 85.05pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>a.<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Indikasi absolut</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 85.05pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Indikasi absolut adalah adanya perdarahan ginjal persisten yang ditandai oleh adanya hematom retroperitoneal yang meluas dan berdenyut. Tanda lain adalah adanya avulsi vasa renalis utama pada pemeriksaan CT scan atau arteriografi.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 200%; margin-left: 85.05pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>b.<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Indikasi relatif</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 200%; margin-left: 113.4pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>1)<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Jaringan nonviable</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 113.4pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Parenkim ginjal yang nekrosis lebih dari 25% adalah indikasi relatif untuk dilakukan eksplorasi.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraph" style="line-height: 200%; margin-left: 113.4pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>2)<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Ekstravasasi urin</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 113.4pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Ekstravasasi urin menandakan adanya cedera ginjal mayor. Bila ekstravasasi menetap maka membutuhkan intervensi bedah.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraph" style="line-height: 200%; margin-left: 113.4pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>3)<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Incomplete staging</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 113.4pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Penatalaksanaan nonoperatif dimungkinkan apabila telah dilakukan pemeriksaan imaging untuk menilai derajat trauma ginjal. Adanya incomplete staging memerlukan pemeriksaan imaging dahulu atau eksplorasi /rekonstruksi ginjal. Pada pasien dengan kondisi tidak stabil yang memerlukan tindakan laparotomi segera, pemeriksaan imaging yang bisa dilakukan hanyalah one shot IVU di meja operasi. Bila hasil IVU abnormal atau tidak jelas atau adanya perdarahan persisten pada ginjal harus dilakukan eksplorasi ginjal.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraph" style="line-height: 200%; margin-left: 113.4pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>4)<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Trombosis Arteri</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 113.4pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Cedera deselerasi mayor menyebabkan regangan pada arteri renalis dan akan menyobek tunika intima, terjadi trombosis arteri renalis utama atau cabang segmentalnya yang akan menyebebkan infark parenkim ginjal. Penegakan diagnosis yang tepat serta timing operasi sangat penting dalam penyelamatan ginjal. Renal salvage dimungkinkan apabila iskemia kurang dari 12 jam. Jika ginjal kontralateral normal, ada kontroversi apakah perlu revaskularisasi atau observasi.Jika iskemia melebihi 12 jam, ginjal akan mengalami atrofi. Nefrektomi dilakukan hanya bila delayed celiotomy dilakukan karena adanya cedera organ lain atau jika hipetensi menetap pasca operasi. Trombosis arteri renalis bilateral komplit atau adanya ginjal soliter dibutuhkan eksplorasi segera dan revaskularisasi.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraph" style="line-height: 200%; margin-left: 113.4pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>5)<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Trauma tembus</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 113.4pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Pada trauma tembus indikasi absolut dilakukan eksplorasi adalah perdarahan arteri persisten. Hampir semua trauma tembus renal dilakukan tindakan bedah. Perkecualian adalah trauma ginjal tanpa adanya penetrasi peluru intraperitoneum Luka tusuk sebelah posterior linea aksilaris posterior relatif tidak melibatkan cedera organ lain.(Brandes, 2003)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 200%; margin-left: 56.7pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>3.<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Tehnik Operasi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 200%; margin-left: 85.05pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>a.<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Approach</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 85.05pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Dilakukan transperitoneal karena dapat mengenali dan menanggulangi trauma intraabdominal lain serta dapat melakukan isolasi pembuluh darah ginjal sebelum melakukan eksplorasi ginjal.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraph" style="line-height: 200%; margin-left: 85.05pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>b.<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Isolasi </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">pembuluh<b><span style="color: black;"> darah ginjal(Prosedur MCAninch)</span></b></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 85.05pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Dimaksudkan untuk mengendalikan perdarahan waktu dilakukan eksplorasi ginjal sebelum tamponade hematom retroperitoneal dibuka. Usus halus dan kolon disingkirkan ke lateral dan cranial. Buat insisi pada peritoneum posterior sebelah medial dan sejajar dengan vena mesentrika superior. Insisi berada di ventral aorta dan dengan meneruskan insisi ke cranial akan didapat vena renalis kiri yang berjalan melintang di ventral aorta. Vena renalis kiri merupakan tanda yang penting karena relatif mudah ditemukan, sementara di kraniodorsal akan didapat arteri renalis kiri. Vena renalis kanan bermuara pada vena kava lebih kaudal disbanding vena renalis kiri dan di cranial vena renalis kanan akan dijumpai arteri renalis kanan.Pada saat pembuluh darah dijerat untuk mengendalikan perdarahan tapi wrm ischaemic time tidak boleh lebih dari 30 menit. Bila diperlukan lebih lama ginjal didinginkan dengan es. Dengan teknik ini di RSCM dapat diturunkan angka nefrektomi dari 635 menjadi 36%. Setelah prosedur ini, eksplorasi ginjal dilakukan dengan membuat irisan peritoneum parakolika.(Taher A, 2003).</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable"><tbody>
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</tbody></table><div class="MsoNormal" style="line-height: 200%; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Gambar 11. Isolasi pembuluh darah utama ginjal. (McAninch, 2003)</span></div><div class="MsoNormal" style="line-height: 200%; text-align: justify;"><br />
</div><div class="MsoListParagraph" style="line-height: 200%; margin-left: 85.05pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>c.<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Rekonstruksi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 85.05pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Setelah membuka fascia gerota maka ginjal harus terpapar seluruhnya. Pada saat inilah biasanya terjadi perdarahan yang dapat dikendalikan dengan melakukan oklusi sementara pembuluh darah ginjal. Selanjutnya dilakukan debridemen fasia dan jaringan ginjal diikuti hemostasis sebaik mungkin. Bila dijumpai perdarahan pada leher kaliks, dilakukan penjahitan dengan benang absorabel kecil dan jarum atraumatik. Defek pelviokalises memerlukan penjahitan yang kedap air. Setelah itu baru dilakukan penjahitan parenkim sekaligus kapsulnya dengan jahitan matras menggunakan benang kromik 2-0. Lemak omentum dapat digunakan untuk menutup defek parenkim yang luas. Jaringan nonviable pada kutub atas maupun bawah yang luas memerlukan nefrektomi pasrsial. Cara guillotine merupakan cara yang mudah, namun penting untuk menyisakan kapsul ginjal agar dapat dipakai untuk menutup defek parenkim ginjal. Sebagai penggantinya dapat dipakai free graft peritoneum. Nefrektomi biasanya dilakukan pada robekan scattered atau mengenai daerah hilus. Laserasi luas pada bagian tengah ginjal dan mengenai pelviokalises sering berakhir dengan nefrektomi. Repair pembuluh darah perlu diusahakan dan cedera yang mengenai sekaligus a/v ginjal umumnya berakhir dengan nefrektomi. Di USA dari semua cedera arteriil hanya 44% kasus yang berhasil direpair. Ureter harus dikenali dan bila terdapat bekuan darah di ureter maupun pielum, pemasangan nefrostomi harus dilakukan dengan kateter foley 16F. Sebelum menutup rongga retroperitoneum dilaskukan pemasangan pipa drain. (Taher , 2003)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 200%; margin-left: 56.7pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>4.<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Komplikasi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 200%; margin-left: 85.05pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>a.<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Komplikasi Awal</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 85.05pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Komplikasi awal terjadi I bulan pertama setelah cedera.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraph" style="line-height: 200%; margin-left: 113.4pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>1)<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Urinoma</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 113.4pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Terjadi < 1% kasus trauma ginjal. Jika kecil dan noninfeksius maka tidak membutuhkan intervensi bedah. Bila besar perlu dilakukan pemasangan tube ureter atau nefrostomi perkutan /endoskopik.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraph" style="line-height: 200%; margin-left: 113.4pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>2)<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Delayed bleeding</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 113.4pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Terjadi dalam waktu 2 minggu cedera. Bila besar dan simtomatik dilakukan embolisasi.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraph" style="line-height: 200%; margin-left: 113.4pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>3)<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Urinary fistula</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 113.4pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Terjadi karena adanya urin yang tidak didrain atau infark segmen besar parenkim gunjal.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraph" style="line-height: 200%; margin-left: 113.4pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>4)<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Abses</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 113.4pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Terdapat ileus, panas tinggi dan sepsis. Mudsah didrainase perkutan.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoListParagraph" style="line-height: 200%; margin-left: 113.4pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>5)<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Hipertensi</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 113.4pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Pada periode awal pasca operasi biasanya karena rennin mediated, transient dan tidak membutuhkan tindakan .</span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 113.4pt; text-align: justify;"><br />
</div><div class="MsoListParagraph" style="line-height: 200%; margin-left: 85.05pt; text-align: justify; text-indent: -28.35pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"><span>b.<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Komplikasi Lanjut</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 85.05pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Hidronefrosis, arteriovenous fistula, pielonefritis. Kalkulus, delayed hipertensi</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;"></span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 85.05pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Scarring pada daerah pelvis renis dan ureter pasca trauma bisa menyebabkan obstruksi urine yang menyebabkan terbentuknya batu dan infeksi kronik. Fistula arteriovenosa sering terjadi setelah luka tusuk yang ditandai dengan delayed bleeding. Angiografi akan memperlihatkan ukuran dan posisi fistula.Pada sebagian besar kasus mudah dilakukan penutupan fistula dengan embolisasi. Hipertensi delayed pasca cedera ginjal karena iskemi ginjal merangsang aksis renin-angiotensin.</span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 85.05pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Ginjal sangat terlindungi oleh organ-organ disekitarnya sehingga diperlukan kekuatan yang cukup yang bisa menimbulkan cedera ginjal. Namun pada kondisi patologis seperti hidronefrosis atau malignansi ginjal maka ginjal mudah ruptur oleh hanya trauma ringan. Mobilitas ginjal sendiri membawa konsekuensi terjadinya cedera parenkim ataupun vaskuler. Sebagian besar trauma ginjal adalah trauma tumpul dan sebagian besar trauma tumpul menimbulkan cedera minor pada ginjal yang hanya membutuhkan bed rest.</span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 85.05pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Diagnosis trauma ginjal ditegakkan dengan anamnesis, pemeriksaan fisik dan penunjang. Pada pemeriksaan fisik digali mekanisme trauma serta kemungkinan gaya yang menimpa ginjal maupun organ lain disekitarnya. Pemeriksaan fisik diperlukan untuk menilai ABC nya trauma, local ginjal maupun organ lain yang terlibat. Pada pasien ini mungkin ditemukan hematuria gross ataupun mikroskopis atau mungkin tanpa hematuria.Bila kondisi tidak stabil walau dengan resusitasi maka tidak ada pilihan kecuali eksplorasi segera . Pada pemeriksaan penunjang plain photo bisa ditemukan patah tulang iga bawah, prosesus transversus vertebra lumbal yang menunjukkan kecurigaan kita terhadap trauma ginjal. Pada pemeriksaan IVU akurasinya 90% namun pada pasien hipotensi tidak bisa diharapkan hasilnya. IVU juga tidak bisa menilai daerah retroperitoneal serta sangat sulit melakukan grading. Pada kondisi tak stabil, maka hanya dilakukan one shot IVU yang bisa menilai ginjal kontralateral. Pemeriksaan dengan CT scan merupakan gold standard karena dengan alat ini bisa melakukan grading dengan baik. Bagian-bagian infark ginjal terlihat, serta seluruh organ abdomen serta retroperitoneum juga jelas. Pemeriksaan angiografi sangat baik dilakukan pada kecurigaan cedera vaskuler. Dilakukan arteriografi apabila CT scan tidak tersedia. Kerugiannya pemeriksaan ini invasif.</span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 85.05pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 200%;">Prinsip penanganan trauma ginjal adalah meminimalisasi morbiditas dan mortalitas serta sedapat mungkin mempertahankan fungsi ginjal. Hanya pasien dengan indikasi jelas dilakukan nefrektomi. Keselamatan jiwa pasien tentunya lebih penting dari pada usaha peyelamatan ginjal namun jiwa melayang. Teknik operasi saat ini memegang peranan penting dalam penyelamatan ginjal. Dengan kontrol pembuluh darah ginjal maka terjadi penurunan angka nefrektomi. Kontrol pembuluh darah dilakukan diluar fasia Gerota sebelum masuk zona trauma. Tanpa isolasi arteri dan vena , dekompresi hematom ginjal yang dilakukan durante operasi meningkatkan insidensi nefrektomi.</span></div><div class="MsoNormal" style="line-height: 200%; margin-left: 85.05pt; text-align: justify;"><br />
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</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB III</span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">KESIMPULAN DAN SARAN</span></b></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 45pt; text-align: justify; text-indent: -27pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>A.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kesimpulan</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 45pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Trauma tumpul sering menyebabkan luka pada ginjal, misalnya karena kecelakaan kendaraan bermotor, terjatuh atau trauma pada saat berolah raga. Luka tusuk pada ginjal dapat karena tembakan atau tikaman.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 45pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelainan traumatic yang mengenai saluran kemih antara lain kelainan teraumatik pada ginjal, ureter, kandung kemih, uretra serta venis. Tanda klinis yang mungkin terjadi antara lain : (a)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mungkin tidak ditemukan tanda klinis. (b)Bengkak dan memar daerah pinggang (swelling & bruising renal angle).(c)Distensi abdomen akibat penimbunan darah atau urine,(d)Dapat terjadi ileus.(e)Respiratory distress akibat penekanan diafragma.(f)Tahikardi dan hipotensi oleh karena hipovolemia, (g)Hematuri.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 45pt; text-align: justify; text-indent: -27pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>B.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Saran</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 45pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelainan traumatic pada saluran kemih seringkali tak disadari dan mungkin tidak meninggalkan tanda/gejala klinis. Namun apabila tanda dan gejala tersebut diatas anda alami maka penulis menyarankan untuk sepat memeriksakan diri ke pelayanan kesehatan.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 45pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penulis menyadari bahwa dalam penulisan makalah ini masih jauh dari kata sempurna oleh karena itu penulis mengharapkan kritik dan saran yang membangun. Semoga makalah ini dapat bermanfaat untuk penulis khususnya dan umumnya bagi pembaca.</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 45pt; text-align: justify;"><br />
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</div>TEAM_ONE KMB 2A AKPEM GARUThttp://www.blogger.com/profile/01719877433346227735noreply@blogger.com0tag:blogger.com,1999:blog-1245729285541543255.post-30905252863185253662011-04-08T05:13:00.000-07:002011-04-08T05:13:15.235-07:00TUGAS KMB III Ke 14 (GAGAL GINJAL AKUT)<!--[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:narylim></m:intlim> </m:wrapindent><!--[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%; text-align: center;"><span style="font-size: small;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; line-height: 150%;">BAB I</span></b><b><span lang="SV" style="font-family: "Times New Roman","serif"; line-height: 150%;"></span></b></span></div><div align="center" class="MsoNormal" style="line-height: 300%; text-align: center;"><span style="font-size: small;"><b><span lang="SV" style="font-family: "Times New Roman","serif"; line-height: 300%;">PENDAHULUAN </span></b></span></div><div class="MsoNormal" style="text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">1.1 Latar Belakang</span></b></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ginjal merupakan organ vital yang berperan sangat penting sangat penting dalam mempertahankan kestabilan lingkungan dalam tubuh. Ginjal mengatur keseimbangan cairan tubuh dan elektrolit dan asam basa dengan cara menyaring darah yang melalui ginjal, reabsorbsi selektif air, elektrolit dan non-elektrolit, serta mengekskresi kelebihannya sebagai kemih. </span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gagal ginjal akut <span> </span>merupakan suatu sindrom klinis yang secara cepat (biasanya dalam beberapa hari) yang menyebabkan azotemia yang brkembang cepat. Laju filtrasi gromelurus yang menurun dengan cepat menyebabkan kadar kreatinin serum meningkat sebanyak 0,5 mg/dl/hari dan kadar nitrogen urea darah sebanyak 10 mg/dl/hari dalam beberapa hari. ARF biasanya disertai oleh oligurea (keluaran urine < 400 ml/hari). Criteria oliguria tidak mutlak tapi berkaitan dengan fakta bahwa rata-rata diet orang amerika mengandung<span> </span>sekitar 600 mOsm zat terlarut. Jika kemampuan pemekatan urine maksimum sekitar 1200 mOsm /L air, maka kehilangan air obligat dalam urine adalah 500 ml. oleh karna itu ,bila keluaran urine menurun hingga kurang dari 400 ml/hari, penambahan jat terlarut tidak bisa dibatasi dengan kadar BUN serta kreatinin meningkat.</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 23.25pt; text-align: justify; text-indent: -18.75pt;"><b><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>1.2<span style="font: 7pt "Times New Roman";"> </span></span></span></b><b><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rumusan Masalah</span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>A.<span style="font: 7pt "Times New Roman";"> <span style="font-size: small;">A</span>. </span></span></span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Apa yang dimaksud dengan </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gagal </span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ginjal</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> akut</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>B.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">B.Apa Etiologi </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>gagal ginjal akut?</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>C.<span style="font: 7pt "Times New Roman";"> <span style="font-size: small;">C.</span> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perjalanan klinis gagal ginjal akut?</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; text-indent: -18pt;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>D.<span style="font: 7pt "Times New Roman";"> <span style="font-size: small;"> D</span></span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">.Bagaimana pengelolaan gagal ginjal akut?</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 4.5pt; text-align: justify;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.3 </span></b><b><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tujuan Penulisan</span></b></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>A. </span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui apa yang dimaksud dengan </span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gagal </span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ginjal</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> akut</span><span lang="IN" 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: 14pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;"><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>B. </span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui </span><span class="apple-style-span"><span style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagaimana</span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">etiologi gagal ginjal akut</span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">C.</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%;">Untuk mengetahui</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%;">Perjalanan klinis gagal ginjal akut</span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">D.Untuk mengetahui bagaimana pengelolaan gagal ginjal akut</span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 4.5pt; text-align: justify;"><b><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.4 </span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sistematika Penulisan</span></b></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Makalah ini terdiri dari 3 bab. Bab 1 yaitu pendahuluan yang terdiri dari latar belakang , rumusan masalah, tujuan penulisan,dan sistematika penulisan. Bab2 Pembahasan. Bab3 Kesimpulan dan Saran.</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><br />
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</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><span style="font-size: small;"><b><span lang="SV" style="font-family: "Times New Roman","serif"; line-height: 150%;">BAB II</span></b></span></div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><span style="font-size: small;"><b><span lang="SV" style="font-family: "Times New Roman","serif"; line-height: 150%;">PEMBAHASAN</span></b></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 25.1pt; text-align: justify; text-indent: -18pt;"><b><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span>2.1<span style="font: 7pt "Times New Roman";"> </span></span></span></b><b><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"><span> </span>Pengertian </span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Gagal Ginjal Akut</span></b><b><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></b></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif";">Gagal ginjal akut (GGA) adalah suatu sindrom klinis yang di tandai dengan penurunan mendadak (dalam beberapa jam sampai beberapa hari) laju filtrasi glomerulus (LFG), di sertai akumulasi nitrogen sisa metabolisme (ureum dan kreatinin).</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gagal ginjal akut (acute renal failure, ARF) merupakan suatu sindrom klinis yang secara cepat (biasanya dalam beberapa hari) yang menyebabkan azotemia yang brkembang cepat. Laju filtrasi gromelurus yang menurun dengan cepat menyebabkan kadar kreatinin serum meningkat sebanyak 0,5 mg/dl/hari dan kadar nitrogen urea darah sebanyak 10 mg/dl/hari dalam beberapa hari. ARF biasanya disertai oleh oligurea (keluaran urine < 400 ml/hari). Criteria oliguria tidak mutlak tapi berkaitan dengan fakta bahwa rata-rata diet orang amerika mengandung<span> </span>sekitar 600 mOsm zat terlarut. Jika kemampuan pemekatan urine maksimum sekitar 1200 mOsm /L air, maka kehilangan air obligat dalam urine adalah 500 ml. oleh karna itu ,bila keluaran urine menurun hingga kurang dari 400 ml/hari, penambahan jat terlarut tidak bisa dibatasi dengan kadar BUN serta kreatinin meningkat. Namun oliguria bukan merupakan gambaran penting pada ARF. Bukti penelitian terbaru mengesankan bahwa pada sepertiga hingga separuh kasus ARF,keluaran urine melebihi 400 ml /hari.dan dapat mencapai hingga 2L/hari. Bentuk ARF ini disebut ARF keluaran-tinggi atau disebut non-ologurik. ARF menyebabkan timbulnya gejala dan tanda menyerupai sindrom uremik pada gagal ginjal kronik,yang mencerminkan terjadinya kegagalan fungsi regulasi, eksresi, dan endokrin ginjal. Namun demikian , osteodistrofi<span> </span>ginjal dan anemiabukan merupakan gambaran yang lazim terdapat pada ARF karena awitanya akut.</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ARF merupakan sindrom klinis yang sangat lazim , terjadi pada sekitar 5 % pasien rawat inap dan sebanyak 30 % pasien yang dirawat di unit perawatan intensif. Beragam jenis komplikasi yang berkaitan dengan penyakit, obat, kehamilan, trauma, dan tindakan bedah dapat menyebakan ARF . berlawanan dengan gagal ginjal kronik , sebagian besar pasien ARF biasanya memiliki fungsi ginjal yang sebelumnya, dan keadaan ini umumnya dapat pulih kembali. Selain kenyataan ini, mortalitas akibat ARF sangat tinggi (sekitar 50%), bahkan dengan ketersediaan pengobatan dialysis, mungkin menunjukan penyakit kritis yang biasanya turut terkait.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 25.1pt;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 25.1pt; text-align: justify; text-indent: -18pt;"><span class="apple-style-span"><b><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.2<span style="font: 7pt "Times New Roman";"> </span></span></span></b></span><span class="apple-style-span"><b><span style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span></span></b></span><span class="apple-style-span"><b><span lang="IN" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Etiologi gagal ginjal akut</span></b></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-right: 36pt;"><span lang="IN"><br />
</span><span lang="IN" style="font-family: "Times New Roman","serif";">Hipovolemia</span><span lang="IN" style="font-family: "Times New Roman","serif";"> </span><span lang="IN" style="font-family: "Times New Roman","serif";">di sebabkan oleh;</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-right: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif";">• Kehilangan darah /plasma : perdarahan, luka baker.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-right: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif";">• Kehilangan cairan melalui gastrointestinal, kulit, ginjal (diuretik, penyakit ginjal lain), pernafasan, pembedahan.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-right: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif";">• Redistribusi dari intravaskuler ke ekstravaskuler (hipoalbuminemia, sindrom kompartemen ketiga, pankreatitis, peritonitis, kerusakan otot yang luas, sindrom distres pernafasan).</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-right: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif";">• Kekurangan asupan cairan.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-right: 36pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-right: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif";">Vasodilatasi sistemik;</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-right: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif";">• Sepsis</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-right: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif";">• Sirosis hati</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-right: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif";">• Anestesi/blokade ganglion</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-right: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif";">• Reaksi anafilaksis</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-right: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif";">• Vasodilatasi oleh obat</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-right: 36pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-right: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif";">Penurunan curah jantung/kegagalan pompa jantung;</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-right: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif";">• Renjatan kardiogenik,infark jantung</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-right: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif";">• Gagal jantung kongestif (disfungsi miokard, katup jantung)</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-right: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif";">• Tamponade jantung</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-right: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif";">• Distrimia</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-right: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif";">• Emboli paru</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-right: 36pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-right: 36pt;"><span style="font-family: "Times New Roman","serif";"><span> </span></span><span lang="IN" style="font-family: "Times New Roman","serif";">Kegagalan autoregulasi</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-right: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif";">• Vasokontriksi praglomerulus oleh karena sepsis, hiperkalsemia, sindrom hepatorenal, obat-obat seperti inflamasi non steroid (AINS), adrenalin, noradrenalin, siklosporin, dan ampoterisin B.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-right: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif";">• Vasodilatasi pascaglomerulus: di sebabkan oleh obat-obat penghambat angiotensin-converting enzyme (ACE), dan antagonis reseptor AT1 angiotensin</span><span style="font-family: "Times New Roman","serif";">.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-right: 36pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 25.1pt; margin-right: 36pt; text-indent: 10.9pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 25.1pt; margin-right: 36pt; text-indent: 10.9pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 9pt; margin-right: 36pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.3</span></b><b><span style="color: #333333; font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"> </span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">Perjalanan Klinis Gagal Ginjal Akut</span></b><b><span style="font-family: "Times New Roman","serif";"></span></b></div><ul><li><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span>a.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Oligurria</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span><span style="font: 7pt "Times New Roman";"> </span></span></span></li>
<li><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span><span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Diuresis</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span><span style="font: 7pt "Times New Roman";"> </span></span></span></li>
<li><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span><span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">Pemulihan</span></li>
</ul><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pembagian ini dipakai pada penjelasan dibawah ini , tetapi harus di ingat bahwa gagal ginjal akut dan azotemia dapat saja terjadi saat keluaran urine lebih dari 400 ml/jam.</span></div><div class="MsoNormal" style="text-indent: 18pt;"><span style="font-size: x-small;"><b><span style="font-family: "Times New Roman","serif";">STADIUM OLIGURIA</span></b></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penting<b> </b>sekali untuk<b> </b>mengetahui awitan oligiria, menentukan penyebabab gagal ginjal, dan mulai mengobati setiap penyebab yang reversible. ARF tipe ATN harus dibedakan dari kegagalan prarenal dan pascarenal dan kelainan intrarenal lainnya (contohnya, glomerulonefritis pascatreftokokus akut). Diagnosis gagal ginjal akut ditegakan setelah penyebab lainnya disingkirkan.</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Obstruksi pascarenal harus disingkirkan terutama jika penyebab gagal ginjal tidak jelas. Adanya anuria atau periode anuaria yang diselingi periode berkemih dalam jumlah normal mengarah pada kemungkinan obstruksi. Obstruksi pada uretra dan leher kandung kemih dapat dilakukan pemeriksaan ultrasonografi atau scan ginjal dengan radioisotope dan pielograpi retrograde.</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ultrasonografi dapat mengungkap ukuran ginjal dan dapat menunjukan adanya obstruksi batu pada pelfis ginjal atau ureter. Scan radiosotop dapat dipakai untuk menilai keadaan pembuluh darah utama ginjal dan utama ginjal dan berguna jika dicurigai terdapat oklusi arteri atau vena<span> </span>Obstruksi yang berkepanjangan dapat menyebabkan gagal ginjal instrinsik yang sering kali irreversible. Penanganannya dengan segera mengatasi obstruksi. Yang terakhir, oligurea pararenal adalah keadaan yang paling sering menyebabkan ARF dan harus dibedakan dengan ATN.</span></div><div class="MsoNormal" style="line-height: 16.75pt; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="line-height: 16.75pt; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="text-indent: 36pt;"><span style="font-size: x-small;"><b><span style="font-family: "Times New Roman","serif";">OLIGURIA PRARENAL VERSUS ATN</span></b></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Oliguria prarenal dan azotemia merupakan keadaan fisiologis dan sebenarnya reversible. Ke adaan ini disebabkan oleh syok, penurunan volume plasma dengan konsekuensi penurunan aliran darah ginjal dan GPR. Oliguria dapat terjadi akibat salah satu penyebab prarenal gagal ginjal akut seprti yang telah dibahas sebelumnya. Bila tidak dibatasi , oliguria dapat berkembang menjadi ATN.</span></div><div class="MsoNormal" style="text-indent: 36pt;"><span style="font-size: x-small;"><b><span style="font-family: "Times New Roman","serif";">STADIUM DIURESIS</span></b></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">St<b>adium </b>dieresis gagal ginjal akut dimulai bila keluaran urine meningkat sampai lebih dari 400 ml per hari<b> Rasio urea urine/plasma. Stadium ini biasanya berlangsung</b> 2 sampai 3 minggu. Pengeluaran urine harian jarang melebihi 4 liter ,asalkan pasien itu tidak mengalami hidrasi yang berlebihan. Volume urine yang tinggi pada stadium dieresis ini agaknya karena dieresis<span> </span>osmotic akibat tingginya kadar urea darah, dan mungkin juga disebabkan masih belum pulih nya kemampuan tubulus yang sedang pada masa penyembuhan untuk<span> </span>mempertahankan garam dan air yang difiltrasi.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="text-indent: 36pt;"><b><span style="font-family: "Times New Roman","serif";">STADIUM PENYEMBUHAN</span></b><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Stadium penyembuhan gagal ginjal akut berlangsung sampai satu tahun, dan selama itu anemia dan kemampuan pemekatan ginjal sedikit demi sedikit membaik. Tetapi beberapa pasien tetap menderita penurunan GPR yang permanen. Sekitar 5% pasien membutuhkan dialysis untuk waktu yang lama atan transplantasi ginjal, sebanyak 5% pasien yang lain mungkin mengalami penurunan fungsi ginjal yang progresif.</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Meskipun kerusakan epitel tubulus secara teoritis reversible , ATN merupakan keadaan<span> </span>stadium oliguria , dan sepertiga pasien ATN meninggal selama stadium dieresis.</span><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="text-indent: 36pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><span style="font-size: x-small;">PENANGANAN NEKROSIS TUBULAR AKUT (ATN</span>)</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pencegahan cedera iskemik dan nefrotoksik penyebab ATN membutuhkan pengawasan ketet untuk mengoptimalkan fungsi kardiovaskuler, dan mempertahankan volume ECF , terutama pada pasien yang memiliki factor resiko atau yang menjalani pengobatan neprotoksik. Pengobatan yang menurunkan resistensi dapat menyebabkan terjadinya vasokonstriksi ginjal atau mengenai respon autoregulasi ginjal,<span> </span>Dan juga harus digunakan secara hati- hati.</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Setelah ditegakannya diagnosis ATN , maka pertimbangan primer adalah mempertahankan keseimbangan cairan dan elektrolit dan penanganan setiap komplikasi misalnya infeksi. Dialisis menggantikan fungsi ginjal hingga tubulus ginjal mengalami regenerasi dan fungsi ginjal menjadi pulih. Indikasi absolute untuk dialysis adalah adanya gejala dan tanda sindrom uremik, hiperkalemia, retensi urine, dan asidosis berat.penggantian ginjal secara terus menerus juga dapat digunakan dalam pengobatan ARF, baik hemofiltrasi maupun hemodiafiltrasi.</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 25.1pt; text-indent: -18pt;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span>2.4<span style="font: 7pt "Times New Roman";"> </span></span></span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PENGELOLAAN GGA</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif";">Prinsip pengelolaannya di mulai dengan mengidentifikasi pasien yang berisiko GGA (sebagai tindak pencegahan), mengatasi penyakit penyebab GGA, mempertahankan hemoestatis; mempertahankan euvolemia, keseimbangan cairandan elektrolit, mencegah komplikasimetabolik seperti hiperkalemia, asidosis, hiperfosfatemia, mengevaluasi status nutrisi, kemudian mencegah infeksi dan selalu mengevaluasi obat –obat yang di pakai. </span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif";"><br />
<br />
<b>Pengelolaan medis GGA</b></span><b><span style="font-family: "Times New Roman","serif";"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%;"><span lang="IN" style="font-family: "Times New Roman","serif";">Pada GGA terdapat 2 masalah yang sering di dapatkan yang mengancam jiwa yaitu edema paru dan hiperkalemia.<br />
<br />
<b>Edema paru</b></span><b><span style="font-family: "Times New Roman","serif";"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif";">Keadaan ini terjadi akibat ginjal tak dapat mensekresi urin, garam dalam jumlah yang cukup. Posisi pasien setengah duduk agar cairan dalam paru dapat didistribusi ke vaskular sistemik, di pasang oksigen, dan di berikan diuretik kuat (furosemid inj.).</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif";"><br />
<b>Hiperkalemia </b></span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif";">Mula-mula di berikan kalsium intravena (Ca glukonat) 10% sebanyak 10 ml yang dapat di ulangi sampai terjadi perubahan gelombang T. Belum jelas cara kerjanya, kadar kalium tak berubah, kerja obat ini pada jatung berfungsi untuk menstabilkan membran. Pengaruh obat ini hanya sekitar 20-60 menit. <br />
Pemberian infus glukosa dan insulin (50 ml glukosa 50% dengan 10 U insulin kerja cepat) selama 15 menit dapat menurunkan kalium 1-2mEq/L dalam waktu 30-60 menit. Insulin bekerja dengan menstimulasi pompa N-K-ATPase pada otot skelet dan jantung, hati dan lemak, memasukkan kalium kedalam sel. Glukosa di tambahkan guna mencegah hipoglikemia.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif";">Obat golongan agonis beta seperti salbutamol intravena (0,5mg dalam 15 menit) atau inhalasi nebuliser (10 atau 20mg) dapat menurunkan 1mEq/L. Obat ini bekerja dengan mengaktivasi pompa Na-K-ATPase. Pemberian sodium bikarbonat walaupun dapat menurukan kalium tidak begitu di anjurkan oleh karena menambah jumlah natrium, dapat menimbulkan iritasi, menurunkan kadar kalsium sehingga dapat memicu kejang. Tetapi bermanfaatapbila ada asidosis atau hipotensi. </span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif";"><br />
<b>Pemberian diuretik</b></span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif";">Pada GGA sering di berikan diuretik golongan loop yang sering bermanfaat pada keadaan tertentu. Pemberian diuretik furosemid mencegah reabsorpsi Na sehingga mengurangi metabolisme sel tubulus, selain itu juga di harapkan aliran urin dapat membersihkan endapan, silinder sehingga menghasilkan obstruksi, selain itu furosemid dapat mengurangi masa oliguri.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif";">Dosis yang di berikan amat bervariasi di mulai dengan dosis konvensional 40 mg intravena, kemudian apabila tidak ada respons kenaikan bertahap dengan dosis tinggi 200 mg setiap jam, selanjutnya infus 10-40 mg/jam. Pada tahap lebih lanjut apabila belum ada respons dapat di berikan furosemid dalam albumin yang di berikan secara intravena selama 30 menit dengan dosis yang sama atau bersama dengan HCT.<br />
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<b>Nutrisi </b></span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif";">Pada GGA kebutuhan nutrisi di sesuaikan dengan keadaan proses kataboliknya.<br />
GGA menyebabkan abnormalitas metabolisme yag amat kompleks, tidak hanya mengatur air, asam-basa, elektrolit, tetapi juga asam amino/protein, karbohidrat, dan lemak.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif";"><br />
<b>Dialisis atau Pengobatan Pengganti Ginjal</b></span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif";">Indikasi yang mutlak untuk dialisis adalah terdapatnya sindrom uremia dan terdapatnya kegawatan yang mengancam jiwa yaitu hipervolemia (edema paru), hiperkalemia, atau asidosis berat yang resisten terhadap pengobatan konservatif.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><span lang="IN" style="font-family: "Times New Roman","serif";">Pengobatan pengganti ginjal secara kontinyu dengan CAVH (continous arterivenous hemofiltration) yang tidak memerlukan mesin pompa sederhana. CAVH dan CVVH berdasarkan prinsip pengeluaran cairan bersama solutnya melalui membran semipermeabel atau hemofilter oleh karena perbedaan tekanan (convective clearance).</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%;"><br />
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</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB<span> </span>III</span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">KESIMPULAN DAN SARAN</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%;">3.1 Kesimpulan</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif";">Gagal ginjal akut ( GGA ) adalah suatu keadaan fisiologik dan klinik yang ditandai dengan pengurangan tiba-tiba glomerular filtration rate (GFR) dan perubahan kemampuan fungsional ginjal untuk mempertahankan eksresi air yang cukup untuk keseimbangan dalam tubuh. Atau sindroma klinis akibat kerusakan metabolik atau patologik pada ginjal yang ditandai dengan penurunan fungsi yang</span><span style="font-family: "Times New Roman","serif";"> </span><span style="font-family: "Times New Roman","serif";">nyata</span><span style="font-family: "Times New Roman","serif";"> </span><span style="font-family: "Times New Roman","serif";">dan</span><span style="font-family: "Times New Roman","serif";"> </span><span style="font-family: "Times New Roman","serif";">cepat</span><span style="font-family: "Times New Roman","serif";"> </span><span style="font-family: "Times New Roman","serif";">serta</span><span style="font-family: "Times New Roman","serif";"> </span><span style="font-family: "Times New Roman","serif";">terjadinya</span><span style="font-family: "Times New Roman","serif";"> </span><span style="font-family: "Times New Roman","serif";">azotemia..</span><span lang="IN" style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif";">Peningkatan kadar kreatinin juga bisa disebabkan oleh obat-obatan (misalnya cimetidin dan trimehoprim) yang menghambat sekresi tubular ginjal. Peningkatan tingkat BUN juga dapat terjadi tanpa disertai kerusakan ginjal, seperti pada perdarahan mukosa atau saluran pencernaan, penggunaan steroid, pemasukan protein. Oleh karena itu diperlukan pengkajian yang hati-hati dalam menentukan</span><span style="font-family: "Times New Roman","serif";"> </span><span style="font-family: "Times New Roman","serif";">apakah</span><span style="font-family: "Times New Roman","serif";"> </span><span style="font-family: "Times New Roman","serif";">seseorang</span><span style="font-family: "Times New Roman","serif";"> </span><span style="font-family: "Times New Roman","serif";">terkena</span><span style="font-family: "Times New Roman","serif";"> </span><span style="font-family: "Times New Roman","serif";">kerusakan</span><span style="font-family: "Times New Roman","serif";"> </span><span style="font-family: "Times New Roman","serif";">ginjal</span><span style="font-family: "Times New Roman","serif";"> </span><span style="font-family: "Times New Roman","serif";">atau</span><span style="font-family: "Times New Roman","serif";"> </span><span style="font-family: "Times New Roman","serif";">tidak</span><span lang="IN" style="font-family: "Times New Roman","serif";">.</span><span style="font-family: "Times New Roman","serif";"></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif";">Adapun penyebab dari gagal ginjal akut perlu di perhatikan betul banyaknya asupan cairan (input), kehilangan cairan (output) melalui: urin, muntah, diare, keringat yang berlebih,dll, serta pencatatan berat badan pasien. Perlu di perhatikan kemungkinan kehilangan cairan ke ekstravaskular (redistribusi) seperti pada peritonitis, asetis, ileus paralitik, edema anasarka, trauma luas (kerusakan otot atau crush syndrome). Riwayat penyakit jantung, gangguan hemodinamik, adanya penyakit sirosis hati, hipoalbuminemia, alergi yang mengakibatkan penurunan volume efektif perlu selaludi tanyakan.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Times New Roman","serif";"><br />
</span><b><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3.2</span></b><b><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></b><b><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Saran</span></b><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><span style="font-family: "Times New Roman","serif";">Memberrikan penjelasan yang jelas tentang penyakit gagal ginjal dan mempercepat penyembuhan.untuk</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></b><span style="font-family: "Times New Roman","serif";">Penatalaksanaan yang efektif dan efisien pada pasien untuk mendapatkan hasil yang maksimal dan mencegah terjadinya komplikasi.</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
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</div><div align="center" class="MsoNormal" style="text-align: center;"><b><span lang="IN" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">DAFTAR PUSTAKA</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"></span></b></div><div align="center" class="MsoNormal" style="text-align: center;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1. Sukandar, Enday. 2006. Gagal Ginjal dan Panduan Terapi Dialisis. Pusat Informasi </span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ilmiah Bagian Ilmu Penyakit Dalam FK.UNPAD. Bandung. </span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;"><span style="font-family: "Times New Roman","serif";">2.Anderton,J.L,dkk.1992.Nefrologi.Jakarta:Hipokrates<br />
Price,SA.1995.Patofisiologi.Jakarta:EGC <br />
3.Lynda Juall carpernito, Rencana Asuhan keperawatan dan dokumentasi keperawatan, Diagnosis KeperawatandanMasalahKolaboratif,ed.2,EGC,Jakarta,1999.<br />
http://keperawatankita.wordpress.com/2009/02/13/gagal-ginjal-akut/</span><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">4.Lintong, Poppy M. 2005. Ginjal Dan Saluran Kencing Bagian Bawah. Bagian Patologi </span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Anatomi FK.UNSRAT. Manado </span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;"><br />
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</div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">POSTING GAGAL GINJAL AKUT oleh:</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nama<span> </span>:LINA RATIANA</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tingkat<span> </span>:2A</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelompok<span> </span>:1</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>-Anisah nur azizah</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>-asep diki</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>-Farid ma’roef</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>-Lina Ratiana</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>-Pipit puspita Permana</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>-Susanti</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;"><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><span> </span>-Ucu cahyati</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36pt; text-align: justify;"><br />
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</div></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac>TEAM_ONE KMB 2A AKPEM GARUThttp://www.blogger.com/profile/01719877433346227735noreply@blogger.com1tag:blogger.com,1999:blog-1245729285541543255.post-16823687234401681332011-04-07T21:23:00.000-07:002011-04-07T21:25:11.982-07:00tugas KMB ke-15 (GAGAL GINJAL KRONIK)<div align="center" class="MsoNormal" style="font-family: Times,"Times New Roman",serif; text-align: center;"><b><span style="font-size: 14pt; line-height: 115%;">BAB </span></b><b><span lang="EN-US" style="font-size: 14pt; line-height: 115%;">I</span></b><span lang="EN-US" style="font-size: 14pt; line-height: 115%;"></span></div><div align="center" class="MsoNormal" style="font-family: Times,"Times New Roman",serif; text-align: center;"><b><span style="font-size: 14pt; line-height: 115%;">PENDAHULUAN</span></b><b><span lang="EN-US" style="font-size: 14pt; line-height: 115%;"></span></b></div><div class="MsoListParagraph" style="font-family: Times,"Times New Roman",serif; text-align: justify; text-indent: -18pt;"><b><span lang="EN-US" style="font-size: 12pt; line-height: 115%;">A.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; 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="EN-US" style="font-size: 12pt; line-height: 115%;">Latar Belakang</span></b></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; text-indent: 36pt;"><span style="font-size: 12pt; line-height: 115%;">Ginjal merupakan organ vital yang berperan sangat penting sangat penting dalam mempertahankan kestabilan lingkungan dalam tubuh. Ginjal mengatur keseimbangan cairan tubuh dan elektrolit dan asam basa dengan cara menyaring darah yang melalui ginjal, reabsorbsi selektif air, elektrolit dan non-elektrolit, serta mengekskresi kelebihannya sebagai kemih. </span><span lang="EN-US" style="font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; text-indent: 36pt;"><span style="font-size: 12pt; line-height: 115%;">Fungsi primer ginjal adalah mempertahankan volume dan komposisi cairan ekstra sel dalam batas-batas normal. Komposisi dan volume cairan ekstrasel ini dikontrol oleh filtrasi glomerulus, reabsorbsi dan sekresi tubulus. </span><span lang="EN-US" style="font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; text-indent: 1cm;"><span style="font-size: 12pt; line-height: 115%;">Ginjal dilalui oleh sekitar 1.200 ml darah per menit, suatu volume yang sama dengan 20 sampai 25 persen curah jantung (5.000 ml per menit). Lebih 90% darah yang masuk ke ginjal berada pada korteks, sedangkan sisanya dialirkan ke medulla. </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; text-indent: 1cm;"><span style="font-size: 12pt; line-height: 115%;">Di negara maju, penyakit kronik tidak menular (<i>cronic non-communicable diseases</i>) terutama penyakit kardiovaskuler, hipertensi, diabetes melitus, dan penyakit ginjal kronik, sudah menggantikan penyakit menular (<i>communicable diseases</i>) sebagai masalah kesehatan masyarakat utama.</span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; text-indent: 1cm;"><span style="font-size: 12pt; line-height: 115%;">Gangguan fungsi ginjal dapat menggambarkan kondisi sistem vaskuler sehingga dapat membantu upaya pencegahan penyakit lebih dini sebelum pasien mengalami komplikasi yang lebih parah seperti stroke, penyakit jantung koroner, gagal ginjal, dan penyakit pembuluh darah perifer. </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; text-indent: 1cm;"><span style="font-size: 12pt; line-height: 115%;">Pada penyakit ginjal kronik terjadi penurunan fungsi ginjal yang memerlukan terapi pengganti yang membutuhkan biaya yang mahal. Penyakit ginjal kronik biasanya desertai berbagai komplikasi seperti penyakit kardiovaskuler, penyakit saluran napas, penyakit saluran cerna, kelainan di tulang dan otot serta anemia. </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; text-indent: 1cm;"><span style="font-size: 12pt; line-height: 115%;">Selama ini, pengelolaan penyakit ginjal kronik lebih mengutamakan diagnosis dan pengobatan terhadap penyakit ginjal spesifik yang merupakan penyebab penyakit ginjal kronik serta dialisis atau transplantasi ginjal jika sudah terjadi gagal ginjal. Bukti ilmiah menunjukkan bahwa komplikasi penyakit ginjal kronik, tidak bergantung pada etiologi, dapat dicegah atau dihambat jika dilakukan penanganan secara dini. Oleh karena itu, upaya yang harus dilaksanakan adalah diagnosis dini dan pencegahan yang efektif terhadap penyakit ginjal kronik, dan hal ini dimungkinkan karena berbagai faktor risiko untuk penyakit ginjal kronik dapat dikendalikan.</span><span lang="EN-US" style="font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpFirst" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-size: 12pt; line-height: 150%;">B<b>.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></b></span><b><span style="font-size: 12pt; line-height: 150%;">Rumusan masalah</span></b></div><div class="MsoListParagraphCxSpMiddle" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 2cm; text-align: justify; text-indent: -21.25pt;"><span style="font-size: 12pt; line-height: 150%;">1.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; 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-size: 12pt; line-height: 150%;">Apa yang di maksud dengan </span><span lang="EN-US" style="font-size: 12pt; line-height: 150%;">gagal ginjal kronik</span><span style="font-size: 12pt; line-height: 150%;">?</span></div><div class="MsoListParagraphCxSpMiddle" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 2cm; text-align: justify; text-indent: -21.25pt;"><span style="font-size: 12pt; line-height: 150%;">2.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; 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-size: 12pt; line-height: 150%;">Bagaimana</span><span lang="EN-US" style="font-size: 12pt; line-height: 150%;"> etiologi gagal ginjal kronik</span><span style="font-size: 12pt; line-height: 150%;">?</span></div><div class="MsoListParagraphCxSpMiddle" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 2cm; text-align: justify; text-indent: -21.25pt;"><span style="font-size: 12pt; line-height: 150%;">3.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; 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-size: 12pt; line-height: 150%;">Bagaimana</span><span lang="EN-US" style="font-size: 12pt; line-height: 150%;"> perjalanan klinisnya </span><span style="font-size: 12pt; line-height: 150%;">?</span></div><div class="MsoListParagraphCxSpMiddle" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 2cm; text-align: justify; text-indent: -21.25pt;"><span style="font-size: 12pt; line-height: 150%;">4.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; 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="EN-US" style="font-size: 12pt; line-height: 150%;">Apa tanda dan gejalanya? </span><span style="font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 2cm; text-align: justify; text-indent: -21.25pt;"><span style="font-size: 12pt; line-height: 150%;">5.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; 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="EN-US" style="font-size: 12pt; line-height: 150%;">Bagaimana pendekatan diagnostiknya? </span><span style="font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 2cm; text-align: justify; text-indent: -21.25pt;"><span style="font-size: 12pt; line-height: 150%;">6.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; 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="EN-US" style="font-size: 12pt; line-height: 150%;">Apa saja diet gagal ginjal kronik? </span><span style="font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 2cm; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: -18pt;"><b><span style="font-size: 12pt; line-height: 150%;">C.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; 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-size: 12pt; line-height: 150%;">Tujuan penulisan</span></b></div><div class="MsoListParagraphCxSpMiddle" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 2cm; text-align: justify; text-indent: -21.25pt;"><span style="font-size: 12pt; line-height: 150%;">1.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; 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-size: 12pt; line-height: 150%;">Untuk menjelask</span><span lang="EN-US" style="font-size: 12pt; line-height: 150%;">an pengertian gagal ginjal kronik</span><span lang="EN-US" style="font-size: 12pt; line-height: 150%;"> </span><span style="font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 2cm; text-align: justify; text-indent: -21.25pt;"><span style="font-size: 12pt; line-height: 150%;">2.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; 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-size: 12pt; line-height: 150%;">Untuk meng</span><span lang="EN-US" style="font-size: 12pt; line-height: 150%;">e</span><span style="font-size: 12pt; line-height: 150%;">tahui </span><span lang="EN-US" style="font-size: 12pt; line-height: 150%;">etiologi gagal ginjal kronik</span><span style="font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 2cm; text-align: justify; text-indent: -21.25pt;"><span style="font-size: 12pt; line-height: 150%;">3.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; 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-size: 12pt; line-height: 150%;">Untuk mengetahui </span><span lang="EN-US" style="font-size: 12pt; line-height: 150%;">perjalanan klinis GGK</span><span style="font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 2cm; text-align: justify; text-indent: -21.25pt;"><span style="font-size: 12pt; line-height: 150%;">4.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; 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="EN-US" style="font-size: 12pt; line-height: 150%;">Untuk mengetahui tanda dan gejala GGK</span><span style="font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 2cm; text-align: justify; text-indent: -21.25pt;"><span style="font-size: 12pt; line-height: 150%;">5.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; 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="EN-US" style="font-size: 12pt; line-height: 150%;">Untuk mengetahui pendekatan diagnostic GGK</span><span style="font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 2cm; text-align: justify; text-indent: -21.25pt;"><span style="font-size: 12pt; line-height: 150%;">6.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; 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="EN-US" style="font-size: 12pt; line-height: 150%;">Untuk mengetahui diet GGK</span><span style="font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: -18pt;"><b><span style="font-size: 12pt; line-height: 150%;">D.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; 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-size: 12pt; line-height: 150%;">Sistematika Penulisan</span></b></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 36pt;"><span style="font-size: 12pt; line-height: 150%;">Makalah ini terdiri dari </span><span lang="EN-US" style="font-size: 12pt; line-height: 150%;">3</span><span style="font-size: 12pt; line-height: 150%;"> bab. Bab 1 yaitu pendahuluan yang terdiri dari latar belakang , rumusan masalah, tujuan penulisan,dan sistematika penulisan. Bab2 </span><span lang="EN-US" style="font-size: 12pt; line-height: 150%;">Pembahasan</span><span style="font-size: 12pt; line-height: 150%;">. Bab3 </span><span lang="EN-US" style="font-size: 12pt; line-height: 150%;">Kesimpulan dan Saran</span><span style="font-size: 12pt; line-height: 150%;">.</span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif;"><br />
</div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif;"><br />
</div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif;"><br />
</div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif;"><br />
</div><div align="center" class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: center;"><br />
</div><div align="center" class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span style="color: black; font-size: 14pt; line-height: 115%;">BAB I</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: black; font-size: 14pt; line-height: 115%;">I</span></b></div><div align="center" class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: black; font-size: 14pt; line-height: 115%;">PEMBAHASAN</span></b></div><div align="center" class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: center;"><br />
</div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><b><span style="color: black; font-size: 12pt; line-height: 115%;">A. Definisi Gagal Ginjal Kronik </span></b><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify; text-indent: 36pt;"><span style="color: black; font-size: 12pt; line-height: 115%;">Gagal ginjal kronik (GGK) : ketidak mampuan ginjal untuk mempertahankan<span style="letter-spacing: 17.75pt;"> </span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">keseimbangan dan itergritas tubuh yang mncul secara bertahap sebelum terjun ke fase </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">penurunan faal ginjal tahap akhir. </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify; text-indent: 36pt;"><span style="color: black; font-size: 12pt; line-height: 115%;">Gagal ginjal kronik : penurunan semua faal ginjal secara bertahap, diikuti penimbunan sisa metabolisme protein dan gangguan keseimbangan cairan dan elektrolit. </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify; text-indent: 36pt;"><span style="color: black; font-size: 12pt; line-height: 115%;">Penyakit ginjal kronik (PGK) adalah kerusakan ginjal atau penurunan faal ginjal lebih<span style="letter-spacing: 17.75pt;"> </span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">atau sama dengan 3 bulan sebelum diagnosis ditegakkan. Sesuai rekomendasi dari </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">NKF-DOQI (2202). </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">Ada beberapa pengertian gagal ginjal kronik yang dikemukakan oleh beberapa ahli yaitu : </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify; text-indent: 36pt;"><span style="color: black; font-size: 12pt; line-height: 115%;">Gagal ginjal kronik merupakan kegagalan fungsi ginjal (unit nefron) yang berlangsu</span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">n</span><span style="color: black; font-size: 12pt; line-height: 115%;">g</span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;"> perlahan-lahan</span><span style="color: black; font-size: 12pt; line-height: 115%;"> karena penyebab berlangsung lama dan menetap yang mengakibatkan penumpukan sisa metabolit (toksin uremik) sehingga ginjal tidak dapat memenuhi kebutuhan biasa lagi dan menimbulkan gejala sakit (Hudak & Gallo, 1996). <span style="letter-spacing: 17.75pt;"></span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify; text-indent: 36pt;"><span style="color: black; font-size: 12pt; line-height: 115%;">Long (1996 : 368) mengemukakan bahwa gagal ginjal kronik adalah ginjal sudah tidak<span style="letter-spacing: 17.75pt;"> </span>mampu lagi mempertahankan lingkugan internal yang konsisten dengan kehidupan dan pemulihan fungsi sudah tidak ada. <span style="letter-spacing: 17.75pt;"></span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify; text-indent: 36pt;"><span style="color: black; font-size: 12pt; line-height: 115%;">Gagal ginjal kronik merupakan penurunan faal ginjal yang menahun yang umumnya<span style="letter-spacing: 17.75pt;"> </span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">tidak riversibel dan cukup lanjut. (Suparman, 1990: 349). </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify; text-indent: 36pt;"><span style="color: black; font-size: 12pt; line-height: 115%;">Gagal ginjal kronik merupakan perkembangan gagal ginjal yang progresif dan lambat,<span style="letter-spacing: 17.75pt;"> </span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">biasanya berlangsung dalam beberapa tahun (Lorraine M Wilson, 1995: 812). </span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><br />
</div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><b><span style="color: black; font-size: 12pt; line-height: 115%;">B. Etiologi Gagal Ginjal Kronik </span></b><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify; text-indent: 17.15pt;"><span style="color: black; font-size: 12pt; line-height: 115%;">Umumnya gagal ginjal kronik disebabkan penyakit ginjal intrinsic difus dan menahun. Tetapi hamp</span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">i</span><span style="color: black; font-size: 12pt; line-height: 115%;">r semua nefropati bilateral dan progresif akan ber</span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">a</span><span style="color: black; font-size: 12pt; line-height: 115%;">khir dengan gagal ginjal kronik. Umumnya penyakit diluar ginjal, missal nefropati obstruktif dapat menyebabkan kelainan ginjal intrinsic dan berakhir dengan gagal ginjal kronik. </span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify; text-indent: 17.15pt;"><span style="color: black; font-size: 12pt; line-height: 115%;">Glomerulonefritis hipertensi essensial dan pielonefritis merupakan penyebab paling sering dari gagal ginjal kronik kira-kira 60%. Gagal ginjal kronik yang berhubungan dengan penyakit ginjal polikistik dan nefropati obstruktif hanya 15 – 20 %. Glomerulonefritis kronik merupakan penyakit parenkim ginjal progresif dan difus, seringkali berakhir dengan gagal ginjal kronik. Laki-laki lebih sering dari wanita, umur 20 – 40 tahun. Sebagian besar pasien relatif muda dan merupakan calon utama untuk transplantasi ginjal. Glomerulonefritis mungkin berhubungan dengan penyakit-penyakit system (Glomerulonefritis sekunder) seperti Lupus Eritomatosus Sitemik, Poliarthritis Nodosa, Granulomatosus Wagener. Glomerulonefritis (Glomerulopati) yang berhubungan dengan diabetes melitus (Glomerulosklerosis) tidak jarang dijumpai dan dapat berakhir dengan gagal ginjal kronik. Glomerulonefritis yang berhubungan dengan amiloidosis sering dijumpai pada pasien-pasien dengan penyakit menahun sperti tuberkolosis, lepra, osteomielitis, dan arthritis rheumatoid, dan myeloma. </span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify; text-indent: 17.15pt;"><span style="color: black; font-size: 12pt; line-height: 115%;">Penyakit ginjal hipertensif (arteriolar nefrosklerosis) merupakan salah satu penyebab gagal ginjal kronik. Insiden hipertensi essensial berat yang berekhir dengan gagal ginjal kronik kurang dari 10 %. Kira-kira 10 -15% pasien-pasien dengan gagal ginjal kronik disebabkan penyakit ginjal </span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify; text-indent: 17.15pt;"><span style="color: black; font-size: 12pt; line-height: 115%;">Pada orang dewasa, gagal ginjal kronik yang berhubungan dengan infeksi saluran kemih dan ginjal (Pielonefritis) tipe uncomplicated jarang dijumpai, kecuali tuberculosis, abses multiple, nekrosis papilla renalis yang tidak mendapatkan pengobatan adekuat. </span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify; text-indent: 17.15pt;"><span style="color: black; font-size: 12pt; line-height: 115%;">Seperti diketahui,nefritis interstisial menunjukkan kelainan histopatologi berupa fibrosis dan reaksi inflamasi atau radang dari jaringan interstisial dengan etiologi yang banyak. Kadang dijumpai juga kelainan-kelainan mengenai glomerulus dan pembuluh darah, vaskuler. Nefropati asam urat menempati urutan pertama dari etiolgi nefrotis interstisial.</span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify; text-indent: 17.15pt;"><br />
</div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">C. </span><b><span style="color: black; font-size: 12pt; line-height: 115%;">Perjalanan klinis</span></b><b><span lang="EN-US" style="color: black; font-size: 12pt; font-weight: normal; line-height: 115%;"></span></b></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">Perjalanan umum gagal ginjal progresif dapat dibagi menjadi 3 </span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">s</span><span style="color: black; font-size: 12pt; line-height: 115%;">tadium</span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">: </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><b><i><span style="color: black; font-size: 12pt; line-height: 115%;">Stadium</span></i></b><b><i><span style="color: black; font-size: 12pt; line-height: 115%;"> </span></i></b><b><i><span style="color: black; font-size: 12pt; line-height: 115%;">I</span></i></b><b><span lang="EN-US" style="color: black; font-size: 12pt; font-weight: normal; line-height: 115%;"></span></b></div><div style="font-family: Times,"Times New Roman",serif; line-height: 115%; text-align: justify; text-indent: 36pt;"><span style="color: black;">Penurunan cadangan ginjal (faal ginjal antar 40 % – 75 %). Tahap inilah yang paling ringan, dimana faal ginjal masih baik. Pada tahap ini penderita ini belum merasasakan gejala gejala dan pemeriksaan laboratorium faal ginjal masih dalam masih dalam batas normal. Selama tahap ini kreatinin serum dan kadar BUN (Blood Urea Nitrogen) dalam batas normal dan penderita asimtomatik. Gangguan fungsi ginjal mungkin hanya dapat diketahui dengan memberikan beban kerja yang berat, sepersti tes pemekatan kemih yang lama atau dengan mengadakan test GFR yang teliti.</span><span lang="EN-US" style="color: black;"></span></div><div style="font-family: Times,"Times New Roman",serif; line-height: 115%; text-align: justify; text-indent: 36pt;"><span style="color: black;"><br />
<b><i>Stadium II</i></b></span><b><i><span lang="EN-US" style="color: black;"></span></i></b></div><div style="font-family: Times,"Times New Roman",serif; line-height: 115%; text-align: justify; text-indent: 36pt;"><span style="color: black;">Insufiensi ginjal (faal ginjal antar 20 % – 50 %). Pada tahap ini penderita dapat melakukan tugas tugas seperti biasa padahal daya dan konsentrasi ginja</span><span lang="EN-US" style="color: black;">l</span><span style="color: black;"> menurun. Pada stadium ini pengobatan harus cepat dalam hal mengatasi kekurangan cairan, kekurangan garam, gangguan jantung dan pencegahan pemberian obat obatan yang bersifat menggnggu faal ginjal. Bila langkah langkah ini dilakukan secepatnya dengan tepat dapat mencegah penderita masuk ketahap yang lebih berat. Pada tahap ini lebih dari 75 % jaringan yang berfungsi telah rusak. Kadar BUN baru mulai meningkat diatas batas normal. Peningkatan konsentrasi BUN ini berbeda beda, tergantung dari kadar protein dalam diit.pada stadium ini kadar kreatinin serum mulai meningkat melebihi kadar normal.</span><b><i><span lang="EN-US" style="color: black;"></span></i></b></div><div style="font-family: Times,"Times New Roman",serif; line-height: 115%; text-align: justify; text-indent: 36pt;"><span style="color: black;">Poliuria akibat gagal ginjal biasanya lebih besar pada penyakit yang terutama menyerang tubulus, meskipun poliuria bersifat sedang dan jarang lebih dari 3 liter / hari. Biasanya ditemukan anemia pada gagal ginjal dengan faal ginjal diantara 5 % – 25 % . faal ginjal jelas sangat menurun dan timbul gejala gejala kekurangan darah, tekanan darah akan naik, , aktifitas penderita mulai terganggu.</span><span lang="EN-US" style="color: black;"></span></div><div style="font-family: Times,"Times New Roman",serif; line-height: 115%; text-align: justify; text-indent: 36pt;"><br />
</div><div style="font-family: Times,"Times New Roman",serif; line-height: 115%; text-align: justify; text-indent: 36pt;"><span style="color: black;"><br />
<b><i>Stadium III</i></b></span><b><i><span lang="EN-US" style="color: black;"></span></i></b></div><div style="font-family: Times,"Times New Roman",serif; line-height: 115%; text-align: justify; text-indent: 36pt;"><span style="color: black;">Uremi gagal ginjal (faal ginjal kurang dari 10 %)<br />
Semua gejala sudah jelas dan penderita masuk dalam keadaan diman tak dapat melakukan tugas sehari hair sebaimana mestinya. Gejal gejal yang timbul antara lain mual, munta, nafsu makan berkurang., sesak nafas, pusing, sakit kepala, air kemih berkurang, kurang tidur, kejang kejang dan akhirnya terjadi penurunan kesadaran sampai koma. Stadum akhir timbul pada sekitar 90 % dari massa nefron telah hancur. Nilai GFR nya 10 % dari keadaan normal dan kadar kreatinin mungkin sebesar 5-10 ml / menit atau kurang.</span><b><i><span lang="EN-US" style="color: black;"></span></i></b></div><div style="font-family: Times,"Times New Roman",serif; line-height: 115%; text-align: justify; text-indent: 36pt;"><span style="color: black;">Pada keadaan ini kreatinin serum dan kadar BUN akan meningkat dengan sangat mencolok sebagai penurunan. Pada stadium akhir gagal ginjal, penderita mulai merasakan gejala yang cukup parah karena ginjal tidak sanggup lagi mempertahankan homeostatis caiaran dan elektrolit dalam tubuh. Penderita biasanya menjadi oliguri (pengeluaran kemih) kurang dari 500/ hari karena kegagalan glomerulus meskipun proses penyakit mula mula menyerang tubulus ginjal,</span><b><i><span lang="EN-US" style="color: black;"></span></i></b></div><div style="font-family: Times,"Times New Roman",serif; line-height: 115%; text-align: justify; text-indent: 36pt;"><span style="color: black;">kompleks menyerang tubulus gijal, kompleks perubahan biokimia dan gejala gejala yang dinamakan sindrom uremik mempengaruhi setiap sistem dalam tubuh. Pada stadium akhir gagal ginjal, penderita pasti akan menggal kecuali ia mendapat pengobatan dalam bentuk transplantasi ginjal atau dialisis.</span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><br />
</div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">D. Gejala Klinik Gagal Ginjal Kronik </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; text-align: justify; text-indent: 18.85pt;"><span style="color: black; font-size: 12pt; line-height: 115%;">Pada gagal ginjal kronis, gejala-gejalanya berkembang secara perlahan. Pada awalnya tidak ada gejala sama sekali, kelainan fungsi ginjal hanya dapat diketahui dari pemeriksaan laboratorium.Pada gagal ginjal kronis ringan sampai sedang, gejalanya ringan meskipun terdapat peningkatan urea dalam darah. Pada stadium ini terdapat nokturia dan hipertensi. Sejalan dengan perkembangan penyakit, maka lama kelamaan akan terjadi peningkatan kadar ureum darah semakin tinggi.Pada stadium ini, penderita menunjukkan gejala-gejala: letih,</span><span style="color: black; font-size: 12pt; line-height: 115%;"> </span><span style="color: black; font-size: 12pt; line-height: 115%;">mudahlelah,</span><span style="color: black; font-size: 12pt; line-height: 115%;"> </span><span style="color: black; font-size: 12pt; line-height: 115%;">sulitkonsentrasi</span><span lang="EN-US" style="color: black; font-size: 12pt; letter-spacing: 17.75pt; line-height: 115%;">,</span><span style="color: black; font-size: 12pt; line-height: 115%;">nafsumakanturun,</span><span style="color: black; font-size: 12pt; line-height: 115%;"> </span><span style="color: black; font-size: 12pt; line-height: 115%;">mual</span><span style="color: black; font-size: 12pt; line-height: 115%;"> </span><span style="color: black; font-size: 12pt; line-height: 115%;">muntah</span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">, </span><span style="color: black; font-size: 12pt; line-height: 115%;">cegukan</span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">, </span><span style="color: black; font-size: 12pt; line-height: 115%;">tungkai</span><span style="color: black; font-size: 12pt; line-height: 115%;"> </span><span style="color: black; font-size: 12pt; line-height: 115%;">lemah,</span><span style="color: black; font-size: 12pt; line-height: 115%;"> </span><span style="color: black; font-size: 12pt; line-height: 115%;">parastesi,</span><span style="color: black; font-size: 12pt; line-height: 115%;"> </span><span style="color: black; font-size: 12pt; line-height: 115%;">keramotot-otot,</span><span style="color: black; font-size: 12pt; line-height: 115%;"> </span><span style="color: black; font-size: 12pt; line-height: 115%;">insomia,</span><span style="color: black; font-size: 12pt; line-height: 115%;"> </span><span style="color: black; font-size: 12pt; line-height: 115%;">nokturai,</span><span style="color: black; font-size: 12pt; line-height: 115%;"> </span><span style="color: black; font-size: 12pt; line-height: 115%;">oliguria</span><span lang="EN-US" style="color: black; font-size: 12pt; letter-spacing: 17.75pt; line-height: 115%;">,</span><span style="color: black; font-size: 12pt; line-height: 115%;">sesaknafas,</span><span style="color: black; font-size: 12pt; line-height: 115%;"> </span><span style="color: black; font-size: 12pt; line-height: 115%;">sembab,</span><span style="color: black; font-size: 12pt; line-height: 115%;"> </span><span style="color: black; font-size: 12pt; line-height: 115%;">batuk,</span><span style="color: black; font-size: 12pt; line-height: 115%;"> </span><span style="color: black; font-size: 12pt; line-height: 115%;">nyeri</span><span style="color: black; font-size: 12pt; line-height: 115%;"> </span><span style="color: black; font-size: 12pt; line-height: 115%;">perikardial</span><span lang="EN-US" style="color: black; font-size: 12pt; letter-spacing: 17.75pt; line-height: 115%;">,</span><span style="color: black; font-size: 12pt; line-height: 115%;">malnutrisi, penurunan berat badan letih.</span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; text-align: justify; text-indent: 17.15pt;"><span style="color: black; font-size: 12pt; line-height: 115%;">Pada stadium yang sudah sangat lanjut, penderita bisa menderita ulkus dan perdarahan saluran pencernaan. Kulitnya berwarna kuning kecoklatan dan kadang konsentrasi urea sangat tinggi sehingga terkristalisasi dari keringat dan membentuk serbuk putih di kulit (bekuan uremik). Beberapa penderita merasakan gatal di seluruh tubuh. </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">Menurut Suhardjono (2001), manifestasi klinik yang muncul pada pasien dengan gagal ginjal </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">kronik yaitu: </span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">1.</span><span style="color: black; font-size: 12pt; line-height: 115%;">Gangguan pada sistem gastrointestinal<span style="letter-spacing: 17.75pt;"> </span></span><span lang="EN-US" style="color: black; font-size: 12pt; letter-spacing: 17.75pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify; text-indent: 14.2pt;"><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">a.</span><span style="color: black; font-size: 12pt; line-height: 115%;">Anoreksia, nausea, dan vomitus yang berhubungan dengan gangguan metaboslime<span style="letter-spacing: 15.35pt;"> </span></span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify; text-indent: 14.2pt;"><span style="color: black; font-size: 12pt; line-height: 115%;">protein dalam usus. </span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify; text-indent: 14.2pt;"><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">b. </span><span style="color: black; font-size: 12pt; line-height: 115%;">Mulut bau amonia disebabkan oleh ureum yang berlebihan pada air liur.</span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify; text-indent: 14.2pt;"><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">c. </span><span style="color: black; font-size: 12pt; line-height: 115%;">Cegukan (hiccup)<span style="letter-spacing: 15.35pt;"> </span></span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><br />
</div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">2. </span><span style="color: black; font-size: 12pt; line-height: 115%;">Gastritis erosif, ulkus peptik, dan kolitis uremi</span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">k.</span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">a. Sistem Integumen</span><span lang="EN-US" style="color: black; font-size: 12pt; letter-spacing: 17.75pt; line-height: 115%;"> </span><span lang="EN-US" style="color: black; font-size: 12pt; letter-spacing: 15.35pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm;"><span style="color: black; font-size: 12pt; letter-spacing: 15.35pt; line-height: 115%;">-</span><span style="color: black; font-size: 12pt; line-height: 115%;">Kulit berwarna pucat akibat anemia. Gatal dengan ekskoriasi akibat toksin uremik.<span style="letter-spacing: 15.35pt;"><br />
-</span>Ekimosis akibat gangguan hematologis<span style="letter-spacing: 15.35pt;"><br />
-</span>Urea frost akibat kristalisasi urea<span style="letter-spacing: 15.35pt;"><br />
-</span>Bekas-bekas garukan karena gatal</span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm;"><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">- </span><span style="color: black; font-size: 12pt; line-height: 115%;">Kulit kering bersisik</span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm;"><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">- </span><span style="color: black; font-size: 12pt; line-height: 115%;">Kuku tipis dan rapuh</span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm;"><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">- </span><span style="color: black; font-size: 12pt; line-height: 115%;">Rambut tipis dan kasar<br />
</span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">b. </span><span style="color: black; font-size: 12pt; line-height: 115%;">Sistem Hematologi<span style="letter-spacing: 17.75pt;"> </span></span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm;"><span style="color: black; font-size: 12pt; letter-spacing: 15.35pt; line-height: 115%;">-</span><span style="color: black; font-size: 12pt; line-height: 115%;">Anemia<span style="letter-spacing: 15.35pt;"><br />
-</span>Gangguan fungsi trombosit dan trombositopenia<span style="letter-spacing: 15.35pt;"><br />
-</span>Gangguan fungsi leukosit.</span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm;"><span style="color: black; font-size: 12pt; line-height: 115%;">c.</span><span style="color: black; font-size: 12pt; line-height: 115%;"> </span><span style="color: black; font-size: 12pt; line-height: 115%;">Sistem saraf dan otot<span style="letter-spacing: 17.75pt;"> </span></span><span lang="EN-US" style="color: black; font-size: 12pt; letter-spacing: 17.75pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm;"><span style="color: black; font-size: 12pt; letter-spacing: 15.35pt; line-height: 115%;">-</span><span style="color: black; font-size: 12pt; line-height: 115%;">Restles leg syndrome<span style="letter-spacing: 15.35pt;"><br />
-</span>Burning feet syndrome<span style="letter-spacing: 15.35pt;"><br />
-</span>Ensefalopati metabolic<span style="letter-spacing: 15.35pt;"><br />
-</span>Miopati</span><span lang="EN-US" style="color: black; font-size: 12pt; letter-spacing: 17.75pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">d. </span><span style="color: black; font-size: 12pt; line-height: 115%;">Sistem Kardiovaskuler<span style="letter-spacing: 17.75pt;"> </span></span><span lang="EN-US" style="color: black; font-size: 12pt; letter-spacing: 17.75pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm;"><span style="color: black; font-size: 12pt; letter-spacing: 15.35pt; line-height: 115%;">-</span><span style="color: black; font-size: 12pt; line-height: 115%;">Hipertensi<span style="letter-spacing: 15.35pt;"><br />
-</span>Akibat penimbunan cairan dan garam.<span style="letter-spacing: 15.35pt;"><br />
-</span>Nyeri dada dan sesak nafas<span style="letter-spacing: 15.35pt;"><br />
-</span>Gangguan irama jantung<span style="letter-spacing: 15.35pt;"><br />
-</span>Edema akibat penimbunan caira</span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">n.</span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm;"><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">e. </span><span style="color: black; font-size: 12pt; line-height: 115%;">Sistem Endokrin<span style="letter-spacing: 17.75pt;"> </span></span><span lang="EN-US" style="color: black; font-size: 12pt; letter-spacing: 17.75pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm;"><span style="color: black; font-size: 12pt; letter-spacing: 15.35pt; line-height: 115%;">-</span><span style="color: black; font-size: 12pt; line-height: 115%;">Gangguan seksual: libido, fertilitas dan ereksi menurun pada laki-laki.<span style="letter-spacing: 15.35pt;"><br />
-</span>Gangguan metabolisme glukosa, resistensi insulin, dan gangguan sekresi insulin.<span style="letter-spacing: 15.35pt;"><br />
-</span>Gangguan metabolisme lemak.</span><span lang="EN-US" style="color: black; font-size: 12pt; letter-spacing: 17.75pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; letter-spacing: 15.35pt; line-height: 115%;">-</span><span style="color: black; font-size: 12pt; line-height: 115%;">Gangguan metabolisme vitamin </span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">D.</span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><br />
</div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">E. Pendekatan Diagnosis Gagal Ginjal Kronik </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">Sasarannya yaitu : </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif;"><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">1. </span><span style="color: black; font-size: 12pt; line-height: 115%;">Memastikan adanya penurunan faal ginjal (LFG)<span style="letter-spacing: 17.75pt;"><br />
</span></span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">2. </span><span style="color: black; font-size: 12pt; line-height: 115%;">Mengejar etiologi GGK yang mungkin dapat di koreksi<span style="letter-spacing: 17.75pt;"><br />
</span></span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">3. </span><span style="color: black; font-size: 12pt; line-height: 115%;">Mengidentifikasi semua factor pemburuk faal ginjal (reversible factors)<span style="letter-spacing: 17.75pt;"><br />
</span></span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">4. </span><span style="color: black; font-size: 12pt; line-height: 115%;">Menentukan strategi terapi rasional<span style="letter-spacing: 17.75pt;"><br />
</span></span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">5. </span><span style="color: black; font-size: 12pt; line-height: 115%;">Meramalkan prognosis<span style="letter-spacing: 17.75pt;"></span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">1. </span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">P</span><span style="color: black; font-size: 12pt; line-height: 115%;">emeriksaan fisik diagnosis </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; text-align: justify; text-indent: 17.15pt;"><span style="color: black; font-size: 12pt; line-height: 115%;">Gambaran klinik mempunyai spectrum klinik luas dan melibatkan banyak dan tergantung dari derajat penurunan faal ginjal dan lebih makin nyata bila pasien sudah terjun ke fase terminal dari gagal ginjal terminal (GGT) dengan melibatkan banyak organ seperti system hemopoiesis, saluran cerna yang lebih berat, saluran nafas, mata, kulit, selaput serosa (pluritis dan perikarditis), system kardiovaskuler, dan neuropsikatri. </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; text-align: justify; text-indent: 17.15pt;"><span style="color: black; font-size: 12pt; line-height: 115%;">Pada anamnesis dan pemeriksaan fisik harus dapat mengungkapkan etiologi GGK yang dapat dikoreksi maupun yang tidak dapat dikoreksi. Semua factor etiologi yang mungkin dapat dikoreksi biasanya sulit terungkap pada anamnesis dan pemeriksaan fisik diagnosis tetapi informasi ini sangat penting sebagai panduan pengejaran diagnosis dengan memakai sarana penunjang laboratorium dan pemeriksaan yang lebih spesifik. </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">2. Pemeriksaan Laboratorium </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; text-align: justify; text-indent: 17.15pt;"><span style="color: black; font-size: 12pt; line-height: 115%;">Untuk menentukan ada tidaknya kegawatan, menentukan derajat GGK, menentukan gangguan sistem, dan membantu menetapkan etiologi. Blood ureum nitrogen (BUN)/kreatinin meningkat, kalium meningkat, magnesium meningkat, kalsium menurun, protein menurun. Tujuan pemeriksaan laboratorium yaitu (1) memastikan dan menentukan derajat penurunan faal ginjal LFG, (2) identifikasi etiologi, (3) menentukan perjalanan penyakit termasuk semua factor pemburuk faal ginjal yang sifatnya terbalikan (reversible). </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">Beberapa pemeriksaan penunjang diagnosis : </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">a. Foto polos perut </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">b. USG </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">c. Nefrotomogram </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">d. Pielografi retrograde </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">e. Pielografi antegrade </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">f.</span><span style="color: black; font-size: 12pt; line-height: 115%;"> </span><span style="color: black; font-size: 12pt; line-height: 115%;">Micturatingcysto urography (MCU) </span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><br />
</div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; text-align: justify; text-indent: 17.15pt;"><span style="color: black; font-size: 12pt; line-height: 115%;">Sebagian besar pasien GGK harus menjalani program terapi simtomatik untuk mencegah atau mengurangi populasi gagal ginjal terminal (GGT).Banyak faktor perlu dikendalikan untuk mencegah/memperlambat progresivitas penurunan faal ginjal (LFG). </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; text-align: justify; text-indent: 17.15pt;"><span style="color: black; font-size: 12pt; line-height: 115%;">Protein hewani, hiperkolesterolemia, hipertensi sistemik, gangguan elektrolit (hipokalsemia & hipokalemia) merupakan faktor-faktor yang memperburuk faal ginjal. Kelainan hemodinamik intrarenal (hipertensi intraglomerulus) seperti terdapat pada hipertensi essensial dan nefropati diabetik merupakan faktor yang harus diantisipasi dan dikendalikan untuk mencegah penyakit ginjal terminal. Intervensi terhadap perubahan- perubahan patogenesis dan patofisiologi ini merupakan kunci keberhasilan upaya untuk mencegah/ mengurangi penurunan faal ginjal (LFG) yang berakhir dengan penyakit </span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">Perubahan faal ginjal (LFG) bersifat individual untuk setiap pasien GGK, lama terapi konservatif bervariasi dari bulan sampai tahun. </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">Tujuan terapi konservatif, yaitu:<span style="letter-spacing: 17.75pt;"> </span></span></div><div class="MsoListParagraphCxSpFirst" style="font-family: Times,"Times New Roman",serif; text-indent: -18pt;"><span style="color: black; font-size: 12pt; line-height: 115%;">a.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; 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="color: black; font-size: 12pt; line-height: 115%;">mencegah memburuknya faal ginjal secara progresif</span></div><div class="MsoListParagraphCxSpMiddle" style="font-family: Times,"Times New Roman",serif; text-indent: -18pt;"><span style="color: black; font-size: 12pt; line-height: 115%;">b.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; 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="color: black; font-size: 12pt; line-height: 115%;"> meringankan keluhan-keluhan akibat akumulasi toksin azotemia</span></div><div class="MsoListParagraphCxSpMiddle" style="font-family: Times,"Times New Roman",serif; text-indent: -18pt;"><span style="color: black; font-size: 12pt; line-height: 115%;">c.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; 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="color: black; font-size: 12pt; line-height: 115%;">mempertahankan dan memperbaiki metabolisma secara optima</span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">l</span><span style="color: black; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpLast" style="font-family: Times,"Times New Roman",serif; text-indent: -18pt;"><span style="color: black; font-size: 12pt; line-height: 115%;">d.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; 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="color: black; font-size: 12pt; line-height: 115%;"> memelihara keseimbangan cairan dan elektrolit.</span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">Beberapa prinsip terapi konservatif<span style="letter-spacing: 17.75pt;"> </span></span></div><div class="MsoListParagraphCxSpFirst" style="font-family: Times,"Times New Roman",serif; margin: 0cm 0cm 0cm 21.3pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">1.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; 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="color: black; font-size: 12pt; line-height: 115%;">mencegah buruknya faal ginjal (LFG) </span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="font-family: Times,"Times New Roman",serif; margin: 0cm 0cm 0cm 21.3pt; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">hati-hati pemberian obat yang bersifat nefrotoksik</span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">,</span><span style="color: black; font-size: 12pt; line-height: 115%;"> hindari keadaan yang menyebabkan deplesi volume cairan ekstraseluler dan hipotensi hindari gangguan keseimbngan elektrolit hindari pembatasan ketat konsumsi protein hewani hindari proses kehamilan dan pemberian obat kontrasepsi hindari insttrumentsasi (keteterisasi dan sistoskopi) tanpa indikasi medik yang kuat hindari pemeriksaan radiologi dengan media kontras tanpa indikasi medik yang kuat</span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">.</span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;"> </span><span style="color: black; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="font-family: Times,"Times New Roman",serif; margin: 0cm 0cm 0cm 21.3pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">2.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; 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="color: black; font-size: 12pt; line-height: 115%;">program memperlambat penurunan progresif faal ginjal </span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="font-family: Times,"Times New Roman",serif; margin: 0cm 0cm 0cm 21.3pt; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">kendalikan hipertensi sistemik dan intraglomerularkendalikan terapi ISKdiet protein yang proporsionalkendalikan hiperfosfatemiaterapi hiperurikemia bila asam urat serum > 10 mg%</span><span style="color: black; font-size: 12pt; line-height: 115%;"> </span><span style="color: black; font-size: 12pt; line-height: 115%;">terapi keadaan asidosis metabolik kendalikan keadaan hiperglikemia </span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="font-family: Times,"Times New Roman",serif; margin: 0cm 0cm 0cm 21.3pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">3.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; 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="color: black; font-size: 12pt; line-height: 115%;">terapi alleviative gejala azotemia </span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="font-family: Times,"Times New Roman",serif; margin: 0cm 0cm 0cm 21.3pt; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">pembatasan konsumsi protein hewani terapi gatal-gatal terapi keluhan gastrointestinal terapi gejala neuromuskuler terapi kelainan tulang b</span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">a</span><span style="color: black; font-size: 12pt; line-height: 115%;">dan sendi</span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">,</span><span style="color: black; font-size: 12pt; line-height: 115%;"> terapi anemia</span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">,</span><span style="color: black; font-size: 12pt; line-height: 115%;"> te</span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">r</span><span style="color: black; font-size: 12pt; line-height: 115%;">api setiap infeksi (bakteri, virus HBV atau HCV) </span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoListParagraphCxSpLast" style="font-family: Times,"Times New Roman",serif; margin: 0cm 0cm 0cm 21.3pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">F. </span><span style="color: black; font-size: 12pt; line-height: 115%;">Peranan diet </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify; text-indent: 1cm;"><span style="color: black; font-size: 12pt; line-height: 115%;">Terapi diet rendah protein (DRP). Terapi diet rendah protein menguntungkan untuk mencegah atau mengurangi toksik azotemia tetapi untuk jangka lama dapat merugikan terutama gangguan keseimbangan negatif nitrogen</span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-indent: 1cm;"><span style="color: black; font-size: 12pt; line-height: 115%;">Tujuan program diet rendah protein(DRE)<br />
a. mempertahankan kkeadaan nutrisi optimal<br />
b. mengurangi atau mencegah akumulasi toksin azotemia<br />
c. mencegah menbruknyafaal ginjal (LFG) akibat proses glomerulosklerosis</span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-indent: 1cm;"><span style="color: black; font-size: 12pt; line-height: 115%;">Pasien kelompok GGK dengan LFG ≤ 5 ml per hari dan sindrom nefrotik dapat diberikan diuretika untuk memperlancar diuresis, misal furosemide. Takaran furosemide 40-80 mg per hari, dapat dinaikkan 40 mg per hari (interval 2 hari) sampai jumlah takaran maksimal 3 gram per hari. </span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-indent: 1cm;"><br />
</div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">Diet Rendah Protein untuk Penyakit Ginjal Kronik</span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;">:</span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;"><br />
</span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;"> </span><span style="color: black; font-size: 12pt; line-height: 115%;">Selain faktor keturunan, diabetes, hipertensi, infeksi, batu ginjal, gaya hidup dan pola makan juga sangat berpengaruh kejadian penyakit ginjal kronik yang berakibat pada gagal ginjal. Agar kondisi ginjal tidak semakin parah, perlu dilakukan diet khusus bagi pederita penyakit ginjal kronik.</span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify; text-indent: 1cm;"><span style="color: black; font-size: 12pt; line-height: 115%;">Penyakit ginjal kronik (Chronic Kidney Disease) adalah keadaan dimana terjadi penurunan fungsi ginjal yang menahun disebabkan oleh berbagai penyakit ginjal. Penyakit ini bersifat progresif dan umumnya tidak dapat pulih kembali (irreversible). Gejalanya biasanya ditandai dengan menurunnya nafsu makan, mual, pusing, muntah, rasa lelah, sesak nafas, edema pada tangan dan kaki serta uremia. Apabila Tes Kliren Kreatinin (TKK) <> 5,5 mEq), oliguria atau anuria. Cairan dibatasi, yaitu sebanyak jumlah urin sehari ditambah pengeluaran melalui keringat dan pernafasan (± 500 ml)</span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify; text-indent: 1cm;"><span style="color: black; font-size: 12pt; line-height: 115%;">Vitamin cukup, bila perlu diberikan suplemen piridoksin, asam folat, vitamin C dan vitamin D.</span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify; text-indent: 1cm;"><span style="color: black; font-size: 12pt; line-height: 115%;">Kebutuhan nutrisi tubuh sangat dipengaruhi dengan berat badan, karenanya diet diberikan disesuaikan dengan berat badan pasien. Berdasarkan Penuntun Diet yang disarankan oleh Instalasi Gizi Perjan Rumah Sakit Cipto Mangunkusumo (RSCM), jenis diet digolongkan menjadi tiga, yaitu diet rendah protein I: Asupan protein 30 g dan diberikan kepada pasien dengan berat badan 50 kg. Diet protein rendah II, asupan protein 35 g diberikan pasien dengan berat badan 60 kg. Diet protein rendah III, diberikan kepada pasien dengan berat badan 65 kg. Makanan diberikan dalam bentuk makanan cair atau lunak untuk meringankan organ pencernaan.</span><span lang="EN-US" style="color: black; font-size: 12pt; line-height: 115%;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-indent: 1cm;"><br />
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</div><div align="center" class="MsoNormal" style="font-family: Times,"Times New Roman",serif; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: black; font-size: 14pt; line-height: 115%;">BAB III</span></b></div><div align="center" class="MsoNormal" style="font-family: Times,"Times New Roman",serif; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: black; font-size: 14pt; line-height: 115%;">KESIMPULAN DAN SARAN</span></b></div><div style="font-family: Times,"Times New Roman",serif; line-height: 115%; margin-left: 21.3pt; text-indent: -18pt;"><b><span lang="EN-US" style="color: black;">A.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; 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="EN-US" style="color: black;">KESIMPULAN</span></b><span lang="EN-US" style="color: #333399;"> </span><span lang="EN-US" style="color: #333399;"></span></div><div style="font-family: Times,"Times New Roman",serif; line-height: 115%; margin-left: 7.1pt;"><span style="color: black;">Penyebab gagak ginjal kronik cukup banyak tetapi untuk keperluan klinis dapat dibagi dalam 2 </span><span style="color: black;"> </span><span style="color: black;">kelompok</span><span lang="EN-US" style="color: black;">:</span><span style="color: black;"><br />
<b style="font-weight: normal;">1. Penyakit parenkim ginjal</b><br />
Penyakit ginjal primer : Glomerulonefritis, Mielonefritis, Ginjal polikistik, Tbc ginjal<br />
Penyakit ginjal sekunder : Nefritis lupus, Nefropati, Amilordosis ginjal, Poliarteritis nodasa, Sclerosis sistemik progresif, Gout, Dm</span><span lang="EN-US" style="color: black;">.</span><span style="color: black;"><br />
<b style="font-weight: normal;">2. Penyakit ginjal obstruktif : pembesaran prostat,Batu saluran kemih, Refluks ureter,</b><b style="mso-bidi-font-weight: normal;"><br />
</b>Secara garis besar penyebab gagal ginjal dapat dikategorikan</span><span style="color: black;"> </span><span style="color: black;">Infeksi yang berulang dan</span><span style="color: black;"> </span><span style="color: black;">nefron yang memburuk</span><span style="color: black;"> </span><span style="color: black;">Obstruksi saluran kemih</span><span lang="EN-US" style="color: black;">, </span><span style="color: black;">Destruksi pembuluh darah akibat diabetes dan hipertensi yang lama</span></div><div style="font-family: Times,"Times New Roman",serif; line-height: 115%; margin-left: 7.1pt;"><span style="color: black;"> </span><span style="color: black;"> <span lang="EN-US"></span></span></div><div style="font-family: Times,"Times New Roman",serif; line-height: 115%; margin-left: 34pt; text-indent: -18pt;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: black;">B.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; 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 style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: black;">SARAN</span></b></div><div style="font-family: Times,"Times New Roman",serif; line-height: 115%; margin-left: 21.3pt;"><span lang="EN-US" style="color: black;">Jadi diet untuk penyakit Gagal Ginjal Kronis sebaiknya:</span></div><div style="font-family: Times,"Times New Roman",serif; line-height: 115%; margin-left: 36pt; text-indent: -18pt;"><span lang="EN-US" style="color: black;">1.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; 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="EN-US" style="color: black;">Makanan yang </span><span style="color: black;">Dianjurkan</span><span lang="EN-US" style="color: black;">: </span><span style="color: black;">Nasi, bihun, jagung, kentang, makaroni, mi, tepung-tepungan, singkong, ubi, selai, madu, telur, daging ayam, daging, ikan, susu, minyak jagung, minyak sawit, semua sayuran dan buah kecuali yan mengandung kalium tinggi bagi penderita hiperkalemia tidak disarankan</span><span lang="EN-US" style="color: black;"></span></div><div style="font-family: Times,"Times New Roman",serif; line-height: 115%; margin-left: 36pt; text-indent: -18pt;"><span lang="EN-US" style="color: black;">2.<span style="-moz-font-feature-settings: normal; -moz-font-language-override: normal; 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="EN-US" style="color: black;">Makanan yang </span><span style="color: black;">Tidak Dianjurkan</span><span lang="EN-US" style="color: black;">: </span><span style="color: black;">Kacang-kacangan dan hasil olahannya (tahu tempe), kelapa, santan, minyak kelapa, margarin, lemak hewan dan sayuran dan buah yang tinggi kal</span><span lang="EN-US" style="color: black;">i</span><span style="color: black;">um.<br style="mso-special-character: line-break;" /> <br style="mso-special-character: line-break;" /> </span><span lang="EN-US" style="color: black;"></span></div><div style="font-family: Times,"Times New Roman",serif; line-height: 115%;"><br />
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</div><div style="font-family: Times,"Times New Roman",serif; line-height: 115%;"><br />
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</div><div align="center" style="font-family: Times,"Times New Roman",serif; line-height: 115%; margin-left: 7.1pt; text-align: center;"><b><span style="color: black; letter-spacing: -0.1pt;">DAFTAR PUSTAKA</span></b><span lang="EN-US" style="color: black;"></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">1. Sukandar, Enday. 2006. Gagal Ginjal dan Panduan Terapi Dialisis. Pusat Informasi </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">Ilmiah Bagian Ilmu Penyakit Dalam FK.UNPAD. Bandung. </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">2. Perhimpunan Dokter Spesialis Penyakit Dalam Indonesia. 2006. Buku Ajar Ilmu </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">Penyakit Dalam Jilid 1 Edisi 4. Balai Penerbitan Dep. IPP. FKUI. Jakarta </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">3. http://hanif.web.ugm.ac.id/gagal-ginjal-kronik.html </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">4. http://jiptunair/gdlsuharto-cox.html </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">5. Guyton and Hall.1997. Buku Ajar Fisiologi Kedokteran Edisi 9. EGC. Jakarta </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">6. Kapantow, Nova. 2008. Bahan Ajar Ilmu Gizi Klinik. Bagian Ilmu Gizi Fakultas Kedok- </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">teran, Universitas Sam Ratulangi. Manado </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">7. Mubin, Halim. 2007. Panduan Praktis Ilmu Penyakit Dalam Diagnosis dan Terapi Edisi </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">2. EGC. Jakarta. </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">8. Lintong, Poppy M. 2005. Ginjal Dan Saluran Kencing Bagian Bawah. Bagian Patologi </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0cm; text-align: justify;"><span style="color: black; font-size: 12pt; line-height: 115%;">Anatomi FK.UNSRAT. Manado </span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif;"><b><span style="font-size: 12pt; line-height: 115%;">Diposting Oleh : </span></b></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif;"><b><span style="font-size: 12pt; line-height: 115%;">Nama :Susanti</span></b></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif;"><b><span style="font-size: 12pt; line-height: 115%;">NIM :05200ID09036</span></b></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif;"><b><span style="font-size: 12pt; line-height: 115%;">Kelas :2A </span></b></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif;"><b><span style="font-size: 12pt; line-height: 115%;">Kelompok :1</span></b></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif;"><b><span style="font-size: 12pt; line-height: 115%;"> -Anisah Nur Azizah</span></b></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif;"><b><span style="font-size: 12pt; line-height: 115%;"> -Asep Diki Permana</span></b></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif;"><b><span style="font-size: 12pt; line-height: 115%;"> -Farid Maroef Maulana Ishak</span></b></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif;"><b><span style="font-size: 12pt; line-height: 115%;"> -Lina Ratiana</span></b></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif;"><b><span style="font-size: 12pt; line-height: 115%;"> -Pipit Puspita Permana</span></b></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif;"><b><span style="font-size: 12pt; line-height: 115%;"> -Rini Yulianai</span></b></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif;"><b><span style="font-size: 12pt; line-height: 115%;"> -Susanti</span></b></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif;"><b><span style="font-size: 12pt; line-height: 115%;"> -Ucu Cahyati</span></b></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif;"><br />
</div><div align="center" class="MsoNormal" style="font-family: Times,"Times New Roman",serif; text-align: center;"><b><span style="font-size: 12pt; line-height: 115%;">MAHASISWA AKPER PEMDA GARUT</span></b></div><div align="center" class="MsoNormal" style="font-family: Times,"Times New Roman",serif; text-align: center;"><br />
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<div align="center" class="MsoNormal" style="text-align: center;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">BAB I </span></b></div><div align="center" class="MsoNormal" style="text-align: center;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">PENDAHULUAN</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;"></span></b></div><div class="MsoNormal"><br />
</div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 17.85pt; margin-right: 0cm; margin-top: 0cm; mso-list: l13 level1 lfo11; text-align: justify; text-indent: -17.85pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">A.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Latar Belakang</span></b></div><div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Tindakan keperawatan tidak terlepas dari beberapa metode yang berhubungan dengan penyakitnya itu sendiri. Seperti halnya pada gangguan sistem </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US;">Urinaria, <span style="letter-spacing: -.5pt;">anomali </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%;">pada ginjal,ialah</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%; mso-ansi-language: EN-US;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%;">penggabungan kedua ginjal kanan dan kiri oleh bagian yang disebut isthmus</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%; mso-ansi-language: EN-US;"> </span><span class="ff44"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%;">melalui kedua pole (extremitas) atas atau</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%;"> bawah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%; mso-ansi-language: EN-US;">. </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%;">Yang terbanyak penyatuan kedua pole bawah, sedang</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.6pt; line-height: 115%;">kan kedua pole atas hanya sekitar 5 — 10%</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.6pt; line-height: 115%; mso-ansi-language: EN-US;"> .Besarnya </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.6pt; line-height: 115%;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%;">isthmus sangat bervariasi, kadang-kadang merupakan bagian yang lengkap terdiri dari jaringan ginjal (parenchymatous tissue), tetapi pada beberapa kasus, hanya merupakan bagian kecil yang terdiri dari jaringan ikat (fibrous tissue)</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%; mso-ansi-language: EN-US;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Untuk memahami dan mengetahui lebih lanjut maka penulis mencoba untuk membahas mengenai inhalasi pada bab berikutnya.</span></div><div class="MsoNormal" style="text-align: justify;"><br />
</div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 17.85pt; margin-right: 0cm; margin-top: 0cm; mso-list: l13 level1 lfo11; text-align: justify; text-indent: -17.85pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">B.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Rumusan Masalah</span></b></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.85pt; margin-right: 0cm; margin-top: 0cm; mso-list: l1 level1 lfo12; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; 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: 115%;">Apa anomali pada ginja</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US;"> itu</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">?</span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.85pt; margin-right: 0cm; margin-top: 0cm; mso-list: l1 level1 lfo12; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; 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 lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US;">Apa saja anomali kongential?</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.85pt; margin-right: 0cm; margin-top: 0cm; mso-list: l1 level1 lfo12; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; 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 lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US;">Sistem yang berpengaruh pada anomali ginjal?</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.85pt; margin-right: 0cm; margin-top: 0cm; mso-list: l1 level1 lfo12; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; 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 lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US;">Apa tanda anomali pada ginjal?</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 17.85pt; margin-right: 0cm; margin-top: 0cm; mso-list: l13 level1 lfo11; text-align: justify; text-indent: -17.85pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">C.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Tujuan Penulisan</span></b></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 35.7pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo13; text-align: justify; text-indent: -14.4pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; 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: 115%;">Untuk mengetahui </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US;">anomali ginjal?</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo13; text-align: justify; text-indent: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; 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: 115%;">Untuk mengetahui </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US;">apa saja anomali kongential ?</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"></span></div><div class="MsoListParagraph" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l0 level1 lfo13; text-align: justify; text-indent: 7.1pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; 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: 115%;">Untuk </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US;">mengetahui system yang mempengaruhi anomali?</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 17.85pt; margin-right: 0cm; margin-top: 0cm; mso-list: l0 level1 lfo13; text-align: justify; text-indent: 3.45pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; 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 lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US;">Untuk mengetahui tanda anomali?</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"></span></div><div class="MsoListParagraph" style="margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; mso-list: l13 level1 lfo11; tab-stops: 14.2pt; text-align: justify; text-indent: 0cm;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">D.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US;">Sistematika Penulisan</span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"></span></b></div><div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US;">Makalah ini mterdiri dari 3 bab, Bab 1 Pendahuluan yang berisikan Latar Belakang, Rumusan Masalah, Tujuan Penulisan, dan sistematika Penulisan. Bab 2 Pembahasan. Bab 3 kesimpulan dan saran</span></div><div class="MsoNormal" style="text-align: justify;"><br />
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</div><div align="center" class="MsoNormal" style="text-align: center; text-indent: 36.0pt;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">BAB II </span></b></div><div align="center" class="MsoNormal" style="text-align: center; text-indent: 36.0pt;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">PEMBAHASAN</span></b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: EN-US;"></span></div><div align="center" class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: center;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="margin-left: 21.3pt; mso-add-space: auto; mso-list: l12 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-indent: -14.2pt;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">A.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Anomali Ginjal</span></b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%;"> </span><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 14.7pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%; mso-ansi-language: EN-US;">Anomali </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%;">pada ginjal,ialah</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%; mso-ansi-language: EN-US;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%;">penggabungan kedua ginjal kanan dan kiri oleh bagian yang disebut isthmus</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%; mso-ansi-language: EN-US;"> </span><span class="ff44"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%;">melalui kedua pole (extremitas) atas atau</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%;"> bawah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%; mso-ansi-language: EN-US;">. </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%;">Yang terbanyak penyatuan kedua pole bawah, sedang</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.6pt; line-height: 115%;">kan kedua pole atas hanya sekitar 5 — 10%</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.6pt; line-height: 115%; mso-ansi-language: EN-US;"> .Besarnya </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.6pt; line-height: 115%;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%;">isthmus sangat bervariasi, kadang-kadang merupakan bagian yang lengkap terdiri dari jaringan ginjal (parenchymatous tissue), tetapi pada beberapa kasus, hanya merupakan bagian kecil yang terdiri dari jaringan ikat (fibrous tissue)</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%; mso-ansi-language: EN-US;"> . </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%;">Dari </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.35pt; line-height: 115%;">hasil</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.35pt; line-height: 115%; mso-ansi-language: EN-US;"> </span><span class="ff16"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%;">autopsi, anomali ini tidak jarang dijumpai, meliputi</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.35pt; line-height: 115%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%;">1 : 600 sampai 1 : 800 dari seluruh kasus</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%; mso-ansi-language: EN-US;">. </span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 14.7pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%; mso-ansi-language: EN-US;">Letak kedua </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%;"><span style="mso-spacerun: yes;"> </span>ginjal relatip lebih berdekatan dan lebih rendah dari biasa, 40% diantaranya mencapai ketinggian normal Kedua ginjal biasanya terdapat pada sisi yang berlainan,</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.6pt; line-height: 115%; mso-ansi-language: EN-US;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%;">di kanan kiri columna vertebralis, bisa juga keduanya terletak pada satu sisi, dalam hal ini salah satu di antara kedua ginjal tersebut terletak di atas lainnya</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%; mso-ansi-language: EN-US;"> .</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 14.7pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="mso-add-space: auto; mso-list: l12 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">B.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Anomali-anomali kongential yang sering terjadi pada system urinarius antara lain sebagai berikut : </span></b></div><div class="MsoListParagraphCxSpMiddle" style="mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 2.0cm; mso-add-space: auto; mso-list: l2 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Ginjal polikistik </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">yaitu adanya kista-kista di ginjal yang menyebabkan insufisiensi.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 70.9pt; mso-add-space: auto; mso-list: l2 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -14.2pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Agenesis</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> ginjal </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">yaitu kegagalan pembentukan ginjal<span style="mso-spacerun: yes;"> </span>dan dapat bersifat unilateral maupun bilateral.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 63.8pt; mso-add-space: auto; mso-list: l2 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -7.1pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Duplikasi ureter parsial atau lengkap.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 70.9pt; mso-add-space: auto; mso-list: l2 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -14.2pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Ureter ektopik, yaitu ureter yang ujungnya tidak bermuara ke kandung kemih melainkan organ-organ lain seperti uretra atau vagina.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 70.9pt; mso-add-space: auto; mso-list: l2 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -14.2pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Ginjal </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">pelvis, yaitu</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> ginjal </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">yang gagal naik ke rongga perut.<span style="mso-bidi-font-weight: bold;"> </span></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 70.9pt; mso-add-space: auto; mso-list: l2 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -14.2pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Ginjal </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">tapal kuda, yaitu ujung kaudal kedua ginjal<span style="mso-spacerun: yes;"> </span>mengalami penyatuan</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 70.9pt; mso-add-space: auto; mso-list: l2 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -14.2pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">7.<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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Arteri renalis asesorius, yaitu menetapnya pembuluh-pembuluh darah embrional pada ginjal</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 70.9pt; mso-add-space: auto; mso-list: l2 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -14.2pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">8.<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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Fistula/kista/sinus urakus, yaitu fistula/kista/sinus yang terbentuk antara kandung kemih dan lumen allantois.</span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 70.9pt; mso-add-space: auto; mso-list: l2 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -14.2pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">9.<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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Ekstrofi kandung kemih, yaitu mukosa kandung kemih yang terpajan ke udara luar.</span></div><div class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br />
</div><div class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="mso-add-space: auto; mso-list: l12 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">C.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Sistem genitalis</span></b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 2.0cm; mso-add-space: auto; mso-list: l4 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -14.15pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><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: 115%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pembentukan gonad, duktus genitalis, dan genital eksterna primitif (indiferen)</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormal" style="margin-left: 36.0pt; 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: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Gonad primitive<b> </b></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">dibentuk oleh <span style="mso-bidi-font-weight: bold;">rigi gonad</span> yang merupakan hasil proliferasi epitel selom dan pemadatan mesenkim di bawahnya.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Pada </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">minggu ke-6 setelah pembuahan, sel-sel benih primordial datang dan mencapai gonad. Sel-sel benih primordial inilah yang akan menentukan apakah gonad indiferen primitif ini kelak berkembang menjadi testis</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">( pada </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">pria) atau ovarium </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">(pada </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">wanita).<span style="mso-bidi-font-weight: bold;">Duktus genitalis primitif<b> </b></span>terbentuk dari <span style="mso-bidi-font-weight: bold;">duktus mesonefros<b> </b></span>dan <span style="mso-bidi-font-weight: bold;">duktus paramesonefros.</span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormal" style="margin-left: 36.0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Genital eksterna primitif<b> </b></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">terbentuk dari sel-sel mesenkim yang bermigrasi ke daerah kloaka pada<span style="mso-spacerun: yes;"> </span>minggu ke-3, membentuk <span style="mso-bidi-font-weight: bold;">lipatan kloaka</span>. Bagian kranial lipatan kloaka disebut <span style="mso-bidi-font-weight: bold;">tuberkulum<b> </b>genital</span> (yang nantinya akan berkembang menjadi klitoris</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> pada </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">wanita, atau phallu</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">s pada </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-spacerun: yes;"> </span>pria). Selain itu lipatan kloaka terbagi dua menjadi <span style="mso-bidi-font-weight: bold;">lipatan uretra</span> dan <span style="mso-bidi-font-weight: bold;">lipatan anus.</span> Membran di antara lipatan uretra disebut <span style="mso-bidi-font-weight: bold;">membran urogenital</span>, sedang membran di antara lipatan anus disebut <span style="mso-bidi-font-weight: bold;">membran analis.</span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoListParagraphCxSpFirst" style="margin-left: 38.25pt; mso-add-space: auto; mso-list: l4 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><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: 115%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pembentukan sistem genitalis <span style="color: black;">pada</span> pria</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 54.0pt; mso-add-space: auto; mso-list: l7 level1 lfo10; 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: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: IN;"><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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pembentukan testis</span></div><div class="MsoNormal" style="margin-left: 36.0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Kromosom Y yang terdapa</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">t pada </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-spacerun: yes;"> </span>embrio (pria) akan mengubah gonad primitif menjadi <span style="mso-bidi-font-weight: bold;">testis.<b> </b></span>Ciri khas dari pembentukan testis adalah perkembangan bagian medula yang lebih pesat dibandingkan dengan bagian korteks yang menghilang. Bagian medula akan berkembang menjadi <span style="mso-bidi-font-weight: bold;">tubulus seminiferus</span>, sedangkan di bagian perifernya akan muncul <span style="mso-bidi-font-weight: bold;">tunika albuginea</span> yang merupakan suatu jaringan ikat fibrosa. Selain itu terdapat <span style="mso-bidi-font-weight: bold;">sel Sertoli<b> </b></span>(berasal dari epitel permukaan kelenjar) dan <span style="mso-bidi-font-weight: bold;">sel Leydig<b> </b></span>(berasal dari rigi kelamin)</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> pada </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-spacerun: yes;"> </span>korda testis. Tubulus seminiferus akan terhubung ke duktus mesonefros melalui saluran <span style="mso-bidi-font-weight: bold;">duktus eferens.</span></span></div><div class="MsoNormal" style="margin-left: 36.0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Kemudia</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">n pada </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-spacerun: yes;"> </span>akhir bulan ke-2 akan terjadi perubahan posisi testis menjadi lebih turun (mendekati posisi phallus/penis). Penyebab penurunan (desensus) testis ini masih belum jelas, namun diperkirakan perkembangan organ-organ abdomen yang begitu pesat akan mendorong turun testis.Pembentukan duktus genitalis</span></div><div class="MsoNormal" style="margin-left: 36.0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Duktus genitali</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">s pada </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-spacerun: yes;"> </span>pria terbentuk dari <span style="mso-bidi-font-weight: bold;">duktus mesonefros,<b> </b></span>sedangkan duktus paramesonefros menghilang. Duktus mesonefros akan berhubungan dengan tubulus seminiferus (testis) melalui <span style="mso-bidi-font-weight: bold;">duktus eferens</span>, sedangkan bagian duktus mesonefros yang masih melekat di testis namun tidak membentuk hubungan dengan testis disebut <span style="mso-bidi-font-weight: bold;">epididimis</span>. Bagian selanjutnya dari duktus mesonefros berbentuk panjang dandisebut <span style="mso-bidi-font-weight: bold;">duktus deferens<b> </b></span>yang berujung ke <span style="mso-bidi-font-weight: bold;">vesikulaseminalis.<b> </b></span>Daerah duktus lain di luar vesikula seminalis disebut <span style="mso-bidi-font-weight: bold;">duktus ejakulotorius.</span></span></div><div class="MsoListParagraph" style="margin-left: 54.0pt; mso-add-space: auto; mso-list: l9 level1 lfo9; 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: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: IN;"><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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pembentukan genital eksternal</span></div><div class="MsoNormal" style="margin-left: 36.0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pembentukan genital eksternal pria <span style="mso-bidi-font-weight: bold;">(phallus/penis)<b> </b></span>merupakan hasil pemanjangan <span style="mso-bidi-font-weight: bold;">tuberkulum genital</span> di bawah pengaruh hormon androgen. Lipatan uretra akan menutup membentuk <span style="mso-bidi-font-weight: bold;">uretra pars kavernosa<b>, </b></span>sehingga bagian uretra harus memanjang hingga ke ujung penis dan keluar melalui <span style="mso-bidi-font-weight: bold;">orifisium uretra eksternum.</span></span></div><div class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 36.0pt;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="margin-left: 14.2pt; mso-add-space: auto; mso-list: l4 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 7.1pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><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: 115%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pembentukan sistem genitalis <span style="color: black;">pada</span> wanita</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 38.25pt; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 36.0pt;"><br />
</div><div class="MsoListParagraphCxSpLast" style="margin-left: 49.65pt; mso-add-space: auto; mso-list: l3 level1 lfo8; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -14.2pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: IN;"><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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pembentukan ovarium</span></div><div class="MsoNormal" style="margin-left: 36.0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Berbed</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">a pada </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-spacerun: yes;"> </span>pembentukan testis dari gonad primitif</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">, pada </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-spacerun: yes;"> </span>pembentukan <span style="mso-bidi-font-weight: bold;">ovarium</span> akan terjadi perkembangan (penebalan) bagian korteks yang pesat membentuk <span style="mso-bidi-font-weight: bold;">korda korteks</span> sedangkan bagian medulanya menghilang dan digantikan oleh <span style="mso-bidi-font-weight: bold;">medula ovarium</span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">. Pada<b> </b></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-spacerun: yes;"> </span>bulan ke-4 telah terdapat oogonia dan sel folikule</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">r pada </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-spacerun: yes;"> </span>ovarium. Selanjutnya ovarium akan mengalami perubahan posisi menjadi sedikit lebih turun (desensus) hingga terletak di bawah tepi pelvis sejati.</span></div><div class="MsoListParagraph" style="margin-left: 2.0cm; mso-add-space: auto; mso-list: l6 level1 lfo7; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -21.25pt;"><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: IN;"><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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pembentukan duktus genitalis dan vagina</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormal" style="margin-left: 36.0pt; 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: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pada </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">pembentukan duktus genitalis wanita, bagian yang berkembangmenjadi duktus adalah <span style="mso-bidi-font-weight: bold;">duktus paramesonefros</span>, sedangkan duktus mesonefros akan menghilang. <span style="mso-bidi-font-weight: bold;">Tuba uterina<b> </b></span>terbentuk dari bagian kranial duktus paramesonefros, sedangkan bagian kaudalnya akan bertemu dengan duktus paramesonefros lain dari sisi ipsilateral, menyatu dan mengalami penebalan-penebalan sehingga terbentuklah <span style="mso-bidi-font-weight: bold;">korpus uteri</span> dan <span style="mso-bidi-font-weight: bold;">serviks. </span>Ujung padat duktus paramesonefros ini akan mengalami penojolan yang disebut <span style="mso-bidi-font-weight: bold;">bulbus sinovaginalis</span> yang berproliferasi membentuk <span style="mso-bidi-font-weight: bold;">lempeng vagina.<b> </b></span>Pelebara</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> pada </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-spacerun: yes;"> </span>lempeng vagina akan membentuk <span style="mso-bidi-font-weight: bold;">forniks vagina<b> </b></span>yang terdapat lumen di tengahnya, kelak berkembang menjadi <span style="mso-bidi-font-weight: bold;">selaput dara (himen).</span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoListParagraph" style="margin-left: 42.55pt; mso-add-space: auto; mso-list: l5 level1 lfo6; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: IN;"><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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pembentukan genital eksternal</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormal" style="margin-left: 36.0pt; 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: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pada</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> wanita, tuberkulum genital primitif akan sedikit memanjang membantuk <span style="mso-bidi-font-weight: bold;">klitoris,<b> </b></span>sedangkan lipatan uretra tetap terbuka membantuk <span style="mso-bidi-font-weight: bold;">labia minor<b>. </b></span>Tonjol kelamin membesar dan membentuk <span style="mso-bidi-font-weight: bold;">labia minor,<b> </b></span>sedang alur urogenital terbuka dan membentuk <span style="mso-bidi-font-weight: bold;">vestibulum.</span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormal" style="margin-left: 36.0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 36.0pt;"><br />
</div><div class="MsoListParagraph" style="margin-left: 49.65pt; mso-add-space: auto; mso-list: l11 level1 lfo5; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -.55pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: IN;"><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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pembentukan duktus genitalis dan vagina</span></div><div class="MsoNormal" style="margin-left: 36.0pt; 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: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pada </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">pembentukan duktus genitalis wanita, bagian yang berkembangmenjadi duktus adalah <span style="mso-bidi-font-weight: bold;">duktus paramesonefros</span>, sedangkan duktus mesonefros akan menghilang. <span style="mso-bidi-font-weight: bold;">Tuba uterina<b> </b></span>terbentuk dari bagian kranial duktus paramesonefros, sedangkan bagian kaudalnya akan bertemu dengan duktus paramesonefros lain dari sisi ipsilateral, menyatu dan mengalami penebalan-penebalan sehingga terbentuklah <span style="mso-bidi-font-weight: bold;">korpus uteri</span> dan <span style="mso-bidi-font-weight: bold;">serviks.<b> </b></span>Ujung padat duktus paramesonefros ini akan mengalami penojolan yang disebut <span style="mso-bidi-font-weight: bold;">bulbus sinovaginalis</span> yang berproliferasi membentuk <span style="mso-bidi-font-weight: bold;">lempeng vagina.<b> </b></span>Pelebara</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">n pada </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-spacerun: yes;"> </span>lempeng vagina akan membentuk <span style="mso-bidi-font-weight: bold;">forniks vagina<b> </b></span>yang terdapat lumen di tengahnya, kelak berkembang menjadi <span style="mso-bidi-font-weight: bold;">selaput dara (himen).</span></span></div><div class="MsoListParagraph" style="mso-add-space: auto; mso-list: l11 level1 lfo5; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 6.55pt;"><span lang="EN-US" style="font-family: Symbol; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; mso-fareast-language: IN;"><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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pembentukan genital eksternal</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormal" style="margin-left: 36.0pt; 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: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pada </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">wanita, tuberkulum genital primitif akan sedikit memanjang membantuk <span style="mso-bidi-font-weight: bold;">klitoris,<b> </b></span>sedangkan lipatan uretra tetap terbuka membantuk <span style="mso-bidi-font-weight: bold;">labia minor.<b> </b></span>Tonjol kelamin membesar dan membentuk <span style="mso-bidi-font-weight: bold;">labia minor,<b> </b></span>sedang alur urogenital terbuka dan membentuk <span style="mso-bidi-font-weight: bold;">vestibulum</span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">. </span></div><div class="MsoListParagraphCxSpFirst" style="mso-add-space: auto; mso-list: l12 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">D.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b><span style="color: black; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Anomali</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> sistem genitalia</span></b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoListParagraphCxSpMiddle" style="mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 74.25pt; mso-add-space: auto; mso-list: l10 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Duplikasi uterus, yang disebabkan oleh kegagalan penyatuan kedua duktus paramesonefros dari sisi yang berlawanan sehingga terbentuklah dua uterus dan dua vagina.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 74.25pt; mso-add-space: auto; mso-list: l10 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Uterus didelfis, yaitu jumlah rahim ganda.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 74.25pt; mso-add-space: auto; mso-list: l10 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Uterus arkuatus, yaitu lekukan fundus uteri ke dalam di garis tengahnya.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 74.25pt; mso-add-space: auto; mso-list: l10 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Uterus bikornis, yaitu uterus memiliki dua tanduk yang masuk ke satu rahim yang sama.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 74.25pt; mso-add-space: auto; mso-list: l10 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Atresia serviks atau atresia vagina, yaitu penyumbatan uterus atau vagina.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 74.25pt; mso-add-space: auto; mso-list: l10 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">6.<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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Epispadia, yaitu muara uretra yang berada di dorsum penis, bukan di orifisium uretra eksternum.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 74.25pt; mso-add-space: auto; mso-list: l10 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">7.<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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Ekstrofi kandung kemih, yaitu apabila mukosa kandung kemih terpapar ke dunia luar.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 74.25pt; mso-add-space: auto; mso-list: l10 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">8.<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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Mikropenis, yaitu perangsangan androgen yang tidak cukup sehingga genitalia eksterna kurang bertumbuh dengan baik.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 74.25pt; mso-add-space: auto; mso-list: l10 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">9.<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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Penis bifida dan penis dupleks, terjadi apabila tuberkulum genital membelah.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 74.25pt; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 74.25pt; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 74.25pt; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 74.25pt; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 74.25pt; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="mso-add-space: auto; mso-list: l12 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; 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: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">E.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Tanda dan Gejala Anomali Ginjal</span></b></div><div class="MsoListParagraphCxSpMiddle" style="mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%;">P</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">e<span style="letter-spacing: -.5pt;">nderita anomali ini biasanya tanpa keluhan, tetapi bila timbul penyakit penyulit, bisa terjadi hydronephrose, recurent pyelonephritis, haematuria dan batu ginjal</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%; mso-ansi-language: EN-US;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%;">Keluhan yang terjadi bisa berupa rasa mual dan sakit perut yang </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.35pt; line-height: 115%;">disertai</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.35pt; line-height: 115%; mso-ansi-language: EN-US;"> </span><span class="ff44"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.6pt; line-height: 115%;">kekejangan (R</span></span><span class="ff44"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">o<span style="letter-spacing: -.6pt;">vsing syndrome). Kehamilan pada</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.35pt; line-height: 115%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%;">penderita anomali ini 1/3 di antaranya mendapat kesulitan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%; mso-ansi-language: EN-US;"></span></div><div class="MsoListParagraphCxSpLast" style="mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br />
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</div><div align="center" class="MsoNormal" style="text-align: center;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">BAB III</span></b></div><div align="center" class="MsoNormal" style="text-align: center;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">KESIMPULAN DAN SARAN</span></b></div><div class="MsoNormal" style="text-align: justify;"><br />
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</div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 17.85pt; margin-right: 0cm; margin-top: 0cm; mso-list: l8 level1 lfo14; text-align: justify; text-indent: -17.85pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">A.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Kesimpulan</span></b></div><div class="MsoNormal" style="text-indent: 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%;">Horseshoe kidney merupakan anomali yang tidak jarang dijumpai. Di dalam autopsi didapati rata-rata 1 di dalam 600 — </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.6pt; line-height: 115%;">800 kasus. Pada umumnya penggabungan terjadi pada</span><span class="ff54"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.25pt; line-height: 115%;">pole</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.6pt; line-height: 115%;"> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%;">bawah, akan tetapi pada + 10% kasus terjadi pada pole atas. Pada laki-laki lebih sering terjadi dari pada wanita dengan perbandingan 2 : 1. Gejala-gejala klinis yang terjadi disebabkan oleh adanya tek</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%; mso-ansi-language: EN-US;">a</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%;">nan pada ureter oleh bagian yang menghubungkan kedua ginjal (isthmus), yang<span class="ff23">mengakibatkan terjadinya obstruksi</span> </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.35pt; line-height: 115%;">aliran</span><span class="ff43"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; letter-spacing: -.5pt; line-height: 115%;">kemih</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;"></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 17.85pt; margin-right: 0cm; margin-top: 0cm; mso-list: l8 level1 lfo14; text-align: justify; text-indent: -17.85pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">B.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Saran </span></b></div><div class="MsoNormal" style="margin-left: 17.85pt; text-align: justify; text-indent: 18.15pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">Ginjal merupakan organ yang sangat penting bagi tubuh, dan jika terkena penyakit merupakan serangan yang sistemik. Oleh karena itu, sebagai perawat kita harus menjaga dan meningkatkan kualitas <span style="mso-spacerun: yes;"> </span>hidup pasiennya. Dengan cara melaksanakan askep sesuai dengan kebutuhan pasien, khususnya pada anomali ginjal (urogenital). Kita juga harus memberikan saran kepada pasien agar hidup pola sehat.</span></div><div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt;"><br />
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</div><div class="MsoNormal"><span class="ff24"><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; letter-spacing: -.6pt; line-height: 115%;">Brass JC. Cunningham's Text-book of Anatomi 95h.ed. London,</span></span><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; letter-spacing: -1.1pt; line-height: 115%;"> </span></div><div class="MsoNormal"><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; letter-spacing: -.6pt; line-height: 115%;">New York, Chicago: Oxford U</span><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">n<span style="letter-spacing: -.6pt;">iv Press. 1951 : 736. </span></span></div><div class="MsoNormal"><span class="ff56"><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; letter-spacing: -.5pt; line-height: 115%;">Cafey J. P</span></span><span class="ff56"><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">e<span style="letter-spacing: -.5pt;">diatric X-Ray Diagnosis. 2nd.ed. Chicago: Year Book</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; letter-spacing: -.6pt; line-height: 115%;"> </span></div><div class="MsoNormal"><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; letter-spacing: -.7pt; line-height: 115%;">Publ Inc. 6 — 8. </span></div><div class="MsoNormal"><span class="ff43"><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; letter-spacing: -.5pt; line-height: 115%;">F</span></span><span class="ff43"><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">a<span style="letter-spacing: -.5pt;">ber M et al. Anomalies of the kidney and ureter. Clin Obst</span></span></span><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; letter-spacing: -1.3pt; line-height: 115%;"> </span></div><div class="MsoNormal"><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; letter-spacing: -.6pt; line-height: 115%;">Gynaec 21(3</span><span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 115%;">)<span style="letter-spacing: -.6pt;"> 1978: 831 — 43. </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 14.0pt; letter-spacing: -.6pt; line-height: 115%; mso-ansi-language: EN-US;"></span></div><div class="MsoNormal"><a href="http://anomali/"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 14.0pt; letter-spacing: -.6pt; line-height: 115%; mso-ansi-language: EN-US;">http://anomali</span></a><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 14.0pt; letter-spacing: -.6pt; line-height: 115%; mso-ansi-language: EN-US;"> ginjal.com </span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">Diposting Oleh : </span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">Nama <span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>:Ucu Cahyati</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">NIM<span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>:05200ID09038</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">Kelas<span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>:2A<span style="mso-tab-count: 1;"> </span></span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">Kelompok<span style="mso-tab-count: 1;"> </span>:1</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>-Anisah Nur Azizah</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>-Asep Diki Permana</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>-Farid Maroef Maulana Ishak</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>-Lina Ratiana</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>-Pipit Puspita Permana</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 2;"> </span>-Rini Yulianai</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 2;"> </span>-Susanti</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 2;"> </span>-Ucu Cahyati</span></b></div><div class="MsoNormal"><br />
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</div>TEAM_ONE KMB 2A AKPEM GARUThttp://www.blogger.com/profile/01719877433346227735noreply@blogger.com0tag:blogger.com,1999:blog-1245729285541543255.post-28595487263159380312011-04-07T21:04:00.000-07:002011-04-07T21:04:16.628-07:00tugas KMB ke-12 (TUMOR GINJAL)<!--[if gte mso 9]><xml> <o:OfficeDocumentSettings> <o:RelyOnVML/> <o:AllowPNG/> </o:OfficeDocumentSettings> </xml><![endif]--><!--[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>IN</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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<h3 class="post-title entry-title"><br />
</h3><div class="post-header"> </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"; font-size: 14pt; line-height: 150%;">TUMOR GINJAL</span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><i style="mso-bidi-font-style: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diajukan untuk memenuhi salah satu tugas kelompok mata kuliah</span></i><i style="mso-bidi-font-style: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></i></div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><i style="mso-bidi-font-style: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Keperawatan Medikal Bedah III</span></i></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"; font-size: 12pt; line-height: 150%;">MAKALAH</span></b></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggOBQv_LX4WK3xHI9dDYn3uAo9dM_ynsDLnSwEkXJzz4zBZyxSalrWkISa9eVGW9Tat7pfm8xCiY4zu9muyU9E-UGng_T9XhOaRBgoP2EQjTFZ3wR7myL2C64jyQNd-xuate-9YQbyyYwK/s1600/pemda.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggOBQv_LX4WK3xHI9dDYn3uAo9dM_ynsDLnSwEkXJzz4zBZyxSalrWkISa9eVGW9Tat7pfm8xCiY4zu9muyU9E-UGng_T9XhOaRBgoP2EQjTFZ3wR7myL2C64jyQNd-xuate-9YQbyyYwK/s1600/pemda.jpg" /></a></div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Disusun oleh:</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div align="center" class="MsoNormal" style="line-height: normal; text-align: center;"><b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">FARID MA'ROEF MAULANA I</span></u></b><b style="mso-bidi-font-weight: normal;"><u><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></u></b></div><div align="center" class="MsoNormal" style="line-height: normal; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">05200ID09011</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tingkat 2A</span></b><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoNormal" style="line-height: 150%;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">AKADEMI KEPERAWATAN</span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">PEMERINTAH KABUPATEN GARUT</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">2011</span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><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"; font-size: 12pt; line-height: 150%;">BAB I</span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">PENDAHULUAN</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 style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">1.1 Latar belakang masalah</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: 35.45pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Ginjal adalah bagian dari saluran air seni (kencing). Mereka membuat urin dengan mengeluarkan pembuangan dan kelebihan air dari darah. Urin berkumpul didalam suatu ruang berongga (<span style="mso-bidi-font-weight: bold;">renal pelvis</span>) ditengah-tengah dari setiap ginjal. Ia mengalir dari renal pelvis kedalam kantong kemih melalui suatu tabung yang disebut suatu <span style="mso-bidi-font-weight: bold;">ureter</span>. Urin meninggalkan tubuh melalui tabung lain (<span style="mso-bidi-font-weight: bold;">urethra</span>). Ginjal-ginjal juga membuat senyawa-senyawa yang membantu mengontrol tekanan darah dan produksi dari sel-sel darah merah. </span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">1.2 Rumusan Masalah</span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 12.0pt; tab-stops: 18.0pt; text-align: justify;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: SV;"><span style="mso-tab-count: 2;"> </span>Rumusan masalah yang terdapat pada makalah ini antara lain membahas tentang ” Tumor pada Ginjal”.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: SV;">1.3</span></b><b><span lang="IT-CH" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IT-CH;"> Metode Penyusunan</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"></span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 12.0pt; tab-stops: 18.0pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"><span style="mso-tab-count: 2;"> </span></span><span lang="IT-CH" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IT-CH;">Adapun metode yang kami gunakan dalam penyusunan makalah ini adalah dengan<span style="mso-spacerun: yes;"> </span>mencari sumber informasi berdasarkan website-website di internet.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><b><span lang="IT-CH" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IT-CH;">1.4Tujuan Penyusunan</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"></span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 12.0pt; tab-stops: 18.0pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"><span style="mso-tab-count: 2;"> </span></span><span lang="IT-CH" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IT-CH;">Adapun tujuan dari penyusunan makalah ini adalah untuk memenuhi salah satu tugas mata kuliah Keperawatan Medikal Bedah III dan untuk menambah khazanah ilmu pengetahuan.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 12.0pt; tab-stops: 18.0pt; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: SV;">1.5 Sistematika Penulisan</span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">BAB I</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">PENDAHULUAN</span></div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 18.0pt; mso-list: l6 level2 lfo1; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" 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;">1.1<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Latar Belakang Masalah</span></div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 18.0pt; mso-list: l6 level2 lfo1; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" 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;">1.2<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">. Rumusan Masalah</span></div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 18.0pt; mso-list: l6 level2 lfo1; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" 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;">1.3<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>Metoda Penyusunan</span></div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 18.0pt; mso-list: l6 level2 lfo1; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" 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;">1.4<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Tujuan penyusunan</span></div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 18.0pt; mso-list: l6 level2 lfo1; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" 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;">1.5<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Sistematika Penyusunan</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">BAB II</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">PEMBAHASAN</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">2.1 Pengertian</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">2.2 Jenis-jenis Tumor</span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 2; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">2.3 Yang mungkin berisiko Pada Kanker Ginjal </span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 2; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2.4 <span style="mso-bidi-font-weight: bold;">Gejala-Gejala Kanker Ginjal</span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 18.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"> </span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 2;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">2.5 Mendiagnosis Kanker Ginjal</span></div><h2 style="line-height: 150%;"><span lang="EN-US" style="font-size: 12.0pt; font-weight: normal; line-height: 150%; mso-bidi-font-weight: bold;">2.6 Merawat Kanker Ginjal</span></h2><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 2; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 2; 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;"><br />
</div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br />
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</div><div align="center" class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">BAB II</span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">PEMBAHASAN</span></b></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2.1 Pengertian</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: 42.55pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Ginjal adalah sepasang organ pada setiap sisi dari tulang belakang (spine) didalam perut bagian bawah. Setiap ginjal adalah kira-kira seukuran kepalan tangan. Melekat pada puncak dari setiap ginjal adalah suatu kelenjar adrenal. Suatu massa dari jaringan yang berlemak dan suatu lapisan luar dari jaringan yang berserat (Gerota's fascia) menyelubungi ginjal-ginjal dan kelenjar-kelenjar adrenal. </span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 42.55pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Ginjal adalah bagian dari saluran air seni (kencing). Mereka membuat urin dengan mengeluarkan pembuangan dan kelebihan air dari darah. Urin berkumpul didalam suatu ruang berongga (<b>renal pelvis</b>) ditengah-tengah dari setiap ginjal. Ia mengalir dari renal pelvis kedalam kantong kemih melalui suatu tabung yang disebut suatu <b>ureter</b>. Urin meninggalkan tubuh melalui tabung lain (<b>urethra</b>). Ginjal-ginjal juga membuat senyawa-senyawa yang membantu mengontrol tekanan darah dan produksi dari sel-sel darah merah. </span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 42.55pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kanker mulai pada sel-sel, blok-blok bangunan yang membentuk jaringan-jaringan. Jaringan-jaringan membentuk organ-organ tubuh. Secara normal, sel-sel tumbuh dan membelah untuk membentuk sel-sel baru ketika tubuh memerlukan mereka. Ketika sel-sel tumbuh menua, mereka mati, dan sel-sel baru mengambil tempat mereka. Adakalanya proses yang teratur ini berjalan salah. Sel-sel baru terbentuk ketika tubuh tidak memerlukan mereka, dan sel-sel tua tidak mati ketika mereka seharusnya mati. Sel-sel ekstra ini dapat membentuk suatu massa dari jaringan yang disebut suatu pertumbuhan atau tumor. </span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2.2 Jenis – jenis Tumor</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: 18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tumor-tumor dapat jinak atau ganas :</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 14.2pt; mso-list: l2 level1 lfo7; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -14.2pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 10.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt; 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 lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>Tumor-tumor jinak</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> adalah bukan kanker: </span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 42.55pt; mso-list: l7 level2 lfo5; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -7.1pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 10.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">a.</span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Tumor-tumor jinak adalah jarang mengancam nyawa. </span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 49.65pt; mso-list: l7 level2 lfo5; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -14.2pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 10.0pt; line-height: 150%; mso-bidi-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 lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Biasanya, tumor-tumor jinak dapat diangkat/dikeluarkan, dan mereka jarang tumbuh kembali. </span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 49.65pt; mso-list: l7 level2 lfo5; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -14.2pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 10.0pt; line-height: 150%; mso-bidi-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 lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Sel-sel dari tumor-tumor jinak tidak menyerang jaringan-jaringan disekitar mereka atau menyebar ke bagian-bagian lain tubuh. </span></div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 1.0cm; mso-add-space: auto; mso-list: l2 level1 lfo7; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-autospace: ideograph-numeric ideograph-other; text-indent: -21.25pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 10.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt; 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 lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Tumor-tumor ganas</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> adalah kanker: </span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 49.65pt; mso-list: l5 level2 lfo6; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -14.2pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 10.0pt; line-height: 150%; mso-bidi-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 lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tumor-tumor ganas umumnya adalah lebih serius daripada tumor-tumor jinak. Mereka mungkin adalah mengancam nyawa. </span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 49.65pt; mso-list: l5 level2 lfo6; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -14.2pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 10.0pt; line-height: 150%; mso-bidi-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 lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Tumor-tumor ganas seringkali dapat diangkat/dikeluarkan, namun mereka dapat tumbuh kebali. </span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 49.65pt; mso-list: l5 level2 lfo6; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -14.2pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 10.0pt; line-height: 150%; mso-bidi-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 lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Sel-sel dari tumor-tumor ganas dapat menyerang dan merusak jaringan-jaringan dan organ-organ yang berdekatan. Juga, sel-sel kanker dapat menyebar dari suatu tumor ganas dan memasuki aliran darah atau sistim lymphatic (getah bening). Itu adalah bagaimana sel-sel kanker menyebar dari kanker asal (tumor primer) untuk membentuk tumor-tumor baru pada organ-organ lain. Penyebaran dari kanker disebut <span style="mso-bidi-font-weight: bold;">metastasis</span>. </span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 35.45pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Beberapa tipe-tipe kanker dapat mulai di ginjal. Artikel ini adalah tentang kanker sel ginjal, tipe yang paling umum dari kanker ginjal pada orang-orang dewasa. Tipe ini adakalanya disebut <b>renal adenocarcinoma</b> atau <b>hypernephroma</b>. Tipe yang lain dari kanker, <b>transitional cell carcinoma</b>, mempengaruhi renal pelvis. Ia adalah serupa kanker kantong kemih dan seringkali dirawat seperti kanker kantong kemih. Wilms tumor adalah tipe yang paling umum dari kanker ginjal masa kanak-kanak. Ia berbeda dari kanker ginjal orang dewasa dan memerlukan perawatan yang berbeda. </span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 35.45pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Ketika kanker ginjal menyebar keluar dari ginjal, sel-sel kanker seringkali ditemukan di simpul-simpul getah bening yang berdekatan. Kanker ginjal juga mungkin menyebar ke paru-paru, tulang-tulang, atau hati. Dan ia mungkin menyebar dari satu ginjal ke ginjal lainnya. </span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 35.45pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Ketika kanker menyebar (metastasizes) dari tempat asalnya ke bagian lain dari tubuh, tumor baru mempunyai jenis yang sama dari sel-sel abnormal dan nama yang sama seperti tumor primer. Contohnya, jika kanker ginjal menyebar ke paru-paru, sel-sel kanker di paru-paru sebenarnya adalah sel-sel kanker ginjal. Penyakitnya adalah kanker ginjal yang metastatis, bukan kanker paru. Ia dirawat sebagai kanker ginjal, bukan kanker paru. Dokter-dokter adakalanya menyebut tumor baru sebagai penyakit metastatis atau penyakit "jauh". </span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 2; text-align: justify;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2.3 Yang mungkin berisiko Pada Kanker Ginjal </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: 42.55pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kanker ginjal berkembang paling sering pada orang-orang yang berumur 40 tahun keatas, namun tidak seorang pun mengetahui penyebab-penyebab yang pasti dari penyakit ini. Dokter-dokter jarang dapat menerangkan mengapa seseorang mengembangkan kanker ginjal dan yang lainnya tidak. Bagaimanapun, adalah jelas bahwa kanker ginjal adalah tidak menular. Tidak seorang pun dapat "menangkap" penyakit ini dari orang lain. Penelitian telah menunjukan bahwa orang-orang dengan faktor-faktor risiko tertentu adalah lebih mungkin daripada yang lain-lainnya mengembangkan kanker ginjal. Suatu faktor risiko adalah apa saja yang meningkatkan kesempatan seseorang mengembangkan suatu penyakit. </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"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>faktor-faktor risiko yang berikut untuk kanker ginjal: </span></div><ol start="1" type="1"><li class="MsoNormal" style="line-height: 150%; mso-list: l8 level1 lfo8; 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"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Merokok:</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> Merokok sigaret adalah suatu faktor risiko utama. Perokok-perokok sigaret adalah dua kali lebih mungkin daripada bukan perokok untuk mengembangkan kanker ginjal. Merokok cerutu juga mungkin meningkatkan risiko penyakit ini. </span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l8 level1 lfo8; 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"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Kegemukan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">: Orang-orang yang kegemukan mempunyai suatu risiko yang meningkat dari kanker ginjal. </span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l8 level1 lfo8; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify;"><span lang="EN-US"><a href="http://www.totalkesehatananda.com/hipertensi1.html"><span style="color: windowtext; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; text-decoration: none; text-underline: none;">Tekanan darah tinggi</span></a></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">: Tekanan darah tinggi meningkatkan risiko kanker ginjal. </span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l8 level1 lfo8; 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"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Dialysis jangka panjang</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">: Dialysis adalah suatu perawatan untuk orang-orang yang ginjal-ginjalnya tidak bekerja dengan baik. Ia mengeluarkan pembuangan-pembuangan dari darah. Berada pada dialysis untuk waktu bertahun-tahun adalah suatu faktor risiko untuk kanker ginjal. </span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l8 level1 lfo8; 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"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Von Hippel-Lindau (VHL) syndrome</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">: VHL adalah suatu penyakit yang jarang yang beredar pada beberapa keluarga-keluarga. Ia disebabkan oleh perubahan-perubahan dalam gen VHL. Suatu gen VHL yang abnormal meningkatkan risiko kanker ginjal. Ia juga dapat menyebabkan kista-kista (cysts) atau tumor-tumor di mata-mata, otak, dan bagian-bagian lain tubuh. Anggota-anggota keluarga dari mereka yang dengan sindrom ini dapat memdapatkan suatu tes untuk memeriksa kemungkinan gen VHL yang abnormal. Untuk orang-orang dengan gen VHL abnormal, dokter-dokter mungkin menyarankan cara-cara untuk memperbaiki pendeteksian kanker ginjal dan penyakit-penyakit lain sebelum gejala-gejala berkembang. </span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l8 level1 lfo8; 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"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Pekerjaan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">: Some people have a higher risk of getting kidney cancer because they come in contact with certain chemicals or substances in their workplace. Coke oven workers in the iron and steel industry are at risk. Workers exposed to asbestos or cadmium also may be at risk. </span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l8 level1 lfo8; 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"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Jenis kelamin</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">: Laki-laki adalah lebih mungkin daripada wanita-wanita didiagnosis dengan kanker ginjal. Setiap tahun di Amerika, kira-kira 20,000 laki-laki dan 12,000 wanita-wanita belajar bahwa mereka mempunyai kanker ginjal. </span></li>
</ol><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 2; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2.4 <span style="mso-bidi-font-weight: bold;">Gejala-Gejala Kanker Ginjal</span></span></b><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 18.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> </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: 21.3pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Gejala-gejala umum dari kanker ginjal termasuk: </span></div><ol start="1" type="1"><li class="MsoNormal" style="line-height: 150%; mso-list: l1 level1 lfo9; 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"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Darah dalam urin (membuat urin sedikit merah karatan atau merah dalam) </span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l1 level1 lfo9; 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"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Nyeri pada sisi yang tidak hilang </span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l1 level1 lfo9; 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"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Suatu gumpalan atau massa pada sisi atau diperut </span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l1 level1 lfo9; 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"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kehilangan berat badan </span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l1 level1 lfo9; 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"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Demam </span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l1 level1 lfo9; 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"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Merasakan sangat lelah atau mempunyai suatu perasaan keseluruhan dari kesehatan yang jelek </span></li>
</ol><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 42.55pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Paling sering, gejala-gejala ini tidak berarti kanker. Suatu infeksi, suatu kista, atau persoalan lain juga dapat menyebabkan gejala-gejala yang sama. Seseorang dengan yang mana saja dari gejala-gejala ini harus mengunjungi seorang dokter sehingga persoalan apa saja dapat didiagnosis dan dirawat sedini mungkin. </span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 42.55pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Gambaran kanker ginjal dengan stadium-stadium berikut: </span><span lang="EN-US" 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="MsoNormal" style="line-height: 150%; margin-left: 35.7pt; mso-list: l0 level1 lfo10; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify; text-indent: -17.85pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 10.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt; 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 lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold;">Stadium I</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"> adalah suatu stadium awal dari kanker ginjal. Tumor berukuran sampai 2 3/4 inches (7 centimeter). Ia adalah tidak lebih besar dari sebuah bola tenis. Sel-sel kanker ditemukan hanya di ginjal. </span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 35.7pt; mso-list: l0 level1 lfo10; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify; text-indent: -17.85pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 10.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt; 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 lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold;">Stadium II</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"> adalah juga suatu stadium awal dari kanker ginjal, namun tumor berukuran lebih dari 2 3/4 inches. Sel-sel kanker ditemukan hanya di ginjal. </span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 35.7pt; mso-list: l0 level1 lfo10; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify; text-indent: -17.85pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 10.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt; 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 lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold;">Stadium III</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"> adalah satu dari yang berikut: Tumor tidak meluas diluar ginjal, namun sel-sel kanker telah menyebar melalui sistim getah bening ke suatu simpul getah bening yang berdekatan; atau tumor telah menyerang kelenjar adrenal atau lapisan-lapisan dari lemak dan jaringan yang berserabut yang mengelilingi ginjal, namun sel-sel kanker masih belum menyebar diluar jaringan berserabut. Sel-sel kanker mungkin ditemukan pada satu simpul getah bening yang berdekatan; atau sel-sel kanker telah menyebar dari ginjal ke satu pembuluh darah yang besar yang berdekatan. Sel-sel kanker mungkin ditemukan pada satu simpul getah bening yang berdekatan. </span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 35.7pt; mso-list: l0 level1 lfo10; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify; text-indent: -17.85pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 10.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt; 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 lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold;">Stadium IV</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"> adalah satu dari yang berikut: Tumr meluas diluar jaringan berserabut yang mengelilingi ginjal; atau sel-sel kanker ditemukan pada lebih dari satu simpul getah bening yang berdekatan; atau kanker telah menyebar ke tempat-tempat lain didalam tubuh seperti paru-paru. </span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 35.7pt; mso-list: l0 level1 lfo10; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify; text-indent: -17.85pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 10.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt; 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 lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold;">Kanker yang kambuh</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"> adalah kaker yang telah kembali (kambuh) setelah perawatan. Ia mungkin kembali di ginjal atau di bagian lain tubuh. </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;"><br />
</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; mso-outline-level: 2;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2.5 Mendiagnosis Kanker Ginjal</span></b></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"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Jika seorang pasien mempunyai gejala-gejala yang menyarankan kanker ginjal, dokter mungkin melaksanakan satu atau lebih dari prosedur-prosedur berikut: </span></div><div class="MsoListParagraph" style="line-height: 150%; mso-list: l4 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 10.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt; 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 lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Pemeriksaan fisik</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">: Dokter memeriksa tanda-tanda kesehatan umum dan menguji untuk demam dan tekanan darah tinggi. Dokter juga merasakan (meraba) perut dan pinggang untuk tumor-tumor. </span></div><ol start="2" type="1"><li class="MsoNormal" style="line-height: 150%; mso-list: l4 level1 lfo2; 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"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Tes-tes urin</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">: Urin diperiksa untuk darah dan tanda-tanda lain dari penyakit. </span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l4 level1 lfo2; 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"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Tes-tes darah</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">: Laboratorium memeriksa darah untuk melihat berapa baik ginjal-ginjal bekerja. Lab mungkin memeriksa tingkat dari beberapa senyawa-senyawa, seperti creatinine. Suatu tingkat creatinine yang tinggi mungkin berarti ginjal-ginjal tidak mengerjakan pekerjaan mereka. </span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l4 level1 lfo2; 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"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Intravenous pyelogram (IVP)</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">: Dokter menyuntikan zat warna (dye) kedalam suatu vena di lengan. Zat warna berjalan melalui tubuh dan mengumpul di ginjal-ginjal. Zat warna membuat mereka terlihat pada x-rays. Suatu rentetan dari x-rays kemudian menjejaki zat warna ketika ia bergerak melalui ginjal-ginjal ke ureter-ureter dan kantong kemih. X-rays dapat menunjukan suatu tumor ginjal atau persoalan-persoalan lain. </span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l4 level1 lfo2; 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"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">CT scan (CAT scan)</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">: Suatu mesin x-ray yang dihubungkan ke sebuah komputer mengambil serentetan gambar-gambar yang detil dari ginjal-ginjal. Pasien mungkin menerima suatu suntikan dari zat warna sehingga ginjal-ginjal terlihat dengan jelas didalam gambar-gambar. Suatu CT scan dapat menunjukan suatu tumor ginjal. </span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l4 level1 lfo2; 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"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Tes Ultrasound</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">: Alat ultrasound menggunakan gelombang-gelombang suara yang orang-orang tidak dapat dengar. Gelombang-gelombag memantul balik dari ginjal-ginjal, dan sebuah komputer menggunakan gema-gema untuk menciptakan suatu gambar yang disebut suatu <span style="mso-bidi-font-weight: bold;">sonogram</span>. Suatu tumor atau kista yang solid nampak pada suatu sonogram. </span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l4 level1 lfo2; 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"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Biopsi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">: Pada beberapa kasus-kasus, dokter mungkin melakukan suatu biopsi. Suatu biopsi adalah pengangkatan dari jaringan untuk mencari sel-sel kanker. Dokter memasukan suatu jarum yang tipis melalui kulit kedalam ginjal untuk mengangkat suatu jumlah yang kecil dari jaringan. Dokter mungkin menggunakan ultrasound atau x-rays untuk memandu jarum. Seorang ahli patologi menggunakan sebuah mikroskop untuk mencari sel-sel kanker dalam jaringan. </span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l4 level1 lfo2; 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"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Operasi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">: Pada kebanyakan kasus-kasus, berdasarkan pada hasil-hasil dari CT scan, ultrasound, dan x-rays, dokter mempunyai cukup informasi untuk merekomendasikan operasi untuk mengangkat sebagian atau seluruh dari ginjal. Seorang ahli patologi membuat diagnosis akhir dengan memeriksa jaringan dibawah sebuah mikroskop. </span></li>
</ol><h2 style="line-height: 150%;"><span lang="EN-US" style="font-size: 12.0pt; line-height: 150%;">2.6 Merawat Kanker Ginjal</span></h2><div style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US">Untuk merencanakan perawatan yang paling baik, dokter perlu mengetahui stadium (luasnya) dari penyakit. Stadium didasarkan pada ukuran tumor, apakah kanker telah menyebar dan, jika ya, ke bagian-bagian mana dari tubuh. </span></div><div style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US">Penstadiuman mungkin melibatkan tes-tes pencitraan (imaging) seperti suatu ultrasound scan atau suatu CT scan. Dokter juga mungkin menggunakan suatu MRI. Untuk tes ini, suatu megnet yang kuat yang dihubungkan ke sebuah komputer membuat gambar-gambar detil dari organ-organ dan pembuluh-pembuluh darah. </span></div><div style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US">Banyak orang-orang dengan kanker ginjal ingin mengambil suatu bagian yang aktif dalam membuat keputusan-keputusan tentang perawatan medis mereka. Mereka ingin belajar semua yang mereka bisa tentang penyakit mereka dan pilihan-pilihan perawatan mereka. Bagaimanapun, shock (guncangan) dan stres setelah diagnosis dapat membuatnya sulit untuk memikirkan segala sesuatu yang mereka ingin tanyakan pada dokter. Adalah seringkali membantu untuk membuat suatu daftar dari pertanyaan-pertanyaan sebelum suatu janji temu. Untuk membantu mengingat apa yang dikatakan dokter, orang-orang mungkin membuat catatan-catatan atau bertanya apakah mereka boleh menggunakan suatu alat perekam. Beberapa juga ingin mempunyai seorang anggota keluarga atau teman dengan mereka ketika mereka bicara dengan dokter - untuk mengambil bagian dalam diskusi, untuk membuat catatan, atau hanya mendengar. </span></div><div style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US">Dokter mungkin merujuk pasien kepada seorang spesialis, atau pasien mungkin meminta untuk suatu penyerahan. Spesialis-spesialis yang merawat kanker ginjal termasuk dokter-dokter yang mengkhususkan diri pada penyakit-penyakit sistim urin (<b>urologists</b>) dan dokter-dokter yang mengkhususkan diri pada kanker (<b>medical oncologists</b> dan <b>radiation oncologists</b>). </span></div><h3 style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="color: windowtext; font-family: "Times New Roman","serif";">persiapan untuk perawatan </span></h3><div style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US">Perawatan tergantung terutama pada stadium penyakit dan kesehatan umum dan umur pasien. Dokter dapat menggambarkan pilihan-pilihan perawatan dan mendiskusikan hasil-hasil yang diharapkan. Dokter dan pasien dapat bekerja bersama untuk mengembangkan suatu rencana perawatan yang cocok dengan keperluan-keperluan pasien. </span></div><div style="line-height: 150%; text-align: justify;"><span lang="EN-US">Orang-orang tidak perlu bertanya semua pertanyaan-pertanyaan mereka atau mengerti semua jawaban-jawaban denga segera. Mereka akan mempunyai kesempatan-kesempatan lain untuk meminta dokter untuk menjelaskan hal-hal yang tidak jelas dan untuk meminta lebih banyak informasi. </span></div><h2 style="line-height: 150%;"><span lang="EN-US" style="font-size: 12.0pt; line-height: 150%;">metode-Metode Perawatan</span></h2><div style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US">Orang-orang dengan kanker ginjal mungkin mempunyai operasi, arterial embolization, terapi radiasi, terapi biologi, atau kemoterapi. Beberapa mungkin mempunyai suatu kombinasi dari perawatan-perawatan. Pada setiap stadium penyakit, orang-orang dengan kanker ginjal mungkin mempunyai perawatan untuk mengontrol nyeri dan gejala-gejala lain, untuk menghilangkan efek-efek sampingan terapi, dan untuk meringankan persoalan-persoalan emosi dan praktis. Jenis perawatan ini disebut perawatan pendukung, manajemen gejala-gejala, atau perawatan yang meringankan atau meredakan. Informasi tentang perawatan pendukung tersedia pada website NCI di http://cancer.gov dan dari pelayanan informasi kanker NCI di 1-800-4-CANCER. </span></div><div style="line-height: 150%; text-align: justify;"><span lang="EN-US">Seorang pasien mungkin ingin berbicara pada dokter tentang mengambil bagian dalam suatu percobaan klinik, suatu studi penelitian dari metode-metode perawatan yang baru. </span></div><h3 style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="color: windowtext; font-family: "Times New Roman","serif";">Operasi </span></h3><div style="line-height: 150%; text-align: justify;"><span lang="EN-US">Operasi adalah perawatan yang paling umum untuk kanker ginjal. Ia adalah suatu tipe dari terapi lokal. Ia mearawat kanker di ginjal dan area yang dekat pada tumor. </span></div><div style="line-height: 150%; text-align: justify;"><span lang="EN-US">Suatu operasi untuk mengangkat ginjal disebut suatu <b>nephrectomy</b>. Ada beberapa tipe dari nephrectomies. Tipe tergantng terutama pada stadium dari tumor. Dokter dapat menjelaskan setiap operasi dan mendiskusikan yang mana adalah paling cocok untuk pasien: </span></div><ul type="disc"><li class="MsoNormal" style="line-height: 150%; mso-list: l9 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif";">Radical nephrectomy</span></b><span lang="EN-US" style="font-family: "Times New Roman","serif";">: Kanker ginjal biasanya dirawat dengan radical nephrectomy. Ahli bedah mengangkat seluruh ginjal bersama dengan kelenjar adrenal dan beberapa jaringan sekitar ginjal. Beberapa simpul-simpul getah bening di area itu juga mungkin diangkat. </span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l9 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif";">Simple nephrectomy</span></b><span lang="EN-US" style="font-family: "Times New Roman","serif";">: Ahli bedah mengangkat hanya ginjal. Beberapa orang-orang dengan kanker ginjal stadium I mungkin mempunyai suatu simple nephrectomy. </span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l9 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif";">Partial nephrectomy</span></b><span lang="EN-US" style="font-family: "Times New Roman","serif";">: Ahli bedah mengangkat hanya bagian dari ginjal yang mengandung tumor. Jenis tipe operasi ini mungkin digunakan ketika orang itu mempunyai hanya satu ginjal, atau ketika kanker mempengaruhi kedua ginjal-ginjal. Juga, seorang dengan suatu tumor ginjal yang kecil (kurang dari 4 centimeter atau tiga perempat inch) mungkin mempunyai tipe operasi ini. </span></li>
</ul><h3 style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="color: windowtext; font-family: "Times New Roman","serif";">Arterial embolization </span></h3><div style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US">Arterial embolization adalah suatu tipe terapi lokal yang menyusutkan tumor. Adakalanya itu dilakukan sebelum suatu operasi untuk membuat operasi lebih mudah. Ketika operasi adalah tidak mungkin, embolization mungkin digunakan untuk membantu menghilangkan gejala-gejala dari kanker ginjal. </span></div><div style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US">Dokter memasukan suatu tabung yang sempit (kateter) kedalam suatu pembuluh darah di kaki. Tabung dilewatkan keatas sampai pada pembuluh besar utama (arteri ginjal) yang menyediakan darah pada ginjal. Dokter menyuntikan suatu senyawa kedalam pembuluh darah untuk menghalangi aliran darah kedalam ginjal. Halangan atau rintangan mencegah tumor dari mendapatkan oksigen dan senyawa-senyawa lain yang ia perlukan untuk tumbuh. </span></div><h3 style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="color: windowtext; font-family: "Times New Roman","serif";">Terapi Radiasi </span></h3><div style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US">Terapi radiasi (juga disebut radioterapi) adalah tipe yang lain dari terapi lokal. Ia menggunakan sinar-sinar bertenaga tinggi untuk membunuh sel-sel kanker. Ia mempengaruhi sel-sel kanker hanya diarea yang dirawat. Suatu mesin yang besar mengarahkan radiasi pada tubuh. Pasien mendapatkan perawatan di rumah sakit atau klinik, 5 hari setiap minggu untuk beberapa minggu. </span></div><div style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US">Sejumlah kecil pasien-pasien mempunyai terapi radiasi sebelum operasi untuk menyusutkan tumor. Beberapa mempunyai itu setelah operasi untuk membunuh sel-sel kanker yang mungkin tertinggal di area itu. Orang-orang yang tidak dapat mempunyai operasi mungkin mempunyai terapi radiasi untuk menghilangkan nyeri dan persoalan-persoalan lain yang disebabkan oleh kanker. </span></div><h3 style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="color: windowtext; font-family: "Times New Roman","serif";">Terapi Biologi </span></h3><div style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US">Terapi biologi adalah suatu tipe dari terapi sistemik. Ia menggunakan senyawa-senyawa yang berjalan melalui aliran darah, mencapai dan mempengaruhi sel-sel diseluruh tubuh. Terapi biologi menggunakan kemampuan alamiah tubuh (sistim imun) untuk melawan kanker. </span></div><div style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US">Untuk pasien-pasien dengan kanker ginjal yang metastatis, dokter mungkin menyarankan interferon alpha atau interleukin-2 (juga disebut IL-2 atau aldesleukin). Tubuh secara normal menghasilkan senyawa-senyawa ini dalam jumlah yang kecil dalam merespon pada infeksi-infeksi dan penyakit-penyakit lain. Untuk perawatan kanker, mereka dibuat di laboratorium dalam jumlah yang besar. </span></div><h3 style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="color: windowtext; font-family: "Times New Roman","serif";">Kemoterapi </span></h3><div style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US">Kemoterapi juga adalah suatu tipe dari terapi sistemik. Obat-obat antikanker memasuki aliran darah dan berjalan ke seluruh tubuh. Meskipun berguna untuk banyak kanker-kaner yang lain, obt-obat antikanker telah menunjukan penggunaan yang terbatas terhadap kanker ginjal. Bagaimanapun, banyak dokter-dokter sedang mempelajari obat-obat baru dan kombinasi-kombinasi baru yang mungkin terbukti lebih bermanfaat. </span></div><h2 style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="font-size: 12.0pt; line-height: 150%;">Efek-Efek Sampingan Perawatan Kanker Ginjal </span></h2><div style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US">Karena perawatan mungkin merusak sel-sel dan jaringan-jaringan yang sehat, efek-efek sampingan yang tidak dikehendaki adalah umum. Efek-efek sampingan ini tergantung terutama pada tipe dan luasnya perawatan. Efek-efek sampingan mungkin adalah tidak sama untuk setiap orang, dan mereka mungkin berubah dari satu sesi perawatan ke berikutnya. Sebelum perawatan mulai, team perawatan kesehatan akan menjelaskan kemungkinan efek-efek sampingan dan menyarankan cara-cara untuk membantu pasien mengendalikan mereka. </span></div><div style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US">NCI menyediakan brosur-brosur yang berguna tentang perawatan-perawatan kanker dan mengatasi efek-efek sampingan, seperti Terapi Radiasi dan Anda, Kemoterapi dan Anda, dan Petunjuk-Petunjuk Makan untuk Pasien-Pasien Kanker. </span></div><h3 style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="color: windowtext; font-family: "Times New Roman","serif";">Operasi </span></h3><div style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US">Adalah memakan waktu untuk sembuh setelah operasi, dan waktu yang diperlukan untuk kesembuhan adalah berbeda untuk setiap orang. Pasien-pasien adalah seringkali tidak nyaman selama beberapa hari pertama. Bagaimanapun, obat dapat biasanya mengontrol nyeri mereka. Sebelum operasi, pasien-pasien harus mendiskusikan rencana penghilangan nyeri dengan dokter atau perawat. Setelah operasi, dokter dapat menyesuaikan rencana jika lebih banyak penghilag nyeri diperlukan. </span></div><div style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US">Adalah umum untuk merasakan lelah atau lemah untuk sementara. Team perawat kesehatan mengamati pasien untuk tanda-tanda dari persoalan-persoalan ginjal dengan memonitor jumlah cairan yang diminujm pasien dan jumlah urin yang dihasilkan. Mereka juga mengamati tanda-tanda perdarahan, infeksi, atau persolan-persoalan lain yang memerlukan perawatan segera. Tes-tes lab membantu team perawatan kesehatan memonitor tanda-tanda dari persoalan-persoalan. </span></div><div style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US">Jika satu ginjal diangkat, ginjal yang sisa umumnya mampu untuk melaksanakan pekerjaan dari kedua ginjal-ginjal. Bagaimanapun, jika ginjal yang tersisa tidak bekerja dengan baik atau jika kedua ginjal-ginjal diangkat, dialysis diperlukan untuk membersihkan darah. Untuk sedikit pasien-pasien, transplantasi ginjal mungkin adalah suatu opsi (pilihan). Untuk prosedur ini, ahli bedah transplantasi menggantikan ginjal pasien dengan suatu ginjal yang sehat dari seorang donor. </span></div><h3 style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="color: windowtext; font-family: "Times New Roman","serif";">Arterial embolization </span></h3><div style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US">Setelah arterial embolization, beberapa pasien-pasien mempunyai nyeri punggung atau mengembangkan suatu demam. Efek-efek sampingan lainnya adalah mual dan muntah. Persoalan-persoalan ini segera menghilang. </span></div><h3 style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="color: windowtext; font-family: "Times New Roman","serif";">Terapi Radiasi </span></h3><div style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US">Efek-efek sampingan dari terapi radiasi tergantung terutama pada jumlah dari radiasi yang diberikan dan bagian dari tubuh yang dirawat. Pasien-pasien kemungkinan menjadi sangat lelah selama terap radiasi, terutama pada minggu-minggu kemudian perawatan. Istirahat adalah penting, namun dokter-dokter biasanya menasehati pasien-pasien untuk mencoba untuk tetap aktif sebisa mereka. </span></div><div style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US">Terapi radiasi pada ginjal dan area-area yang berdekatan mungkin menyebabkan mual, muntah, diare, atau ketidaknyamanan membuang air seni. Terapi radiasi juga mungkin menyebabkan suatu pengurangan dalam jumlah dari sel-sel darah putih yang sehat, yang membantu melindungi tubuh terhadap infeksi. Sebagi tambahan, kulit di area yang dirawat mungkin adakalanya menjadi merah, kering, dan peka. Meskipun efek-efek sampingan dari terapi radiasi dapat menyusahkan, dokter biasanya dapat merawat dan mengontrol mereka. </span></div><h3 style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="color: windowtext; font-family: "Times New Roman","serif";">Terapi Biologi </span></h3><div style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US">Terapi biologi mungkin menyebabkan gejal-gejala seperti flu, seperti kedinginan, demam, nyeri-nyeri otot, kelemahan, kehilangan nafsu makan, mual, muntah, dan diare. Pasien-pasien juga mungkin memperoleh suatu ruam kulit (skin rash). Persoalan-persoalan ini dapat menjadi parah, namun mereka menghilang setelah perawatan dihentikan. </span></div><h3 style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="color: windowtext; font-family: "Times New Roman","serif";">Kemoterapi </span></h3><div style="line-height: 150%; text-align: justify; text-indent: 18.0pt;"><span lang="EN-US">Efek-efek sampingan dari kemoterapi tergantung terutama pada obat-obat spesifik dan jumlah yang diterima pada satu kali. Pada umumnya, obat-obat antikanker mempengaruhi sel-sel yang membelah secara cepat, terutama: </span></div><ul type="disc"><li class="MsoNormal" style="line-height: 150%; mso-list: l3 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif";">Sel-sel darah</span></b><span lang="EN-US" style="font-family: "Times New Roman","serif";">: Sel-sel ini melawan infeksi, membantu darah untuk menggumpal/membeku, dan membawa oksigen ke seluruh bagian-bagian tubuh. Ketika obat-obat mempengaruhi sel-sel darah, pasien-pasien lebih mungkin mendapat infeksi-infeksi, mungkin mememar atau berdarah dengan mudah, dan mungkin merasa sangat lemah dan lelah. </span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l3 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif";">Sel-sel di akar-akar rambut</span></b><span lang="EN-US" style="font-family: "Times New Roman","serif";">: Kemoeterapi dapat menyebabkan kerontokan rambut. Rambut tumbuh kembali, namun adakalanya rambut yang baru adalah sedikit banyak berbeda dalam warna dan tekstur. </span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l3 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt; text-align: justify;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif";">Sel-sel yang melapisi saluran pencernaan</span></b><span lang="EN-US" style="font-family: "Times New Roman","serif";">: Kemoterapi dapat menyebabkan nafsu makan yang buruk, mual dan muntah, diare, atau lika-luka mulut dan bibir. Banyak dari efek-efek sampingan ini dapat dikontrol dengan obat-obat. </span></li>
</ul><h3 style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="color: windowtext; font-family: "Times New Roman","serif";">Nutrisi </span></h3><div style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US">Pasien-pasien perlu makan dengan baik selama terapi kanker. Mereka perlu kalori-kalori yang cukup untuk memelihara suatu berat badan yang baik dan protein untuk mempertahankan kekuatan. Nutrisi yang baik sering membantu orang-orang dengan kanker merasa lebih baik dan mempunyai lebih banyak energi. </span></div><div style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US">Namun makan dengan baik dapat menjadi sulit. Pasien-pasien mungkin tidak merasa ingin makan jika mereka tidak nyaman atau lelah. Juga, efek-efek sampingan dari perawatan, seperti nafsu makan yang buruk, mual, atau muntah, dapat menjadi suatu persoalan. Beberapa pasien-pasien menemukan bahwa makanan-makanan tidak terasa enak selama terapi kanker. </span></div><div style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US">Dokterr, ahli diet, atau perawat kesehatan lainnya dapat menyarankan cara-cara untuk memelihara suatu diet yang sehat. Pasien-pasien dan keluarga-keluarga mereka mungkin ingin membaca brosur-brosur National Cancer Institute tentang Petunjuk-Petunjuk Makan sehat untuk Pasien-Pasien Kanker, yang mengandung banyak gagasan-gagasan dan resep-resep yang berguna. </span></div><h3 style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="color: windowtext; font-family: "Times New Roman","serif";">Dukungan untuk orang-orang dengan kanker ginjal </span></h3><div style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US">Hidup dengan suatu penyakit serius seperti kanker ginjal adalah tidak mudah. Orang-orang dengan kanker ginjal mungkin khwatir tentang melayani keluarga-keluarga mereka, mempertahankan pekerjaan-pekerjaan mereka, atau meneruskan aktivitas-aktivitas hariannya. Kekhwatiran-kekhwatiran tentang perawatan-perawatan dan mengendalikan efek-efek sampingan, opname-opname rumah sakit, dan tagihan-tagihan obat adalah juga umum. Dokter-dokter, perawat-perawat, dan anggota-anggota lain dari team perawatan kesehatan dapat menjawab pertanyaan-pertanyaan tentang perawatan, bekerja, atau aktivitas-aktivitas lain. Bertemu dengan seorang pekerja sosial, penasihat, atau anggota dari keagamaan dapat bermanfaat pada mereka yang ingin berbicara tentang perasaan-perasaan mereka atau mendiskusikan kekhwatiran-kekhwatiran mereka. Seringkali, seorang pekerja sosial dapat menyarankan sumber-sumber untuk bantuan keuangan, pengangkutan (transport), perawatan rumah, atau dukungan emosi. </span></div><div style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US">Kelompok-kelompok pendukung juga dapat membantu. Pada kelompok-kelompok ini, pasien-pasien atau anggota-anggota keluarga mereka bertemu dengan pasien-pasien lain atau keluarga-keluarga mereka untuk berbagi apa yang telah mereka pelajari tentang mengatasi penyakit dan efek-efek dari perawatan. Kelompok-kelompok ini mungkin menawarkan dukungan dalam pribadinya, melalui telephone, atau di Internet. Pasien-pasien mungkin ingin berbicara dengan seorang anggota dari team perawatan kesehatan mereka tentang menemukan suatu kelompok pendukung. </span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 42.55pt;"><br />
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</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center; text-indent: 42.55pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">BAB III</span></div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center; text-indent: 42.55pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">KESIMPULAN DAN SARAN</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">3.1 KESIMPULAN </span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 35.45pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Ginjal merupakan bagian dari saluran air seni (kencing). Mereka membuat urin dengan mengeluarkan pembuangan dan kelebihan air dari darah. Urin berkumpul didalam suatu ruang berongga (<span style="mso-bidi-font-weight: bold;">renal pelvis</span>) ditengah-tengah dari setiap ginjal. Ia mengalir dari renal pelvis kedalam kantong kemih melalui suatu tabung yang disebut suatu <span style="mso-bidi-font-weight: bold;">ureter</span>. Urin meninggalkan tubuh melalui tabung lain (<span style="mso-bidi-font-weight: bold;">urethra</span>). Ginjal-ginjal juga membuat senyawa-senyawa yang membantu mengontrol tekanan darah dan produksi dari sel-sel darah merah. </span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 42.55pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Kanker mulai pada sel-sel, blok-blok bangunan yang membentuk jaringan-jaringan. Jaringan-jaringan membentuk organ-organ tubuh. Secara normal, sel-sel tumbuh dan membelah untuk membentuk sel-sel baru ketika tubuh memerlukan mereka. Ketika sel-sel tumbuh menua, mereka mati, dan sel-sel baru mengambil tempat mereka. Adakalanya proses yang teratur ini berjalan salah. Sel-sel baru terbentuk ketika tubuh tidak memerlukan mereka, dan sel-sel tua tidak mati ketika mereka seharusnya mati. Sel-sel ekstra ini dapat membentuk suatu massa dari jaringan yang disebut suatu pertumbuhan atau tumor. </span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">3.2 SARAN</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"; font-size: 12.0pt; line-height: 150%;">Ginjal merupakan organ yang sangat penting oleh karena itu diharapkan kita dapat berprilaku sehat dalam kehidupan sehari-hari untuk menjaga hidup sehat, agar terhindar dari penyakit yang merusak salah satu organ kita.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 42.55pt;"><br />
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</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span lang="EN-US"><a href="http://www.totalkesehatananda.com/kankerginjal1.html"><span style="font-family: "Times New Roman","serif";">http://www.totalkesehatananda.com/kankerginjal1.html</span></a></span><span lang="EN-US" 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";">www. Wordpress.com</span></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">Diposting Oleh : </span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">Nama <span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>:Farid ma'roef maulana I</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">NIM<span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>:05200ID09011</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">Kelas<span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>:2A<span style="mso-tab-count: 1;"> </span></span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">Kelompok<span style="mso-tab-count: 1;"> </span>:1</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>-Anisah Nur Azizah</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>-Asep Diki Permana</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>-Farid Maroef Maulana Ishak</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>-Lina Ratiana</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>-Pipit Puspita Permana</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 2;"> </span>-Rini Yulianai</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 2;"> </span>-Susanti</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 2;"> </span>-Ucu Cahyati</span></b></div><div class="MsoNormal"><br />
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</div>TEAM_ONE KMB 2A AKPEM GARUThttp://www.blogger.com/profile/01719877433346227735noreply@blogger.com0tag:blogger.com,1999:blog-1245729285541543255.post-85759035116752257342011-04-07T20:58:00.000-07:002011-04-07T20:58:13.686-07:00tugas KMB ke-9 (HEMODIALISA)<!--[if !mso]> <style>
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</style> <![endif]--> <div align="center" class="MsoNormalCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 19.85pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">BAB I</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div align="center" class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 19.85pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">PENDAHULUAN</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div align="center" class="MsoNormalCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 19.85pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: center;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 55.85pt; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -18.0pt;"><span style="mso-list: Ignore;">A.<span style="font: 7.0pt "Times New Roman";"> </span></span><b style="mso-bidi-font-weight: normal;">Latar belakang</b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.85pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 17.15pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Menurut Price dan Wilson (1995) dialisa adalah suatu proses dimana solute dan air mengalami difusi secara pasif melalui suatu membran berpori dari kompartemen cair menuju kompartemen lainnya.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Hemodialisa </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">dan dialisa peritoneal merupakan dua tehnik utama yang digunakan dalam dialisa. Prinsip dasar kedua teknik tersebut sama yaitu difusi solute dan air dari plasma ke larutan dialisa sebagai respon terhadap perbedaan konsentrasi atau tekanan tertentu.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.85pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 17.15pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> didefinisikan sebagai pergerakan larutan dan air dari darah pasien melewati membran semipermeabel (alat dialisis) ke dalam dialisat (Tisher & Wilcox, 1997). Alat dialisis juga dapat digunakan untuk memindahkan sebagian besar volume cairan. Pemindahan ini dilakukan melalui ultrafiltrasi dimana tekanan hidrostatik menyebabkan aliran yang besar dari air plasma (dengan perbandingan sedikit larutan) melalui membran semipermeabel.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> telah menjadi metode yang dominan dalam pengobatan gagal ginjal akut dan kronik di Amerika Serikat (Tisher & Wilcox, 1997).</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.85pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 17.15pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> memerlukan sebuah mesin dialisa dan sebuah filter khusus yang dinamakan dializer (suatu membran semipermeabel) yang digunakan untuk membersihkan darah, darah dikeluarkan dari tubuh penderita dan beredar dalam sebuah mesin diluar tubuh. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> memerlukan jalan masuk ke aliran darah, maka dibuat suatu hubungan buatan antara arteri dan vena (fistula arteriovenosa) melalui pembedahan (NKF, 2006).</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.85pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 17.15pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pasien </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> sangatlah tergantung dengan mesin semasa sisa umurnya. Dalam pelaksanaan </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> sangatlah banyak</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> komplikasi </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">dan kemungkinan yang terjadi, sehingga diperlukan </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">perawatan yang maksimal.</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.85pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 17.15pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">B</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">. </span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-spacerun: yes;"> </span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">RUMUSAN MASALAH </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">1.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Apa pengertian hemodialisis?</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">2.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Apa Indikasi Dilakukannya Hemodialisis?</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">3.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Apa Kontra Indikasi Dilakukannya Hemodialisis?</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">4.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Apa Tujuan Hemodialisis? </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">5.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Bagaimana Proses Hemodialisa?</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">6.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Bagaimana Frekuensi Dilakukannya Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">7.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Apa Komplikasi Yang Terjadi Pada pasien yang dilakukan hemodialisa?</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">C.</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Tujuan </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-margin-top-alt: auto; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Tujuan pembuatan makalah ini ada lah untuk mengetahui :</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">1.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pengertian Hemodialisis</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">2.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Indikasi Dilakukannya Hemodialisis</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">3.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Kontra Indikasi Dilakukannya Hemodialisis</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">4.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Tujuan Hemodialisa </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">5.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Proses Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">6.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Frekuensi Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">7.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Komplikasi Dilakukannya hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">D.</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Sistematika penulisan</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-margin-top-alt: auto; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">BAB 1 PENDAHULUAN</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">A.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Latar belakang</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">B.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Rumusan masalah</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">C.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Tujuan penulisan</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">D.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Sistematika penulisan</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><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;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">BAB II PEMBAHASAN </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">A.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pengertian hemodialisis</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">B.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">indikasi dilakukannya hemodialisis</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">C.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Kontra Indikasi Dilakukannya Hemodialisis</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">D.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Tujuan Hemodialisa </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">E.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Proses Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">F.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Frekuensi Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">G.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Komplikasi dilakukannya hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><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;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">BAB III KESIMPULAN DAN SARAN</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">A.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Kesimpulan</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">B.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Saran </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: justify;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">BAB II</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">PEMBAHASAN</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: center;"><br />
</div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.6pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; tab-stops: list 36.0pt; 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: 10.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">A.</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">KONSEP TEORI </span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">HEMODIALISA</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 39.7pt; mso-add-space: auto; mso-margin-top-alt: auto; 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: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">1.</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pengertian</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></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"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Menurut Price dan Wilson (1995) dialisa adalah suatu proses dimana solute dan air mengalami difusi secara pasif melalui suatu membran berpori dari kompartemen cair menuju kompartemen lainnya.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> dan dialisa peritoneal merupakan dua tehnik utama yang digunakan dalam dialisa. Prinsip dasar kedua teknik tersebut sama yaitu difusi solute dan air dari plasma ke larutan dialisa sebagai respon terhadap perbedaan konsentrasi atau tekanan tertentu.</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"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Sedangkan menurut Tisher dan Wilcox (1997) </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> didefinisikan sebagai pergerakan larutan dan air dari darah pasien melewati membran semipermeabel (dializer) ke dalam dialisat. Dializer juga dapat dipergunakan untuk memindahkan sebagian besar volume cairan. Pemindahan ini dilakukan melalui ultrafiltrasi dimana tekanan hidrostatik menyebabkan aliran yang besar dari air plasma (dengan perbandingan sedikit larutan) melalui membran. Dengan memperbesar jalan masuk pada vaskuler, antikoagulansi dan produksi dializer yang dapat dipercaya dan efisien, </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> telah menjadi metode yang dominan dalam pengobatan gagal ginjal akut dan kronik di Amerika Serikat (Tisher & Wilcox, 1997).</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.85pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 17.15pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> memerlukan sebuah mesin dialisa dan sebuah filter khusus yang dinamakan dializer (suatu membran semipermeabel) yang digunakan untuk membersihkan darah, darah dikeluarkan dari tubuh penderita dan beredar dalam sebuah mesin diluar tubuh.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> memerlukan jalan masuk ke aliran darah, maka dibuat suatu hubungan buatan antara arteri dan vena (fistula arteriovenosa) melalui pembedahan (NKF, 2006).</span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj15RKucVD9KFjoYPCD-UDUn3xixKW0DaZUjathjB6Giofz4jVFwXy7BZE-IHcWmWXgVVkMsbZkCakQjJ9lYiyHR0FM3uZlNi8TE6X3_yaUDDBRBLczjFIMlRcL-s8iZ6QNTqy1bDg0bSG8/s1600/HD.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj15RKucVD9KFjoYPCD-UDUn3xixKW0DaZUjathjB6Giofz4jVFwXy7BZE-IHcWmWXgVVkMsbZkCakQjJ9lYiyHR0FM3uZlNi8TE6X3_yaUDDBRBLczjFIMlRcL-s8iZ6QNTqy1bDg0bSG8/s1600/HD.jpg" /></a></div><div align="center" class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvpbzHQkXRfUXAjw-NSv4c7NBMMsy3hSkyHMIGLgRDnbr48sSkHxTXCRPMQY3bQb6fG0Ldx8r90nzp8lGtlvxgvq90F4GITLjU_Su-YVQGVjfy3P6wq8VJQXpALsTZlFvS8xW42Htp-qBb/s1600/hd3.jpg"><span style="color: blue; font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; mso-no-proof: yes; text-decoration: none; text-underline: none;"><span style="mso-ignore: vglayout;"><br />
</span></span></a><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.85pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 17.15pt;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.85pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 17.15pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
2. Indikasi </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.85pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 17.15pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Price dan Wilson (1995) menerangkan bahwa tidak ada petunjuk yang jelas berdasarkan kadar kreatinin darah untuk menentukan kapan pengobatan harus dimulai. Kebanyakan ahli ginjal mengambil keputusan berdasarkan kesehatan penderita yang terus diikuti dengan cermat sebagai penderita rawat jalan. Pengobatan biasanya dimulai apabila penderita sudah tidak sanggup lagi bekerja purna waktu, menderita neuropati perifer atau memperlihatkan gejala klinis lainnya. Pengobatan biasanya juga dapat dimulai jika kadar kreatinin serum diatas 6 mg/100 ml pada pria , 4 mg/100 ml pada wanita dan glomeluro filtration rate (GFR) kurang dari 4 ml/menit. Penderita tidak boleh dibiarkan terus menerus berbaring ditempat tidur atau sakit berat sampai kegiatan sehari-hari tidak dilakukan lagi. </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.85pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 17.15pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Menurut konsensus Perhimpunan Nefrologi Indonesia (PERNEFRI) (2003) secara ideal semua pasien dengan Laju Filtrasi Goal (LFG) kurang dari 15 mL/menit, LFG kurang dari 10 mL/menit dengan gejala uremia/malnutrisi dan LFG kurang dari 5 mL/menit walaupun tanpa gejala dapat menjalani dialisis. Selain indikasi tersebut juga disebutkan adanya indikasi khusus yaitu apabila terdapat</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> komplikasi </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">akut seperti oedem paru, hiperkalemia, asidosis metabolik berulang, dan nefropatik diabetik.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.85pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 17.15pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Kemudian Thiser dan Wilcox (1997) menyebutkan bahwa </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> biasanya dimulai ketika bersihan kreatinin menurun dibawah 10 mL/menit, ini sebanding dengan kadar kreatinin serum 8–10 mg/dL. Pasien yang terdapat gejala-gejala uremia dan secara mental dapat membahayakan dirinya juga dianjurkan dilakukan </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">. Selanjutnya Thiser dan Wilcox (1997) juga menyebutkan bahwa indikasi relatif dari </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> adalah azotemia simtomatis berupa ensefalopati, dan toksin yang dapat didialisis. Sedangkan indikasi khusus adalah perikarditis uremia, hiperkalemia, kelebihan cairan yang tidak responsif dengan diuretik (oedem pulmonum), dan asidosis yang tidak dapat diatasi.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.85pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 17.15pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
<b style="mso-bidi-font-weight: normal;">3. Kontra Indikasi</b></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.85pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 17.15pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Menurut Thiser dan Wilcox (1997) kontra indikasi dari </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> adalah hipotensi yang tidak responsif terhadap presor, penyakit stadium terminal, dan sindrom otak organik. Sedangkan menurut PERNEFRI (2003) kontra indikasi dari</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> adalah tidak mungkin didapatkan akses vaskuler pada </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">, akses vaskuler sulit, instabilitas hemodinamik dan koagulasi. Kontra indikasi </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> yang lain diantaranya adalah penyakit alzheimer, demensia multi infark, sindrom hepatorenal, sirosis hati lanjut dengan ensefalopati dan keganasan lanjut (PERNEFRI, 2003).</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.85pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 17.15pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
<b style="mso-bidi-font-weight: normal;">4. Tujuan</b></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.85pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 17.15pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Menurut Havens dan Terra (2005) tujuan dari pengobatan </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> antara lain :</span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">a.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-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"; mso-fareast-language: IN;">Menggantikan fungsi ginjal dalam fungsi ekskresi, yaitu membuang sisa-sisa metabolisme dalam tubuh, seperti ureum, kreatinin, dan sisa metabolisme yang lain.</span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">b.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-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"; mso-fareast-language: IN;">Menggantikan fungsi ginjal dalam mengeluarkan cairan tubuh yang seharusnya dikeluarkan sebagai urin saat ginjal sehat.</span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">c.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-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"; mso-fareast-language: IN;">Meningkatkan kualitas hidup pasien yang menderita penurunan fungsi ginjal.</span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">d.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-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"; mso-fareast-language: IN;">Menggantikan fungsi ginjal sambil menunggu program pengobatan yang lain.</span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;"><br />
</div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.85pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; 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: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">5.</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Proses </span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.85pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 17.15pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Suatu mesin </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> yang digunakan untuk tindakan </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> berfungsi mempersiapkan cairan dialisa (dialisat), mengalirkan dialisat dan aliran darah melewati suatu membran semipermeabel, dan memantau fungsinya termasuk dialisat dan sirkuit darah korporeal. Pemberian heparin melengkapi antikoagulasi sistemik. Darah dan dialisat dialirkan pada sisi yang berlawanan untuk memperoleh efisiensi maksimal dari pemindahan larutan. Komposisi dialisat, karakteristik dan ukuran membran dalam alat dialisa, dan kecepatan aliran darah dan larutan mempengaruhi pemindahan larutan (Tisher & Wilcox, 1997).</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.85pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 17.15pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Dalam proses</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> diperlukan suatu mesin </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> dan suatu saringan sebagai ginjal tiruan yang disebut dializer, yang digunakan untuk menyaring dan membersihkan darah dari ureum, kreatinin dan zat-zat sisa metabolisme yang tidak diperlukan oleh tubuh. Untuk melaksanakan </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> diperlukan akses vaskuler sebagai tempat suplai dari darah yang akan masuk ke dalam mesin </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> (NKF, 2006).</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.85pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 17.15pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Suatu mesin ginjal buatan atau hemodializer terdiri dari membran semipermeabel yang terdiri dari dua bagian, bagian untuk darah dan bagian lain untuk dialisat. Darah mengalir dari arah yang berlawanan dengan arah darah ataupun dalam arah yang sama dengan arah aliran darah. Dializer merupakan sebuah hollow fiber atau capillary dializer yang terdiri dari ribuan serabut kapiler halus yang tersusun pararel. Darah mengalir melalui bagian tengah tabung-tabung kecil ini, dan cairan dialisat membasahi bagian luarnya. Dializer ini sangat kecil dan kompak karena memiliki permukaan yang luas akibat adanya banyak tabung kapiler (Price & Wilson, 1995).</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.85pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 17.15pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Menurut Corwin (2000)</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> adalah dialisa yang dilakukan di luar tubuh. Selama</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> darah dikeluarkan dari tubuh melalui sebuah kateter masuk ke dalam sebuah mesin yang dihubungkan dengan sebuah membran semipermeabel (dializer) yang terdiri dari dua ruangan. Satu ruangan dialirkan darah dan ruangan yang lain dialirkan dialisat, sehingga keduanya terjadi difusi. Setelah darah selesai dilakukan pembersihan oleh dializer darah dikembalikan ke dalam tubuh melalui arterio venosa shunt (AV-shunt). </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.85pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 17.15pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Selanjutnya Price dan Wilson (1995) juga menyebutkan bahwa suatu sistem dialisa terdiri dari dua sirkuit, satu untuk darah dan satu lagi untuk cairan dialisa. Darah mengalir dari pasien melalui tabung plastik (jalur arteri/blood line), melalui dializer hollow fiber dan kembali ke pasien melalui jalur vena. Cairan dialisa membentuk saluran kedua. Air kran difiltrasi dan dihangatkan sampai sesuai dengan suhu tubuh, kemudian dicampur dengan konsentrat dengan perantaraan pompa pengatur, sehingga terbentuk dialisat atau bak cairan dialisa. Dialisat kemudian dimasukan ke dalam dializer, dimana cairan akan mengalir di luar serabut berongga sebelum keluar melalui drainase. Keseimbangan antara darah dan dialisat terjadi sepanjang membran semipermeabel dari hemodializer melalui proses difusi, osmosis, dan ultrafiltrasi.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.85pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 17.15pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Ultrafiltrasi terutama dicapai dengan membuat perbedaan tekanan hidrostatik antara darah dengan dialisat. Perbedaaan tekanan hidrostatik dapat dicapai dengan meningkatkan tekanan positif di dalam kompartemen darah dializer yaitu dengan meningkatkan resistensi terhadap aliran vena, atau dengan menimbulkan efek vakum dalam ruang dialisat dengan memainkan pengatur tekanan negatif. Perbedaaan tekanan hidrostatik diantara membran dialisa juga meningkatkan kecepatan difusi solut. Sirkuit darah pada sistem dialisa dilengkapi dengan larutan garam atau NaCl 0,9 %, sebelum dihubungkan dengan sirkulasi penderita. Tekanan darah pasien mungkin cukup untuk mengalirkan darah melalui sirkuit ekstrakorporeal (di luar tubuh), atau mungkin juga memerlukan pompa darah untuk membantu aliran dengan quick blood (QB) (sekitar 200 sampai 400 ml/menit) merupakan aliran kecepatan yang baik. Heparin secara terus-menerus dimasukkan pada jalur arteri melalui infus lambat untuk mencegah pembekuan darah. Perangkap bekuan darah atau gelembung udara dalam jalur vena akan menghalangi udara atau bekuan darah kembali ke dalam aliran darah pasien. Untuk menjamin keamanan pasien, maka hemodializer modern dilengkapi dengan monitor-monitor yang memiliki alarm untuk berbagai parameter (Price & Wilson, 1995).</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.85pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 17.15pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Menurut PERNEFRI (2003) waktu atau lamanya</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> disesuaikan dengan kebutuhan individu. Tiap </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> dilakukan 4 – 5 jam dengan frekuensi 2 kali seminggu. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> idealnya dilakukan 10 – 15 jam/minggu dengan QB 200–300 mL/menit. Sedangkan menurut Corwin (2000) </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> memerlukan waktu 3 – 5 jam dan dilakukan 3 kali seminggu. Pada akhir interval 2 – 3 hari diantara </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">, keseimbangan garam, air, dan pH sudah tidak normal lagi. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> ikut berperan menyebabkan anemia karena sebagian sel darah merah rusak dalam proses </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">. <br />
<b style="mso-bidi-font-weight: normal;">Gambar 1. </b></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxxC060E6XDLJwcPFs465c8oJXU29n_ALHRtoCUe1_IsfZYdt5z9fQ_V2Ol2mb46fKZYX51eQEirqlwbqJtS4cMOFLJ-bTor6wxfIQwtg766URe4mNaloWw2-w-58SAqtwRCZERjEY2D9j/s1600/HEMO.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxxC060E6XDLJwcPFs465c8oJXU29n_ALHRtoCUe1_IsfZYdt5z9fQ_V2Ol2mb46fKZYX51eQEirqlwbqJtS4cMOFLJ-bTor6wxfIQwtg766URe4mNaloWw2-w-58SAqtwRCZERjEY2D9j/s1600/HEMO.gif" /></a></div><div align="center" class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0WEFMj4FVNSfsyYQ-gAIxEEDB-gBgWzIfEHlvyvbZwFklIY8zV7cO0yfVqMgDB5799B3bTos3Egb2q1Hi-CixyfXUQOhOuBrTn-YzE3z-rRnK9ejqUvlr9w6Km3CuoWB_b_c6yOnNmRvr/s1600/hd.gif"><span style="color: blue; font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; mso-no-proof: yes; text-decoration: none; text-underline: none;"><span style="mso-ignore: vglayout;"><br />
</span></span></a><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.85pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 17.15pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
Skema proses </span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">6.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Frekuensi </span></b><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; 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"; mso-fareast-language: IN;">Frekuensi, tergantung kepada banyaknya fungsi ginjal yang tersisa, tetapi sebagian besar penderita menjalani dialisa sebanyak 3 kali/minggu. Program dialisa dikatakan berhasil jika :</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">a.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-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"; mso-fareast-language: IN;">Penderita kembali menjalani hidup normal.</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">b.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-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"; mso-fareast-language: IN;">Penderita kembali menjalani diet yang normal.</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">c.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">ju</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">mlah sel darah merah dapat ditoleransi.</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">d.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-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"; mso-fareast-language: IN;">Tekanan darah normal.</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">e.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-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"; mso-fareast-language: IN;">Tidak terdapat kerusakan saraf yang progresif ( Medicastore.com, 2006 </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-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"; mso-fareast-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 21.6pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; 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"; mso-fareast-language: IN;">Dialisa bisa digunakan sebagai pengobatan jangka panjang untuk gagal ginjal kronis atau sebagai pengobatan sementara sebelum penderita menjalani pencangkokan ginjal. Pada gagal ginjal akut, dialisa dilakukan hanya selama beberapa hari atau beberapa minggu, sampai fungsi ginjal kembali normal.</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">7.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Komplikasi hemodialisa</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 18.85pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: 17.15pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Menurut Tisher dan Wilcox (1997) serta Havens dan Terra (2005) selama tindakan </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> sering sekali ditemukan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> komplikasi </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">yang terjadi, antara lain:</span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">a.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-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"; mso-fareast-language: IN;">Kram otot</span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; 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"; mso-fareast-language: IN;">Kram otot pada umumnya terjadi pada separuh waktu berjalannya </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> sampai mendekati waktu berakhirnya </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">. Kram otot seringkali terjadi pada ultrafiltrasi (penarikan cairan) yang cepat dengan volume yang tinggi. </span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">b.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-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"; mso-fareast-language: IN;">Hipotensi </span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; 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"; mso-fareast-language: IN;">Terjadinya hipotensi dimungkinkan karena pemakaian dialisat asetat, rendahnya dialisat natrium, penyakit jantung aterosklerotik, neuropati otonomik, dan kelebihan tambahan berat cairan.</span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">c.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-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"; mso-fareast-language: IN;">Aritmia</span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; 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"; mso-fareast-language: IN;">Hipoksia, hipotensi, penghentian obat antiaritmia selama dialisa, penurunan kalsium, magnesium, kalium, dan bikarbonat serum yang cepat berpengaruh terhadap aritmia pada pasien </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">.</span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">d.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-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"; mso-fareast-language: IN;">Sindrom ketidakseimbangan dialisa</span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; 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"; mso-fareast-language: IN;">Sindrom ketidakseimbangan dialisa dipercaya secara primer dapat diakibatkan dari osmol-osmol lain dari otak dan bersihan urea yang kurang cepat dibandingkan dari darah, yang mengakibatkan suatu gradien osmotik diantara kompartemen-kompartemen ini. Gradien osmotik ini menyebabkan perpindahan air ke dalam otak yang menyebabkan oedem serebri. Sindrom ini tidak lazim dan biasanya terjadi pada pasien yang menjalani </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> pertama dengan azotemia berat.</span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">e.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-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"; mso-fareast-language: IN;">Hipoksemia</span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; 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"; mso-fareast-language: IN;">Hipoksemia selama </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> merupakan hal penting yang perlu dimonitor pada pasien yang mengalami gangguan fungsi kardiopulmonar.</span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">f.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-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"; mso-fareast-language: IN;">Perdarahan</span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; 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"; mso-fareast-language: IN;">Uremia menyebabkan ganguan fungsi trombosit. Fungsi trombosit dapat dinilai dengan mengukur waktu perdarahan. Penggunaan heparin selama </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> juga merupakan faktor risiko terjadinya perdarahan.</span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">g.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-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"; mso-fareast-language: IN;">Ganguan pencernaan</span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; 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"; mso-fareast-language: IN;">Gangguan pencernaan yang sering terjadi adalah mual dan muntah yang disebabkan karena hipoglikemia. Gangguan pencernaan sering disertai dengan sakit kepala.</span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">h.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-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"; mso-fareast-language: IN;">Infeksi atau peradangan bisa terjadi pada akses vaskuler.</span></div><div class="MsoNormalCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">i.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 7.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-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"; mso-fareast-language: IN;">Pembekuan darah bisa disebabkan karena dosis pemberian heparin yang tidak adekuat ataupun kecepatan putaran darah yang lambat.</span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7I00_U6BPHQ0MDtz8CW4FrDXfRSlIwBUWqLxwud9V28WRr8KSmLrVO-oFs8McPzd5JsqhVfTC0nHnSkz0G3TBsW227XhqtCTHGcHypEF-53k2whP55ghDJK3HiS48YALL59D9Ftvowq3k/s1600/HEN.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7I00_U6BPHQ0MDtz8CW4FrDXfRSlIwBUWqLxwud9V28WRr8KSmLrVO-oFs8McPzd5JsqhVfTC0nHnSkz0G3TBsW227XhqtCTHGcHypEF-53k2whP55ghDJK3HiS48YALL59D9Ftvowq3k/s1600/HEN.jpg" /></a></div><div align="center" class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjSWCnT72MSOu8c6EtyzzGWmkYmLrhGdEbTut_Px16goyAqowH8Vg6yq73Mrc56sb6TtgyqD5wl-ITh1nyaioX79zsYZRTmvVGEKmWR9xvnMOg5QMsZWGiPW9GujCPOgXro5dGVgw-xjrxq/s1600/hd2.jpg"><span style="color: blue; font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; mso-no-proof: yes; text-decoration: none; text-underline: none;"><span style="mso-ignore: vglayout;"><br />
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</div><div align="center" class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkFVZg3wkk-rhwPjB3JWERihRJ7hzVbqUuAs5kMk2LIkj-X4x-yoXnN7fhRDaqqbxgosRkwNRKBrDOakTL1BTx76zFxisL7PHrd0onQilnc_O12bJb323L-4pkApG0cV3djXu135sj7Zha/s1600/hd+2.gif"><span style="color: blue; font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; mso-no-proof: yes; text-decoration: none; text-underline: none;"><span style="mso-ignore: vglayout;"><br />
</span></span></a><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -18.0pt;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">BAB III</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div align="center" class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">KESIMPULAN DAN SARAN</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 36.0pt; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><span style="mso-list: Ignore;">A.<span style="font: 7.0pt "Times New Roman";"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="mso-ansi-language: EN-US;">KESIMPULAN </span></b></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa merupakan </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-spacerun: yes;"> </span>pergerakan larutan dan air dari darah pasien melewati membran semipermeabel (alat dialisis) ke dalam dialisat (Tisher & Wilcox, 1997). Alat dialisis juga dapat digunakan untuk memindahkan sebagian besar volume cairan. Pemindahan ini dilakukan melalui ultrafiltrasi dimana tekanan hidrostatik menyebabkan aliran yang besar dari air plasma (dengan perbandingan sedikit larutan) melalui membran semipermeabel.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> telah menjadi metode yang dominan dalam pengobatan gagal ginjal akut dan kronik di Amerika Serikat (Tisher & Wilcox, 1997).</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> memerlukan sebuah mesin dialisa dan sebuah filter khusus yang dinamakan dializer (suatu membran semipermeabel) yang digunakan untuk membersihkan darah, darah dikeluarkan dari tubuh penderita dan beredar dalam sebuah mesin diluar tubuh. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> memerlukan jalan masuk ke aliran darah, maka dibuat suatu hubungan buatan antara arteri dan vena (fistula arteriovenosa) melalui pembedahan (NKF, 2006).</span></div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 36.0pt; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><span style="mso-list: Ignore;">B.<span style="font: 7.0pt "Times New Roman";"> </span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="mso-ansi-language: EN-US;">SARAN</span></b></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; 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"; mso-fareast-language: IN;">Pasien </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> sangatlah tergantung dengan mesin semasa sisa umurnya. Dalam pelaksanaan </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Hemodialisa</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> sangatlah banyak</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> komplikasi </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">dan kemungkinan yang terjadi, sehingga diperlukan </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">perawatan yang maksimal. Dan sebagai perawat kita harus melaksanakan perawatan dengan sebaik-baiknya pada pasien dan lakukan pendidikan kesehatan agar pasien mau dan mampu untuk menjaga serta meningkatkan kesehatannya.</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 18.0pt;"><br />
</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;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">DAFTAR PUSTAKA</span></b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</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"; mso-fareast-language: IN;">PERNEFRI, 2003, Konsensus dialisis. Sub Bagian Ginjal dan Hipertensi–Bagian Ilmu Penyakit dalam. FKUI-RSUPN Dr. Cipto Mangunkusumo. Jakarta.</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"; mso-fareast-language: IN;">Price, S. A. & Wilson, L. M., 1995, Patofisiologi: Konsep klinis proses-proses penyakit, Edisi 4, EGC, Jakarta. </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"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">www.kidneyatlas.org </span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></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"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">www.nfk.com</span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></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"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">www.wordpress.com</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal"><span style="font-family: "Century Schoolbook","serif"; font-size: 12pt; line-height: 115%;">Diposting Oleh </span><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">: </span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">Nama <span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>Pipit Puspita Permana</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">NIM<span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>:05200ID09026</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">Kelas<span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>:2A<span style="mso-tab-count: 1;"> </span></span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">Kelompok<span style="mso-tab-count: 1;"> </span>:1</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>-Anisah Nur Azizah</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>-Asep Diki Permana</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>-Farid Maroef Maulana Ishak</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>-Lina Ratiana</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>-Pipit Puspita Permana</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 2;"> </span>-Rini Yulianai</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 2;"> </span>-Susanti</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 2;"> </span>-Ucu Cahyati</span></b></div><div class="MsoNormal"><br />
</div><div align="center" class="MsoNormal" style="text-align: center;"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">MAHASISWA AKPER PEMDA GARUT</span></b></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;"><br />
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</div>TEAM_ONE KMB 2A AKPEM GARUThttp://www.blogger.com/profile/01719877433346227735noreply@blogger.com0tag:blogger.com,1999:blog-1245729285541543255.post-37426969063100107332011-04-07T20:39:00.000-07:002011-04-07T20:39:59.540-07:00tugas KMB ke-10 (Transplantasi ginjal)<!--[if !mso]> <style>
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</style> <![endif]--> <div align="center" class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";">BAB I</span></b><b><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 150%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";"></span></b></div><div align="center" class="MsoNormal" style="line-height: 300%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: center;"><b><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 300%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";">PENDAHULAN</span></b></div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 22.5pt; mso-add-space: auto; mso-list: l7 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><b><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.1<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: IN; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span></span></b><b><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";">Latar Belakang</span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"><span class="apple-style-span"><span lang="EN-US" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Transplantasi ginjal adalah suatu metode terapi dengan cara "memanfaatkan" sebuah ginjal sehat (yang diperoleh melalui proses pendonoran) melalui prosedur pembedahan. Ginjal sehat dapat berasal dari individu yang masih hidup (donor hidup) atau yang baru saja meninggal (donor kadaver). Ginjal ‘cangkokan’ ini selanjutnya akan mengambil alih fungsi kedua ginjal yang sudah rusak.</span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"><span class="apple-style-span"><span lang="EN-US" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Transplantasi (cangkok) ginjal adalah proses pencangkokan ginjal ke dalam tubuh seseorang melalui tindakan pembedahan. Ginjal baru bersama ginjal lama yang fungsinya sudah memburuk akan bekerja bersama-sama untuk mengeluarkan sampah metabolisme dari dalam tubuh.</span></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></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"><span class="apple-style-span"><span lang="EN-US" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kedua ginjal lama, walaupun sudah tidak banyak berperan tetap berada pada posisinya semula, tidak dibuang, kecuali jika ginjal lama ini menimbulkan komplikasi infeksi atau tekanan darah tinggi.</span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 36.0pt;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 22.5pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l7 level2 lfo1; text-align: justify; text-indent: -18.0pt;"><b><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.2<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span></span></b><b><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";">Rumusan Masalah</span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 49.65pt; mso-add-space: auto; mso-list: l1 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -1.0cm;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: SV; 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 lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";">Apa yang dimaksud dengan Cangkok Ginjal ?</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 49.65pt; mso-add-space: auto; mso-list: l1 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -1.0cm;"><span class="apple-style-span"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: SV; 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><span class="apple-style-span"><span lang="EN-US" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Bagaimana cara kerja cangkok Ginjal??</span></span><span class="apple-style-span"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";"></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 49.65pt; mso-add-space: auto; mso-list: l1 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -1.0cm;"><span class="apple-style-span"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: SV; 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><span class="apple-style-span"><span lang="EN-US" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Siapa saja yang dapat<span style="mso-spacerun: yes;"> </span>menjalani Transplalansi Ginjal?</span></span><span class="apple-style-span"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";"></span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 49.65pt; mso-add-space: auto; mso-list: l1 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -1.0cm;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: SV; 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 lang="EN-US" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Keuntungan dan Kekurangan Transplamtasi Ginjal</span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 49.65pt; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 22.5pt; mso-add-space: auto; mso-list: l7 level2 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><b><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">1.3<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";">Tujuan Penulisan</span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-add-space: auto; mso-list: l0 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: SV; 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 lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";">Untuk mengetahui apa yang dimaksud dengan Cangkok Ginjal ?</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; mso-add-space: auto; mso-list: l0 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span class="apple-style-span"><span lang="EN-US" style="color: #333333; 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;">B.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></span><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";">Untuk mengetahui </span><span class="apple-style-span"><span lang="EN-US" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Bagaimana Cara Transplalansi Ginjal??</span></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;"><br />
</div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><b><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";">1.4 Metode Penulisan</span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 6.0pt; text-align: justify; text-indent: 36.0pt;"><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";">Metode yang digunakan dalam penyusunan makalah ini adalah menggunakan metode kepustakaan, yaitu mencari sumber dari buku-buku maupun media elektronik (internet).</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: 6.0pt; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: 42.5pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 6.0pt; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: 42.5pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 6.0pt; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: 42.5pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 6.0pt; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: 42.5pt;"><br />
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</div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: 6.0pt; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: 42.5pt;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: center;"><b><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 150%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";">BAB II</span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: center;"><b><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 16.0pt; line-height: 150%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";">TINJAUAN TEORI</span></b></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 25.1pt; mso-add-space: auto; mso-list: l4 level2 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 25.1pt;"><span lang="EN-US" style="color: #333333; 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;">2.1<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";">Pengertian </span></b><span lang="EN-US" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 50.2pt; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 21.8pt;"><span class="apple-style-span"><span lang="EN-US" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Transplantasi ginjal adalah suatu metode terapi dengan cara "memanfaatkan" sebuah ginjal sehat (yang diperoleh melalui proses pendonoran) melalui prosedur pembedahan. Ginjal sehat dapat berasal dari individu yang masih hidup (donor hidup) atau yang baru saja meninggal (donor kadaver). Ginjal ‘cangkokan’ ini selanjutnya akan mengambil alih fungsi kedua ginjal yang sudah rusak.</span></span><span lang="EN-US" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">. </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 25.1pt;"><span class="apple-style-span"><span lang="EN-US" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Transplantasi (cangkok) ginjal adalah proses pencangkokan ginjal ke dalam tubuh seseorang melalui tindakan pembedahan. Ginjal baru bersama ginjal lama yang fungsinya sudah memburuk akan bekerja bersama-sama untuk mengeluarkan sampah metabolisme dari dalam tubuh.</span></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></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 25.1pt;"><span class="apple-style-span"><span lang="EN-US" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Kedua ginjal lama, walaupun sudah tidak banyak berperan tetap berada pada posisinya semula, tidak dibuang, kecuali jika ginjal lama ini menimbulkan komplikasi infeksi atau tekanan darah tinggi.</span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify; text-indent: 25.1pt;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span class="apple-style-span"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%;">2.2 Cara Transplalansi Ginjal??</span></b></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-indent: 36.0pt;"><span lang="EN-US" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Dokter bedah akan meletakkan ginjal di dalam perut sebelah bawah, kemudian menghubungkan pembuluh darah dan saluran kencing (<i>ureter</i>) ginjal baru tersebut ke pembuluh darah dan ureter penderita. Setelah terhubung, ginjal akan dialiri darah yang akan dibersihkan. Air kencing (<i>urine</i>) biasanya langsung diproduksi. Tetapi beberapa keadaan, urine diproduksi bahkan setelah beberapa minggu.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span lang="EN-US" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Ginjal lama kita yang dua buah akan dibiarkan di tempatnya. Tetapi jika ginjal tersebut menyebabkan infeksi atau menimbulkan penyakit darah tinggi, maka harus diangkat.</span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhOXbA-XU8irUjSPvWTjDDbRXONnD4VTVQ4_p5QXaFgRsbTda2v821TWZq5sNZohER0q-3i3hiFfaLH-I7tLgXNm2SR0DI_k_x8-_InBQaEFNWCxSAel8-suaPOeiPzBLq2dwBSotRK4Zhd/s1600/cangkok.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhOXbA-XU8irUjSPvWTjDDbRXONnD4VTVQ4_p5QXaFgRsbTda2v821TWZq5sNZohER0q-3i3hiFfaLH-I7tLgXNm2SR0DI_k_x8-_InBQaEFNWCxSAel8-suaPOeiPzBLq2dwBSotRK4Zhd/s1600/cangkok.jpg" /></a></div><div class="MsoNormal" style="line-height: 16.75pt; margin-bottom: .0001pt; margin-bottom: 0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-ansi-language: IN; mso-fareast-language: IN; mso-no-proof: yes;"><br />
</span><span lang="EN-US" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 16.75pt; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
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</div><div class="MsoNormal" style="line-height: 16.75pt; margin-bottom: .0001pt; margin-bottom: 0cm;"><b><span lang="EN-US" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">2.2.1 Persiapan Transplantasi</span></b></div><div class="MsoNormal" style="line-height: 16.75pt; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-indent: 36.0pt;"><span lang="EN-US" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Bicarakan dengan dokter anda mengenai transplantasi yang akan dijalani, karena tidak semua orang cocok untuk transplantasi. Beberapa kondisi dapat membuat proses transplantasi berbahaya atau tidak mungkin berhasil.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span lang="EN-US" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Ginjal baru dapat diperoleh dari donor yang baru saja meninggal dunia, atau dari donor hidup. Donor hidup bisa keluarga, bisa juga bukan - biasanya pasangan atau teman. Jika anda tidak memiliki donor hidup, anda akan dimasukkan ke dalam daftar tunggu untuk memperoleh ginjal dari donor meninggal. Masa tunggu tersebut dapat berlangsung bertahun-tahun.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-indent: 18.0pt;"><span lang="EN-US" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Petugas transplantasi akan mempertimbangkan tiga faktor untuk menentukan kesesuaian ginjal dengan penerima (resipien). Faktor tersebut akan menjadi tolak ukur untuk memperkirakan apakah sistim imun tubuh penerima akan menerima atau menolak ginjal baru tersebut.</span></div><ol start="1" type="1"><li class="MsoNormal" style="color: #333333; line-height: 150%; mso-list: l6 level1 lfo5; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Golongan darah</span></b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">. Golongan darah penerima (A,B, AB, atau O) harus sesuai dengan golongan darah donor. Faktor golongan darah merupakan faktor penentu kesesuaian yang paling penting.</span></li>
<li class="MsoNormal" style="color: #333333; line-height: 150%; mso-list: l6 level1 lfo5; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Human leukocyte antigens</span></b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";"> (HLAs). Sel tubuh membawa 6 jenis HLAs utama, 3 dari ibu dan 3 dari ayah. Sesama anggota keluarga biasanya mempunyai HLAs yang sesuai. Resipien masih dapat menerima ginjal dari donor walaupun HLAs mereka tidak sepenuhnya sesuai, asal golongan darah mereka cocok, dan tes lain tidak menunjukkan adanya gangguan kesesuaian.</span></li>
<li class="MsoNormal" style="color: #333333; line-height: 150%; mso-list: l6 level1 lfo5; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Uji silang antigen</span></b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">. Tes terakhir sebelum dilakukan pencangkokan adalah uji silang organ. Sejumlah kecil darah resipien dicampur dengan sejumlah kecil darah donor. Jika tidak terjadi reaksi, maka hasil uji disebut uji silang negatif, dan transplantasi dapat dilakukan.</span></li>
</ol><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-indent: 36.0pt;"><span lang="EN-US" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Pembedahan untuk cangkok ginjal biasanya memakan waktu 3 sampai 4 jam. Lama rawat di rumah sakit biasanya adalah satu minggu. Setelah keluar dari rumah sakit, resipien masih harus melakukan kunjungan secara teratur untuk mem<i>follow-up</i> hasil pencangkokan.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;"><span lang="EN-US" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Sedangkan bagi pendonor hidup, waktu yang dibutuhkan hampir sama dengan resipien. Walaupun demikian, karena teknik operasi untuk mengangkat ginjal donor semakin maju, maka waktu rawat menjadi lebih pendek, mungkin 2 sampai 3 har</span></div><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;"><span lang="EN-US" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">2.2.2 komplikasi </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-indent: 36.0pt;"><span lang="EN-US" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Setelah transplantasi, dokter akan memberikan penderita obat imunosupresan, yang berguna untuk mencegah reaksi penolakan, yaitu reaksi dimana sistem tubuh menyerang ginjal baru yang dicangkokkan. Obat imunosupresan harus diminum setiap hari selama ginjal baru terus berfungsi. Kadang-kadang, reaksi penolakan tetap terjadi walaupun penderita sudah minum obat imunosupresan. Jika hal ini terjadi, penderita harus kembali menjalani dialisis, atau melakukan transplantasi dengan ginjal lain.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-indent: 36.0pt;"><span lang="EN-US" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman";">Obat imunosupresan akan melemahkan daya tahan tubuh, sehingga dapat mempermudah timbulnya infeksi. Beberapa jenis obat imunosupresan juga dapat merubah penampilan. Wajah akan tampak lebih gemuk, berat badan bertambah, timbul jerawat, atau bulu di wajah. Tetapi tidak semua resipien mengalami gejala tersebut. Selain itu, imunosupresan juga dapat menyebabkan katarak, diabetes, asam lambung berlebihan, tekanan darah tinggi, dan penyakit tulang.</span></div><div class="MsoNormal" style="line-height: 16.75pt; margin-bottom: .0001pt; margin-bottom: 0cm;"><br />
</div><div class="MsoNormal" style="line-height: 16.75pt; margin-bottom: .0001pt; margin-bottom: 0cm;"><b><span lang="EN-US" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">2.2.2 Keuntungan Transplantasi Ginjal</span></b><span lang="EN-US" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div><ul type="disc"><li class="MsoNormal" style="color: #333333; line-height: 16.75pt; mso-list: l5 level1 lfo6; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Ginjal baru akan bekerja seperti halnya ginjal normal.</span></li>
<li class="MsoNormal" style="color: #333333; line-height: 16.75pt; mso-list: l5 level1 lfo6; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Penderita akan merasa lebih sehat dan "lebih nomal".</span></li>
<li class="MsoNormal" style="color: #333333; line-height: 16.75pt; mso-list: l5 level1 lfo6; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Penderita tidak perlu melakukan dialisis</span></li>
<li class="MsoNormal" style="color: #333333; line-height: 16.75pt; mso-list: l5 level1 lfo6; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Penderita yang mempunyai usia harapan hidup yang lebih besar.</span></li>
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</div><div class="MsoNormal" style="line-height: 16.75pt; margin-bottom: .0001pt; margin-bottom: 0cm;"><b><span lang="EN-US" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">2.2.3 <span style="mso-spacerun: yes;"> </span>Kekurangan Transplantasi Ginjal</span></b><span lang="EN-US" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";"></span></div><ul type="disc"><li class="MsoNormal" style="color: #333333; line-height: 16.75pt; mso-list: l2 level1 lfo7; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Butuh proses pembedahan besar.</span></li>
<li class="MsoNormal" style="color: #333333; line-height: 16.75pt; mso-list: l2 level1 lfo7; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Proses untuk mendapatkan ginjal lebih sulit atau lebih lama.</span></li>
<li class="MsoNormal" style="color: #333333; line-height: 16.75pt; mso-list: l2 level1 lfo7; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Tubuh menolak ginjal yang dicangkokkan.</span></li>
<li class="MsoNormal" style="color: #333333; line-height: 16.75pt; mso-list: l2 level1 lfo7; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman";">Penderita harus rutin minum obat imunosupresan, yang mempunyai banyak efek samping.</span></li>
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</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: SV;">BAB<span style="mso-spacerun: yes;"> </span>III</span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b><span lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: SV;">KESIMPULAN DAN SARAN</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: 12.0pt; line-height: 150%; mso-ansi-language: SV;">3.1 Kesimpulan</span></b></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: 1.0cm;"><span class="apple-style-span"><span lang="EN-US" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Transplantasi ginjal adalah suatu metode terapi dengan cara "memanfaatkan" sebuah ginjal sehat (yang diperoleh melalui proses pendonoran) melalui prosedur pembedahan. Ginjal sehat dapat berasal dari individu yang masih hidup (donor hidup) atau yang baru saja meninggal (donor kadaver). Ginjal ‘cangkokan’ ini selanjutnya akan mengambil alih fungsi kedua ginjal yang sudah rusak.</span></span><span lang="EN-US" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><br />
<span class="apple-style-span">Transplantasi (cangkok) ginjal adalah proses pencangkokan ginjal ke dalam tubuh seseorang melalui tindakan pembedahan. Ginjal baru bersama ginjal lama yang fungsinya sudah memburuk akan bekerja bersama-sama untuk mengeluarkan sampah metabolisme dari dalam tubuh.</span></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></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify; text-indent: 1.0cm;"><span lang="EN-US" style="color: #333333; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;"><br />
<span class="apple-style-span">Kedua ginjal lama, walaupun sudah tidak banyak berperan tetap berada pada posisinya semula, tidak dibuang, kecuali jika ginjal lama ini menimbulkan komplikasi infeksi atau tekanan darah tinggi.</span></span></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 lang="SV" style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";">3.2 Saran</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: 12.0pt; line-height: 150%; mso-ansi-language: SV; mso-fareast-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span></span></b><span class="apple-style-span"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Karena ginjal ‘baru’ ini bukan merupakan ginjal yang berasal dari tubuh pasien sendiri, maka ada kemungkinan terjadi reaksi tubuh untuk menolak ‘benda asing’ tersebut.</span></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span class="apple-style-span"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Untuk mencegah terjadinya reaksi penolakan ini, pasien perlu mengonsumsi obat-obat anti-rejeksi atau imunosupresan segera sesudah menjalani transplantasi ginjal. Obat-obat imunosupresan bekerja dengan jalan menekan sistem imun tubuh sehingga mengurangi risiko terjadinya reaksi penolakan tubuh terhadap ginjal cangkokan.</span></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span class="apple-style-span"><span lang="EN-US" style="color: black; font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%;">Obat imunosupresan dapat membuat sistem imun (daya tahan tubuh terhadap penyakit) menjadi lemah sehingga mudah terkena infeksi. Efek samping lainnya dari imunosupresan: wajah menjadi bulat, berjerawat, atau tumbuh bulu-bulu halus pada wajah, juga dapat menyebabkan peningkatan berat badan. Beritahu dokter jika Anda mengalami efek-efek samping seperti ini untuk segera ditangani secara tepat.</span></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;"></span></div><div class="MsoNormal"><br />
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</div><div align="center" class="MsoNormal" style="text-align: center;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN;">DAFTAR PUSTAKA</span></b></div><div align="center" class="MsoNormal" style="text-align: center;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l3 level1 lfo8; text-indent: -18.0pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 115%; 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 lang="EN-US"><a href="http://www.wartamedika.com/2008/04/transplantasi-ginjal.html"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">http://www.wartamedika.com/2008/04/transplantasi-ginjal.html</span></a></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN;"></span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 72.0pt; mso-add-space: auto; mso-list: l3 level1 lfo8; text-indent: -18.0pt;"><span style="font-family: Symbol; font-size: 12.0pt; line-height: 115%; 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 lang="EN-US"><a href="http://www.sahabatginjal.com/display_articles.aspx?artid=13"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%;">http://www.sahabatginjal.com/display_articles.aspx?artid=13</span></a></span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 72pt; text-indent: -18pt;"><br />
</div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">Diposting Oleh : </span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">Nama <span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>:Rini yuliani</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">NIM<span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>:05200ID09029</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">Kelas<span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>:2A<span style="mso-tab-count: 1;"> </span></span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">Kelompok<span style="mso-tab-count: 1;"> </span>:1</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>-Anisah Nur Azizah</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>-Asep Diki Permana</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>-Farid Maroef Maulana Ishak</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>-Lina Ratiana</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>-Pipit Puspita Permana</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 2;"> </span>-Rini Yulianai</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 2;"> </span>-Susanti</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 2;"> </span>-Ucu Cahyati</span></b></div><div class="MsoNormal"><br />
</div><div align="center" class="MsoNormal" style="text-align: center;"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">MAHASISWA AKPER PEMDA GARUT</span></b></div><div align="center" class="MsoNormal" style="text-align: center;"><br />
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</div>TEAM_ONE KMB 2A AKPEM GARUThttp://www.blogger.com/profile/01719877433346227735noreply@blogger.com0tag:blogger.com,1999:blog-1245729285541543255.post-11537223280673045092011-04-07T20:29:00.000-07:002011-04-07T20:32:33.844-07:00TUGAS KMB ke- 11 Peritoneal dialisis<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">DIALISIS PERITONEAL</span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><i style="mso-bidi-font-style: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diajukan untuk memenuhi salah satu tugas kelompok mata kuliah</span></i><i style="mso-bidi-font-style: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></i></div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><i style="mso-bidi-font-style: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Keperawatan Medikal Bedah III</span></i></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"; font-size: 12pt; line-height: 150%;">MAKALAH</span></b></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggOBQv_LX4WK3xHI9dDYn3uAo9dM_ynsDLnSwEkXJzz4zBZyxSalrWkISa9eVGW9Tat7pfm8xCiY4zu9muyU9E-UGng_T9XhOaRBgoP2EQjTFZ3wR7myL2C64jyQNd-xuate-9YQbyyYwK/s1600/pemda.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggOBQv_LX4WK3xHI9dDYn3uAo9dM_ynsDLnSwEkXJzz4zBZyxSalrWkISa9eVGW9Tat7pfm8xCiY4zu9muyU9E-UGng_T9XhOaRBgoP2EQjTFZ3wR7myL2C64jyQNd-xuate-9YQbyyYwK/s1600/pemda.jpg" /></a></div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Disusun oleh:</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div align="center" class="MsoNormal" style="line-height: normal; text-align: center;"><b style="mso-bidi-font-weight: normal;"><u><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Anisah Nur Azizah</span></u></b><b style="mso-bidi-font-weight: normal;"><u><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></u></b></div><div align="center" class="MsoNormal" style="line-height: normal; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">05200ID09005</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt;"></span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tingkat 2A</span></b><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoNormal" style="line-height: 150%;"><br />
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</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">AKADEMI KEPERAWATAN</span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">PEMERINTAH KABUPATEN GARUT</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;"></span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 150%;">2011</span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><br />
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</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">KATA PENGANTAR</span></b><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div class="paragraf" style="margin-right: 1.3pt; text-indent: 1.0cm;"><span style="font-family: "Times New Roman","serif";">Segala puji bagi Allah SWT, Rabb yang telah melimpahkan segala rizki dan kasih sayang-Nya kepada semua makhluk-Nya di alam semesta ini. Shalawat dan salam semoga senantiasa terlimpah curahkan kepada kekasih dan panutan kehidupan kita, Rasulallah Muhammad saw. Dengan segala keikhlasannya, beliau telah memberikan bimbingan kepada umatnya dan mengarahkannya kepada jalan kehidupan yang lurus dan diridhai oleh Allah swt.</span></div><div class="paragraf" style="margin-right: 1.3pt; text-indent: 1.0cm;"><span style="font-family: "Times New Roman","serif";">Ucapan terima kasih kepada dosen Pembimbing yang telah memberikan banyak ilmu kepada </span><span lang="EN-US" style="font-family: "Times New Roman","serif";">kami</span><span style="font-family: "Times New Roman","serif";">, khususnya pada mata kuliah <b><i>Keperawatan</i></b></span><b><i><span lang="EN-US" style="font-family: "Times New Roman","serif";"> Medikal Bedah</span></i></b><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif";"> III</span></i></b><span lang="EN-US" style="font-family: "Times New Roman","serif";"> </span><span lang="EN-US" style="font-family: "Times New Roman","serif";">.</span><span style="font-family: "Times New Roman","serif";">Kemudian juga kepada Orang tua yang senantiasa memberikan dorongan do’a dan restunya. Dan tak lupa juga kepada rekan-rekan seperjuangan yang telah banyak memberikan bantuan baik berupa materi maupun nonmateri. Semoga Allah SWT membalas semua kebaikan dan dorongan mereka semua. Amin</span><span lang="EN-US" style="font-family: "Times New Roman","serif";">.</span></div><div class="paragraf" style="margin-right: 1.3pt; text-indent: 1.0cm;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Makalah </span><span style="font-family: "Times New Roman","serif";">ini disusun untuk membahas </span><span lang="EN-US" style="font-family: "Times New Roman","serif";">tentang</span><span lang="EN-US" style="font-family: "Times New Roman","serif";"> </span><b><i><span style="font-family: "Times New Roman","serif";">“</span></i></b><b><i><span lang="EN-US" style="font-family: "Times New Roman","serif";">DIALISIS PERITONEAL</span></i></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif";">”.</span></b><span style="font-family: "Times New Roman","serif";"> Dengan tersedianya makalah ini, kami berharap semoga ada manfaatnya baik bagi para pembaca umumnya, khususnya bagi kami sebagai penyusun.</span></div><div class="paragraf" style="margin-right: 1.3pt; text-indent: 1.0cm;"><span lang="EN-US" style="font-family: "Times New Roman","serif";">Kami </span><span style="font-family: "Times New Roman","serif";"> menyadari bahwa dalam makalah ini masih terdapat kekurangan dan kesalahan. Oleh karena itu, kepada para pembaca dan para pakarnya, kami mengharapkan saran </span><span lang="EN-US" style="font-family: "Times New Roman","serif";">dan</span><span style="font-family: "Times New Roman","serif";"> kritikan demi kesempurnaan makalah ini. </span><span lang="EN-US" style="font-family: "Times New Roman","serif";"></span></div><div class="paragraf" style="margin-right: 1.3pt; text-indent: 1.0cm;"><br />
</div><div class="paragraf" style="margin-right: 1.3pt; text-indent: 1.0cm;"><br />
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</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 12.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 6.0pt; tab-stops: 248.1pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Garut, April 2011</span><i><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></i></div><div class="MsoNormal" style="line-height: 150%; margin-left: 216.0pt; text-align: justify; text-indent: 36.0pt;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></i></div><div class="MsoNormal" style="line-height: 150%; margin-left: 288.0pt; text-align: justify; text-indent: 18.0pt;"><b style="mso-bidi-font-weight: normal;"><i><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Penulis,</span></i></b></div><div class="MsoNormal" style="line-height: 150%; margin-left: 324.3pt; text-align: justify; text-indent: 23.0pt;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-left: 324.3pt; text-align: justify; text-indent: 23pt;"><br />
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</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB I</span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PENDAHULUAN</span></b></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 18.0pt; mso-add-space: auto; mso-list: l14 level1 lfo12; text-align: justify; text-indent: -18.0pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">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"; font-size: 12pt; line-height: 150%;">Latar Belakang</span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 18.0pt; mso-add-space: auto; text-align: justify; text-indent: 18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ketika ginjal mengalami kerusakan maka ginjal tidak dapat membersihkan tubuh dari sisa-sisa metabolisme. Sisa-sisa metabolisme dan kelebihan air menumpuk dan lama kelamaan menjadi banyak di dalam darah yang disebut uremia. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 18.0pt; mso-add-space: auto; text-align: justify; text-indent: 18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Gagal ginjal kronik berarti kehilangan fungsi ginjal yang bisa terjadi secara cepat atau lambat dalam beberapa tahun. End Stage Renal Disease (ESRD) terjadi ketika ginjal mengalami kerusakan tahap akhir, dimana ginjal tidak dapat bekerja dengan baik untuk menjaga keseimbangan zat-zat kimia tubuh yang diperlukan untuk hidup. Pada saat ini pasien memerlukan dialysis sebagai terapi pengganti.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 18.0pt; mso-add-space: auto; text-align: justify; text-indent: 18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pada saat ini ada yang di sebut dengan dialysis peritoneal, yaitu </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Metode pencucian darah dengan mengunakan peritoneum (selaput yang melapisi perut dan pembungkus organ perut). Cairan dimasukkan melalui sebuah selang kecil yang menembus dinding perut ke dalam rongga perut. Cairan harus dibiarkan selama waktu tertentu sehingga limbah metabolic dari aliran darah secara perlahan masuk ke dalam cairan tersebut, kemudian cairan dikeluarkan, dibuang, dan diganti dengan cairan yang baru.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Selengkapnya akan di bahas dalam makalah ini.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 18.0pt; mso-add-space: auto; text-align: justify; text-indent: 18.0pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 21.3pt; mso-add-space: auto; mso-list: l14 level1 lfo12; text-align: justify; text-indent: -18.0pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">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"; font-size: 12pt; line-height: 150%;">Rumusan Masalah</span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 39.3pt; mso-add-space: auto; mso-list: l10 level1 lfo14; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Apa yang di maksud dengan peritoneal dialis</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">is?</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 39.3pt; mso-add-space: auto; mso-list: l10 level1 lfo14; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Apa </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Fungsi dialysis ?</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 39.3pt; mso-add-space: auto; mso-list: l10 level1 lfo14; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">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: 150%;">Apa Prinsip Dasar Peritoneal Dialisis?</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 39.3pt; mso-add-space: auto; mso-list: l10 level1 lfo14; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">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: 150%;">Bagaimana Proses Peritoneal Dialisis?</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 39.3pt; mso-add-space: auto; mso-list: l10 level1 lfo14; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">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: 150%;"> Apa </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Keuntungan</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Peritoneal Dialisis</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">?</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 39.3pt; mso-add-space: auto; mso-list: l10 level1 lfo14; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">6.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Apa </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">kelemahan Peritoneal Dialisis?</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 39.3pt; mso-add-space: auto; mso-list: l10 level1 lfo14; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">7.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kontra indikasi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Peritoneal Dialisis?</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 39.3pt; mso-add-space: auto; mso-list: l10 level1 lfo14; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">8.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Bagaimana cara</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Pemasangan Kateter untuk Dialisis Peritoneal</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">?</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 39.3pt; mso-add-space: auto; mso-list: l10 level1 lfo14; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">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: 150%;">Diagnose keperawatan Peritoneal Dialisis?</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 39.3pt; mso-add-space: auto; mso-list: l10 level1 lfo14; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">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: 150%;">Perawatan pada pasien Peritoneal Dialisis?</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 39.3pt; mso-add-space: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 22.5pt; mso-add-space: auto; mso-list: l14 level1 lfo12; text-align: justify; text-indent: -18.0pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">C.<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"; font-size: 12pt; line-height: 150%;">Tujuan Penulisan</span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 40.5pt; mso-add-space: auto; mso-list: l13 level1 lfo13; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">pengertian</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> peritoneal dialis</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">is</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 40.5pt; mso-add-space: auto; mso-list: l13 level1 lfo13; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Fungsi dialysis</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 40.5pt; mso-add-space: auto; mso-list: l13 level1 lfo13; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Prinsip Dasar Peritoneal Dialisis</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 40.5pt; mso-add-space: auto; mso-list: l13 level1 lfo13; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">4.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Proses Peritoneal Dialisis</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 40.5pt; mso-add-space: auto; mso-list: l13 level1 lfo13; text-align: justify; text-indent: -18.0pt;"><b><span style="font-size: 12pt; font-weight: normal; line-height: 150%;">5.<span style="font: 7pt "Times New Roman";"> </span></span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui Keuntungan </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Peritoneal Dialisis</span><b><span style="font-size: 12pt; font-weight: normal; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 40.5pt; mso-add-space: auto; mso-list: l13 level1 lfo13; text-align: justify; text-indent: -18.0pt;"><b><span style="font-size: 12pt; font-weight: normal; line-height: 150%;">6.<span style="font: 7pt "Times New Roman";"> </span></span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">kelemahan Peritoneal Dialisis</span><b><span style="font-size: 12pt; font-weight: normal; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 40.5pt; mso-add-space: auto; mso-list: l13 level1 lfo13; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">7.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui Kontra indikasi</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Peritoneal Dialisis</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 40.5pt; mso-add-space: auto; mso-list: l13 level1 lfo13; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">8.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui cara</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Pemasangan Kateter untuk Dialisis Peritoneal</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 40.5pt; mso-add-space: auto; mso-list: l13 level1 lfo13; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">9.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diagnose keperawatan Peritoneal Dialisis</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 40.5pt; mso-add-space: auto; mso-list: l13 level1 lfo13; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">10.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk mengetahui</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Perawatan pada pasien Peritoneal Dialisis</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 40.5pt; mso-add-space: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 18.0pt; mso-add-space: auto; mso-list: l14 level1 lfo12; text-align: justify; text-indent: -18.0pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">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"; font-size: 12pt; line-height: 150%;">Metode Penulisan</span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Metode yang di gunakan dalam penulisan makalah ini adalah menggunakan metode kepustakaan yaitu mencari sumber dari buku maupun media elektronik (internet) </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">.</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 14.4pt; mso-add-space: auto; mso-list: l14 level1 lfo12; text-align: justify; text-indent: -18.0pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">E.<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"; font-size: 12pt; line-height: 150%;">Sistematika Penulisan</span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 18.0pt; mso-add-space: auto; tab-stops: 22.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Dalam makalah ini terdiri dari BAB ,yaitu:</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; mso-add-space: auto; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB I PENDAHULUAN, yang terdiri dari : Latar Belakang, Rumusan Masalah, Tujuan Penulisan, Metode Penulisan, Dan Sistematika Penulisan.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0cm; mso-add-space: auto; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB II I PEMBAHASAN, yang berisi tentang pembahasan </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">peritoneal dialysis .</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 0cm; mso-add-space: auto; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB III KESIMPULAN DAN </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">SARAN </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">, yang berisi tentang kesimpulan dan rekomendasi.</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="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
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</div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB II</span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">PEMBAHASAN</span></b></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">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"; font-size: 12pt; line-height: 150%;">Pengertian Peritoneal Dialisis</span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Peritoneal Dialisis</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> adalah </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Metode pencucian darah dengan mengunakan peritoneum (selaput yang melapisi perut dan pembungkus organ perut). Cairan dimasukkan melalui sebuah selang kecil yang menembus dinding perut ke dalam rongga perut. Cairan harus dibiarkan selama waktu tertentu sehingga limbah metabolic dari aliran darah secara perlahan masuk ke dalam cairan tersebut, kemudian cairan dikeluarkan, dibuang, dan diganti dengan cairan yang baru.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Peritoneum berfungsi sebagai membran semipermiabel yang memungkinkan transfer sisa nitrogen/toksin dan cairan dari darah ke dalam cairan dialisat. Dialisis Peritoneal dipilih karena menggunakan teknik yang lebih sederhana dan memberikan perubahan fisiologis lebih bertahap daripada hemodialisa. </span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Peritoneal Dialisis (PD :</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l2 level2 lfo2; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">–<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: 150%;">Acute Peritoneal Dialisis (PD Acute)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l2 level2 lfo2; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">–<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: 150%;">Kronis Peritoneal Dialisis (CAPD) </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">C</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ontinous</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">:Terus menerus selama 24 jam </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;"><span 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%;">mbulatory</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">:Bebas bergerak </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">P</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">eritoneal</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">:Peritoneum sebagai membran semi permeable </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">D</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">ialysis</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">:Membersihkan tubuh dari zat sisa-sisa metabolisme dan kelebihan cairan.</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;"><br />
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</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">B.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemasangan Kateter untuk Dialisis Peritoneal</span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Sebelum melakukan Dialisis peritoneal, perlu dibuat akses sebagai tempat keluar masuknya cairan dialisat (cairan khusus untuk dialisis) dari dan ke dalam rongga perut (peritoneum). Akses ini berupa kateter yang “ditanam” di dalam rongga perut dengan pembedahan. Posisi kateter yaitu sedikit di bawah pusar. Lokasi dimana sebagian kateter muncul dari dalam perut disebut “<b style="mso-bidi-font-weight: normal;"><i>exit site</i>”.</b></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">C.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Fungsi </span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Peritoneal Dialisis</span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l18 level2 lfo3; tab-stops: 63.0pt list 72.0pt; text-align: justify; text-indent: -31.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">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: 150%;">Mengeluarkan produk-produk sisa metabolisme </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l18 level2 lfo3; tab-stops: 63.0pt list 72.0pt; text-align: justify; text-indent: -31.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">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: 150%;">Mengeluarkan kelebihan air</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l18 level2 lfo3; tab-stops: 63.0pt list 72.0pt; text-align: justify; text-indent: -31.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">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: 150%;">Membantu menjaga keseimbangan zat-zat kimia tubuh</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72.0pt; mso-add-space: auto; tab-stops: 63.0pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">D.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Prinsip Dasar </span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Peritoneal Dialisis</span></b></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kateter CAPD (tenchoff catheter) dimasukkan ke dalam rongga peritoneum melalui teknik operasi. Konsentrasi adalah kata-kata yang sering kita dengar di dalam cairan CAPD.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraph" style="line-height: 150%; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">E.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Proses </span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Peritoneal Dialisis</span></b></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 36.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Cairan dialysis 2 L dimasukkan dalam rongga peritoneum melalui catheter tunchoff, didiamkan untuk waktu tertentu (6 – 8 jam) dan peritoneum bekerja sebagai membrane semi permeable untuk mengambil sisa-sisa metabolisme dan kelebihan air dari darah. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Osmosis, difusi dan konveksi akan terjadi dalam rongga peritoneum. Setelah dwell time selesai cairan akan dikeluarkan dari rongga peritoneum melalui catheter yang sama, proses ini berlangsung 3 – 4 kali dalam sehari selama 7 hari dalam seminggu.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l17 level2 lfo4; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Difusi</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l4 level1 lfo9; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a.<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: 150%;">Membrane peritoneum menyaring solute dan air dari darah ke rongga peritoneum dan sebaliknya melalui difusi.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l4 level1 lfo9; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b.<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: 150%;">Difusi adalah proses perpindahan solute dari daerah yang berkonsentrasi tinggi ke daerah yang berkonsentrasi rendah, dimana proses ini berlangsung ketika cairan dialisat dimasukkan ke dalam rongga peritoneum. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l4 level1 lfo9; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c.<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: 150%;">Konsentrasi cairan CAPD lebih rendah dari plasma darah, karena cairan plasma banyak mengandung toksin uremik. Toksin uremik berpindah dari plasma ke cairan CAPD.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></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 />
</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l17 level2 lfo4; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Osmosi</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">s</span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; mso-list: l3 level1 lfo15; tab-stops: 54.0pt; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">A</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">dalah perpindahan air melewati membrane semi permeable dari daerah solute yang berkonsentrasi rendah (kadar air tinggi) ke daerah solute berkonsentrasi tinggi (kadar air rendah). Osmosis dipengaruhi oleh tekanan osmotic dan hidrostatik antara darah dan cairan dialisat. </span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; mso-list: l3 level1 lfo15; tab-stops: 54.0pt; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b.<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: 150%;">Osmosis pada peritoneum terjadi karena glukosa pada cairan CAPD menyebabkan tekanan osmotic cairan CAPD lebih tinggi (hipertonik) dibanding plasma, sehingga air</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; mso-list: l3 level1 lfo15; tab-stops: 54.0pt; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c.<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: 150%;">Kandungan glucose yang lebih tinggi akan mengambil air lebih banyak. Cairan melewati membrane lebih cepat dari pada solute. Untuk itu diperlukan dwell time yang lebih panjang untuk menarik solute.</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; mso-list: l3 level1 lfo15; tab-stops: 54.0pt; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">d.<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: 150%;">Untuk membantu mengeluarkan kelebihan air dalam darah, maka cairan dialisat menyediakan beberapa jenis konsentrasi yang berbeda :</span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; tab-stops: 54.0pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Baxter : 1,5%, 2,5%, 4,25%</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; tab-stops: 54.0pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Frescenius : 1,3%, 2,3%, 4,25%</span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZhim-fklt2iHTXF2uNORftprIHPvOmb2q_lCB-iSunuMY1p-bhaEykErVOgTpGvk1JSFo4vQlMw_dNILRdaPTWEzJK9BKTYTGyzTH2-wCQcVAVOiYqfu1mWHF1TDXhYvb-0n_0eL0Tw8n/s1600/pd.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZhim-fklt2iHTXF2uNORftprIHPvOmb2q_lCB-iSunuMY1p-bhaEykErVOgTpGvk1JSFo4vQlMw_dNILRdaPTWEzJK9BKTYTGyzTH2-wCQcVAVOiYqfu1mWHF1TDXhYvb-0n_0eL0Tw8n/s1600/pd.jpg" /></a></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54pt; text-align: justify;"><br />
</div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjw6LIhI5aVi6OXySXI_MKarEIHg2BXN9kyYZ1Oqcbn1lb4OsVB3XJ3DivFiBndxbcJ5pNWG0d1ssR0GbvbWEHDHzLrSfnJyjRjHmriEwaNjPAuXUt2wCcpVCOD-0MkvCzMR6s4YzPxmBrB/s1600/dialisis.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjw6LIhI5aVi6OXySXI_MKarEIHg2BXN9kyYZ1Oqcbn1lb4OsVB3XJ3DivFiBndxbcJ5pNWG0d1ssR0GbvbWEHDHzLrSfnJyjRjHmriEwaNjPAuXUt2wCcpVCOD-0MkvCzMR6s4YzPxmBrB/s1600/dialisis.jpg" /></a><br />
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</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">F.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Perpindahan Cairan Pada</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: 150%;"> </span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Peritoneal Dialisis</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> <span lang="EN-US">Dipengaruhi :</span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; mso-list: l7 level1 lfo10; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a.<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: 150%;">Kualitas membrane</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; mso-list: l7 level1 lfo10; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b.<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: 150%;">Ukuran & karakteristik larutan </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; mso-list: l7 level1 lfo10; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c.<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: 150%;">Volume dialisat </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">G.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Proses Dialysis Pada CAPD Terjadi Karena Adanya Perbedaan :</span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; mso-list: l16 level1 lfo11; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a.<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: 150%;">Tekanan osmotic</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; mso-list: l16 level1 lfo11; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b.<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: 150%;">Konsentrasi zat terlarut antara cairan CAPD dengan plasma darah dalam pembuluh kapiler </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; mso-list: l16 level1 lfo11; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c.<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: 150%;">Pada saat cairan dialisat dimasukkan dalam peritoneum, air akan diultrafiltrasi dari plasma ke dialisat, sehingga meningkatkan volume cairan intra peritoneal. Peningkatan volume cairan intraperitoneal berbanding lurus dengan konsentrasi glukosa dari cairan dialisat.</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; mso-list: l16 level1 lfo11; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">d.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">D. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kecepatan transport air dan zat terlarut dapat diestimasi secara periodic melalui PET test (Peritoneal Equilibrum Test) </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; mso-list: l16 level1 lfo11; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">e.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Standar konsentrasi elektrolit cairan CAPD:</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l5 level2 lfo5; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">–<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Na (132 meq /lt)</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l5 level2 lfo5; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">–<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Cl ( 102 meq /lt)</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l5 level2 lfo5; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">–<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mg (0,5 meq /lt)</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; mso-list: l5 level2 lfo5; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">–<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">K (0 meq /lt)</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%;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">H.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Keuntungan</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Peritoneal Dialisis:</span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level2 lfo6; tab-stops: list 49.5pt; text-align: justify; text-indent: -36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Dapat dilakukan sendiri di rumah atau tempat kerja</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%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level2 lfo6; tab-stops: list 49.5pt; text-align: justify; text-indent: -36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pasien menjadi mandiri (independen), meningkatkan percaya diri</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%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level2 lfo6; tab-stops: list 49.5pt; text-align: justify; text-indent: -36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Simpel, dapat dilatih dalam periode 1-2 minggu.</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%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; mso-list: l0 level2 lfo6; tab-stops: list 49.5pt; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">4.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jadwal fleksibel, tidak tergantung penjadwalan rumah sakit</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%;">sebagaimana HD</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%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level2 lfo6; tab-stops: list 49.5pt; text-align: justify; text-indent: -36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">5.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pembuangan cairan dan racun lebih stabil</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%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level2 lfo6; tab-stops: list 49.5pt; text-align: justify; text-indent: -36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">6.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Diit dan intake cairan sedikit lebih bebas</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%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level2 lfo6; tab-stops: list 49.5pt; text-align: justify; text-indent: -36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">7.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Cocok bagi pasien yang mengalami gangguan jantung</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%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l0 level2 lfo6; tab-stops: list 49.5pt; text-align: justify; text-indent: -36.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">8.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pemeliharaan residual renal function lebih baik pada 2-3 tahun pertama</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72.0pt; mso-add-space: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">I.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kelemahan</span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Peritoneal Dialisis</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: 150%;"> :</span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l12 level2 lfo7; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Resiko infeksi</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%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l12 level2 lfo7; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Peritonitis</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l12 level2 lfo7; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Exit site</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l12 level2 lfo7; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">4.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tunnel </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l12 level2 lfo7; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">5.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BB naik karena glukosa, pada cairan CAPD diabsorbsi</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%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72.0pt; mso-add-space: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">J.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penilaian</span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Peritoneal Dialisis:</span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 108.0pt; mso-add-space: auto; mso-list: l12 level3 lfo7; tab-stops: list 58.5pt; text-align: justify; text-indent: -67.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penilaian bersifat individual</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; mso-list: l12 level3 lfo7; tab-stops: 58.5pt; text-align: justify; text-indent: -22.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adakah faktor kelainan yang menyebabkan CAPD lebih bermanfaat dibanding HD ?</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; mso-list: l12 level3 lfo7; tab-stops: 58.5pt; text-align: justify; text-indent: -22.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kesulitan akses vaskular, penyakit cardiovaskular yang berat</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; mso-list: l12 level3 lfo7; tab-stops: 58.5pt; text-align: justify; text-indent: -22.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">4.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jarak rumah dengan center HD, pekerjaan</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; tab-stops: 58.5pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">K.<span style="font: 7pt "Times New Roman";"> </span></span></b><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kontra Indikasi</span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Peritoneal Dialisis :</span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; mso-list: l9 level2 lfo8; tab-stops: list 63.0pt; text-align: justify; text-indent: -22.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Hilangnya fungsi membran peritoneum</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; mso-list: l9 level2 lfo8; tab-stops: list 63.0pt; text-align: justify; text-indent: -22.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Operasi berulang pada abdomen, kolostomi,</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; mso-list: l9 level2 lfo8; tab-stops: list 63.0pt; text-align: justify; text-indent: -22.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ukuran tubuh yang besar (kemungkinan dengan PD yang adekuat tidak tercapai)</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; mso-list: l9 level2 lfo8; tab-stops: list 63.0pt; text-align: justify; text-indent: -22.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">4.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Identifikasi problem yang potensial timbul sebelum CAPD dimulai</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 90.0pt; mso-add-space: auto; mso-list: l8 level1 lfo16; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Apakah pasien perlu seorang asisten (keterbatasan fisik / mental)</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%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 90.0pt; mso-add-space: auto; mso-list: l8 level1 lfo16; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Adakah hernia</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%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 90.0pt; mso-add-space: auto; mso-list: l8 level1 lfo16; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penglihatan kurang</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%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l9 level2 lfo8; tab-stops: list 72.0pt; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">5.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Malnutrisi yang berat</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72.0pt; mso-add-space: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">L.<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"; font-size: 12pt; line-height: 150%;">Tips Perawatan Chateter Dan Exit Site:</span></b><b><span style="color: white; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rawatanps</span></b><span style="color: white; font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> perawattttttan kateter dan <i>Exit Site</i>:</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; mso-list: l9 level3 lfo8; tab-stops: list 63.0pt; text-align: justify; text-indent: -22.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mandi setiap hari untuk menjaga kebersihan kulit, khususnya di sekitar <i>exit site</i>. Jangan mandi berendam</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; mso-list: l9 level3 lfo8; tab-stops: list 63.0pt; text-align: justify; text-indent: -22.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ganti pakaian dalam maupun pakaian luar setiap hari</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; mso-list: l9 level3 lfo8; tab-stops: list 63.0pt; text-align: justify; text-indent: -22.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jangan gunakan bahan kimia, misalnya alkohol dan bahan yang mengandung klorida untuk membersihkan <i>exit site</i> atau kateter. Anda hanya boleh menggunakan sabun dan air untuk membersihkan <i>exit site</i> dan keteter</span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; mso-list: l9 level3 lfo8; tab-stops: list 63.0pt; text-align: justify; text-indent: -22.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">4.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jangan gunakan krim, salep, atau bedak tabur di sekitar <i>exit site</i></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; mso-list: l9 level3 lfo8; tab-stops: list 63.0pt; text-align: justify; text-indent: -22.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">5.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Jaga posisi keteter krim agar tetap berada pada tempatnya (tidak tertarik, tertekuk, terputar, atau tersangkut) dengan menempelkannya pada kulit dengan bantuan plester.</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%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">M.<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"; font-size: 12pt; line-height: 150%;">Diagnosa Keperawatan Yang Mungkin Terjadi </span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; mso-list: l9 level4 lfo8; text-align: justify; text-indent: -22.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Volume cairan, kelebihan, resiko tinggi terhadap Kekurangan volume caira</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">n</span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; mso-list: l9 level4 lfo8; text-align: justify; text-indent: -22.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Resiko tinggi terhadap</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%;">traum</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a</span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; mso-list: l9 level4 lfo8; text-align: justify; text-indent: -22.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Nyeri (Akut). </span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; mso-list: l9 level4 lfo8; text-align: justify; text-indent: -22.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">4.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Infeksi, resiko tinggi terhadap, (Peritonitis). </span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; mso-list: l9 level4 lfo8; text-align: justify; text-indent: -22.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">5.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Pola pernapasan, tidak efektif, resiko tinggi terhadap. </span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l1 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">N.<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"; font-size: 12pt; line-height: 150%;">Faktor Resiko Meliputi </span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 67.5pt; mso-add-space: auto; mso-list: l9 level5 lfo8; tab-stops: 63.0pt; text-align: justify; text-indent: -22.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Tidak adekuatnya gradien osmotik dialisat. Retensi cairan (malposisi atau kateter terlipat/bekuan,distensi usus;peritonitis, jaringan parut peritoneum). Pemasukan per oral/IV berlebihan.</span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 67.5pt; mso-add-space: auto; mso-list: l9 level5 lfo8; tab-stops: 63.0pt; text-align: justify; text-indent: -22.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penggunaan dialisat hipertonik, dengan pembuangan cairan berlebihan dari volume sirkulasi. </span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 67.5pt; mso-add-space: auto; mso-list: l9 level5 lfo8; tab-stops: 63.0pt; text-align: justify; text-indent: -22.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kateter dimasukan ke dalam rongga peritoneal. Sisi dekat usus/kandung kemih, dengan potensial terjadi perforasi selama pemasukan atau manipulasi kateter. </span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 67.5pt; mso-add-space: auto; mso-list: l9 level5 lfo8; tab-stops: 63.0pt; text-align: justify; text-indent: -22.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">4.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Iritasi/infeksi dalam rongga peritoneal. Infus dialisat dingin atau asam, distensi abdominal, infus dialisat cepat. </span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 67.5pt; mso-add-space: auto; mso-list: l9 level5 lfo8; tab-stops: 63.0pt; text-align: justify; text-indent: -22.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">5.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kontaminasi kateter selama pemasangan. Kontaminasi kulit pada sisi pemasangan kateter. Peritonitis steril (respon terhadap komposisi dialisat) </span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 67.5pt; mso-add-space: auto; mso-list: l9 level5 lfo8; tab-stops: 63.0pt; text-align: justify; text-indent: -22.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">6.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tekanan abdomen/keterbatasan pengembangan diagfragma; infus dialisat terlalu cepat; nyeri. </span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 67.5pt; mso-add-space: auto; tab-stops: 63.0pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l1 level1 lfo1; tab-stops: 63.0pt; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">O.<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"; font-size: 12pt; line-height: 150%;">Tindakan </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: 150%;">Keperawatan </span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 216.0pt; mso-add-space: auto; mso-list: l9 level6 lfo8; tab-stops: 63.0pt; text-align: justify; text-indent: -166.5pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">1.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Mandiri: </span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l11 level1 lfo17; tab-stops: 63.0pt; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Pertahankan pencatatan volume masuk dan keluar, dan kumulatif keseimbangan cairan.</span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; tab-stops: 63.0pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Rasional : Pada kebanyakan kasus, jumlah cairan yang keluar harus sama atau lebih dari</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 yang masuk. <span style="color: white;">:</span></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%;">kehilangan atau peningkatan pasien pada ahkir pertukaran. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l11 level1 lfo17; tab-stops: 63.0pt; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Perhatikan keluhan pusing, mual, peningkatan rasa haus. </span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; tab-stops: 63.0pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Dapat menunjkan hipovolemia/sindrom hiperosmolar. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l11 level1 lfo17; tab-stops: 63.0pt; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Berikan jadwal untuk pengaliran dialisat dari abdomen.</span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; tab-stops: 63.0pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Rasional : Waktu tinggal lama, khususnya bila menggunakan cairan dextrose 4,25 %, dapat menyebabkan kehilangan cairan berlebihan. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l11 level1 lfo17; tab-stops: 63.0pt; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">d.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Inspeksi membran mukosa, evaluasi turgor kulit, nadi perifer, pengisian kapiler. </span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; tab-stops: 63.0pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional :Membran mukosa kering, turgor klit buruk, dan penurunan nadi/pengisian kapiler adalah indikator dehidrasi dan membutuhkan peningkatan pemasukan/perubahan dalam kekuatan dialisat. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; tab-stops: 63.0pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; tab-stops: 63.0pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 72.0pt; mso-add-space: auto; mso-list: l9 level6 lfo8; tab-stops: 63.0pt; text-align: justify; text-indent: -27.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">2.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kolaborasi : </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; mso-list: l19 level1 lfo19; tab-stops: 63.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Awasi pemeriksaan laboratorium sesuai indikasi, contoh, Natrium serum dan kadar glukosa.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; tab-stops: 63.0pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Rasional : </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; tab-stops: 63.0pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Cairan hipertonik dapat menyebabkan hipernatremia dengan membuang lebih banyak air daripada natrium. Selain itu dextrose dapat diabsropsi dari dialisat, sehingga meningkatkan glukosa serum. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; mso-list: l19 level1 lfo19; tab-stops: 63.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan analgesik.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; tab-stops: 63.0pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Rasional :</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; tab-stops: 63.0pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Menghilangkan nyeri dan ketidaknyamanan. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; mso-list: l19 level1 lfo19; tab-stops: 63.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tambahkan Natrium Hidroksida pada dialisat, bila diindikasikan. Rasional :</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; tab-stops: 63.0pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Kadang-kadang digunakan untuk mengubah pH bila pasien tidak toleran pada keasaman dialisat. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; mso-list: l19 level1 lfo19; tab-stops: 63.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">d.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Awasi jumlah SDP dari keluaran.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; tab-stops: 63.0pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Rasional : Adanya SDP pada awal dapat menunjukan respon normal terhadap substansi asing; namun, berlangsungnya peningkatan diduga terjadi infeksi. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; mso-list: l19 level1 lfo19; tab-stops: 63.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">e.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ambil spesimen darah, keluaran cairan, dan/atau drainase.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; tab-stops: 63.0pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Rasional : Mengidentifikasi tipe organisme, pilihan intervensi. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; mso-list: l19 level1 lfo19; tab-stops: 63.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">f.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan antibiotik secara sistemik atau dalam dialisat sesuai indikasi. Rasional : Mengatasi infeksi, mencegah sepsis. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; mso-list: l19 level1 lfo19; tab-stops: 58.5pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">g.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan analgesik sesuai indikasi.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; tab-stops: 58.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Rasional : Menghilangkan nyeri, meningkatkan pernapasan nyaman, upaya batuk maksimal. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; mso-list: l19 level1 lfo19; tab-stops: 58.5pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">h.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Berikan tambahan O2 sesuai indikasi.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; tab-stops: 58.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Memaksimalkan oksigen untuk penyerapan vaskular, pencegahan/pengurangan hipoksia</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></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-left: 63.0pt; mso-add-space: auto; tab-stops: 63.0pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; tab-stops: 63.0pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; tab-stops: 63.0pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 216.0pt; mso-add-space: auto; mso-list: l9 level6 lfo8; tab-stops: 63.0pt; text-align: justify; text-indent: -166.5pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">3.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Mandiri : </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; mso-list: l6 level1 lfo18; tab-stops: 58.5pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">a.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Biarkan pasien mengosongkan kandung kemih sebelum pemasangan katetr peritoneal bila kateter indwelling tidak ada.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; tab-stops: 58.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Rasional : Kandung kemih kosong, lebih jauh dari sisi pemasukan dan menurunkan kemungkinan tertusuk selama pemasangan kateter. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; mso-list: l6 level1 lfo18; tab-stops: 58.5pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">b.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Fiksasi kateter/selang dengan plester. Tekankan pentingnya pasien menghindari penarikan/mendorong kateter. Restrain tangan bila di indikasikan. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; tab-stops: 58.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; tab-stops: 58.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Menurunkan resiko trauma dengan memnipulasi kateter.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; mso-list: l6 level1 lfo18; tab-stops: 58.5pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">c.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Hentikan dialisis bila ada bukti perforasi usus/kandung kemih. Biarkan kateter dialisis tetap pada tempatnya.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; tab-stops: 58.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Rasional : Tindakan cepat akan mencegah cedera selanjutnya. Bedah perbaikan segera dapat dibutuhkan. Membiarkan kateter pada tempatnya, memudahkan diagnosa/lokasi perforasi. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; mso-list: l6 level1 lfo18; tab-stops: 58.5pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">d.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Selidiki keluhan pasien akan nyeri; perhatikan intensitas (0-10), lokasi, dan faktor pencetus.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; tab-stops: 58.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional :</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; tab-stops: 58.5pt; text-align: justify;"><span lang="EN-US" 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%;">Membantu dalam mengidentifikasi sumber nyeri dan intervensi tepat. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; mso-list: l6 level1 lfo18; tab-stops: 58.5pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">e.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Jelaskan bahwa ketidaknyamanan awal biasanya hilang setelah pertukaran pertama. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; tab-stops: 58.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; tab-stops: 58.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Penjelasan dapat menurunkan ansietas, dan meningkatkan relaksasi selama prosedur. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; mso-list: l6 level1 lfo18; tab-stops: 58.5pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">f.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Perhatikan keluhan nyeri pada area bahu. Cegah udara masuk ke rongga peritoneum selama infus. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; tab-stops: 58.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Masuknya udara ke peritoneum dapat mengiritasi diagfragma dan mengakibatkan nyeri pada bahu. Dapat dikeluhkan juga pada awal terapi, gunakan volume yang lebih kecil dulu sampai pasien baik. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; mso-list: l6 level1 lfo18; tab-stops: 58.5pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">g.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Hangatkan dialisat (hangat kering)pada suhu tubuh sebelum diinfuskan. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; tab-stops: 58.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional :</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; tab-stops: 58.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Penghangatan cairan dapat meningkatkan kecepatan pembuangan urea melalui dilatasi pembuluh darah. Dialisat dingin menyebakan vasokonstriksi, yang dapat menyebabkan ketidaknyamanan dan /atau terlalu rendah dari suhu inti tubuh, mencetuskan henti jantung. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; mso-list: l6 level1 lfo18; tab-stops: 58.5pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">h.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Observasi tehnik aseptik dan gunakan masker selama pertukaran cairan, gunakan prinsip steril saat pemasangan kateter, ganti balutan dan kapanpun sistem dibuka. Lakukan pertukaran cairan dialisat sesuai protokol. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; tab-stops: 58.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional :</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; tab-stops: 58.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> Mencegah introduksi organisme dan kontaminasi lewat udara yang dapat menyebabkan infeksi. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; mso-list: l6 level1 lfo18; tab-stops: 58.5pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">i.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Ganti balutan sesuai indikasi dengan hati-hati, dengan tidak mengubah posisi kateter. Perhatikan karakter, warna, bau drainase dari sekitar sisi pemasangan.</span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; tab-stops: 58.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Lingkungan yang lembab meningkatkan pertumbuhan bakteri. Drainase purulen pada sisi insersi menunjukkan adanya infeksi lokal. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; mso-list: l6 level1 lfo18; tab-stops: 58.5pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">j.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Observasi warna dan kejernihan keluaran. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; tab-stops: 58.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Keluaran keruh diduga infeksi peritoneal. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; mso-list: l6 level1 lfo18; tab-stops: 58.5pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">k.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Awasi frekuensi/upaya pernapasan. Penurunan kecepatan infus bila ada dipsnea. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; tab-stops: 58.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Takipnea, dipsnea, dan napas dangkal selama dialisa diduga tekanan diafragmatik dari distensi rongga peritoneal atau mungkin menunjukkan komplikasi. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; mso-list: l6 level1 lfo18; tab-stops: 58.5pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">l.<span style="font: 7pt "Times New Roman";"> </span></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Tinggikan kepala tempat tidur, tingkatkan latihan napas dalam dan batuk. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; tab-stops: 58.5pt; text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Rasional : Memudahkan ekspansi dada/ventilasi dan mobilisasi sekret. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; tab-stops: 58.5pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; tab-stops: 58.5pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; tab-stops: 58.5pt; text-align: justify;"><br />
</div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; tab-stops: 58.5pt; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">BAB III</span></b></div><div align="center" class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 63.0pt; mso-add-space: auto; tab-stops: 58.5pt; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">KESIMPULAN DAN SARAN </span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; mso-list: l15 level1 lfo20; tab-stops: 58.5pt; text-indent: -22.5pt;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">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: 150%;">Kesimpulan </span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; tab-stops: 58.5pt; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"> </span></b><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Peritoneal dialisis merupakan salah satu tipe dialisis, dimana darah dibersihkan di dalam tubuh. Dokter akan melakukan pembedahan untuk memasang akses berupa catheter di dalam abdomen penderita. Pada saat tindakan, area abdominal pasien akan secara perlahan diisi oleh cairan dialisat melalui catheter. Ada dua macam peritoneal dialysis yaitu continous peritoneal dialysis (CAPD) dan Continonus Cycling Peritoneal Dialysis. (CCPD). Untuk Indonesia CAPD lebih lazim digunakan daripada CCPD. Pada CAPD penderita melakukan sendiri tindakan medis tanap bantuan mesin dan biasanya berlangsung 4 kali sehari masing – masing selama 30 menit. </span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"></span></b></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 58.5pt; mso-add-space: auto; mso-list: l15 level1 lfo20; tab-stops: 27.0pt; text-indent: -54.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">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: 150%;">Saran</span></b></div><div class="MsoNormal" style="line-height: 150%; margin-left: 4.5pt; tab-stops: 27.0pt; text-align: justify;"><span lang="EN-US" 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%;">Banyak penderita yang meskipun harus melakukan terapi dialisis namun tetap dapat menjalani hidup secara normal. Pada awalnya memang diperlukan penyesuaian – penyesuaian baik oleh penderita maupun keluarganya, namun dengan berjalannya waktu apabila penderita telah menerima kondisinya tersebut disertai dengan pikiran positif dan menjalankan terapi dengan sungguh sungguh serta mengikuti segala petunjuk dokter, kehidupan normal pun bukan tidak mungkin untuk dicapai. </span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Untuk itu, tidak ada yang tak mungkin .</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; tab-stops: 58.5pt; text-align: justify;"><br />
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</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; tab-stops: 58.5pt; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;"><br />
</span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; tab-stops: 58.5pt; text-align: justify;"><br />
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</div><div align="center" class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 27.0pt; mso-add-space: auto; tab-stops: 58.5pt; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 150%;">Daftara pustaka</span></b></div><div class="MsoNormal" style="color: black; line-height: normal;"><u><i><a href="http://www.ygdi.org/" style="color: black;"><span style="font-family: "Verdana","sans-serif"; font-size: 10pt;">http://www.ygdi.org/</span></a><span style="font-family: "Verdana","sans-serif"; font-size: 10pt;"></span></i></u></div><div class="MsoNormal" style="color: black; line-height: normal;"><u><i><a href="http://www.scribd.com/"><span style="font-family: "Verdana","sans-serif"; font-size: 10pt;"><span style="color: black;">http://www.scribd.com</span>\</span></a><span lang="EN-US" style="font-family: "Verdana","sans-serif"; font-size: 10pt;"></span></i></u></div><div class="MsoNormal" style="color: black; line-height: normal;"><u><i><cite style="color: black;"><span style="font-family: "Calibri","sans-serif";">hemodialisa.files.wordpress.com</span></cite><span style="font-family: "Verdana","sans-serif"; font-size: 10pt;"></span></i></u></div><div class="MsoNormal" style="line-height: 150%; tab-stops: 58.5pt;"><u><i><a href="http://yoursecondfifty.com/indonesia" style="color: black;">http://yoursecondfifty.com/indonesia</a></i></u><br />
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<div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">Diposting Oleh : </span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">Nama <span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>:Anisah Nur Azizah</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">NIM<span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>:05200ID09005</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">Kelas<span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>:2A<span style="mso-tab-count: 1;"> </span></span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">Kelompok<span style="mso-tab-count: 1;"> </span>:1</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>-Anisah Nur Azizah</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>-Asep Diki Permana</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>-Farid Maroef Maulana Ishak</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>-Lina Ratiana</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>-Pipit Puspita Permana</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 2;"> </span>-Rini Yulianai</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 2;"> </span>-Susanti</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 2;"> </span>-Ucu Cahyati</span></b></div><div class="MsoNormal"><br />
</div><div align="center" class="MsoNormal" style="text-align: center;"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">MAHASISWA AKPER PEMDA GARUT</span></b></div><div align="center" class="MsoNormal" style="text-align: center;"><br />
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</div></div>TEAM_ONE KMB 2A AKPEM GARUThttp://www.blogger.com/profile/01719877433346227735noreply@blogger.com0tag:blogger.com,1999:blog-1245729285541543255.post-89721531836606599222011-03-31T02:23:00.000-07:002011-03-31T02:23:08.308-07:00TUGAS KMB 6 (URETRITIS)<!--[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>IN</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> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> <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" style="line-height: 150%; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Book Antiqua","serif";">LAPORAN PENDAHULUAN</span></b></div><div align="center" style="line-height: 150%; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Book Antiqua","serif";">ASUHAN KEPERAWATAN PADA PASIEN URETRITIS</span></b></div><div style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Book Antiqua","serif"; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">A.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Book Antiqua","serif";">Pengertian</span></b></div><div class="MsoNormal" style="line-height: 150%; tab-stops: 27.0pt; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Uretritis adalah peradangan yang terjadi pada uretra <b style="mso-bidi-font-weight: normal;">(Anonym 1997)</b></span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"></span></b></div><div class="MsoNormal" style="line-height: 150%; tab-stops: 27.0pt; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span><a href="http://obat-penyakit.com/uretritis.html" title="Uretritis"><span style="color: windowtext; text-decoration: none; text-underline: none;">Uretritis</span></a> didefinisikan sebagai peradangan akibat infeksi dari uretra. Istilah uretritis untuk <a href="http://obat-penyakit.com/category/penyakit" title="Penyakit"><span style="color: windowtext; text-decoration: none; text-underline: none;">Penyakit</span></a> Menular Seksual (PMS). Uretritis merupakan kondisi peradangan yang dapat menular. </span></div><div class="MsoListParagraph" style="line-height: 150%; mso-list: l6 level1 lfo1; tab-stops: 27.0pt; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">B.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">B. Anatomi Fisiologi</span></b></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><b><span style="font-family: "Book Antiqua","serif"; font-size: 12pt; line-height: 150%;"><br />
</span></b></div><div class="MsoListParagraph" style="line-height: 150%; text-align: justify; text-indent: -18pt;"><br />
</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgoaC3B2Gnbp0uSlRAAkaOgbJrwhXxnbzio7-ox8Z9HQ3yqMpJGALyUMU6CHp8XiK4FnjpwZ4FrdZfv5j9hGIYbwk_jvj06v6wXvpXoQjUWmGLJ8YxbbB_QEridT5OZruIYtPcex1zqBErD/s1600/URETRAKU.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgoaC3B2Gnbp0uSlRAAkaOgbJrwhXxnbzio7-ox8Z9HQ3yqMpJGALyUMU6CHp8XiK4FnjpwZ4FrdZfv5j9hGIYbwk_jvj06v6wXvpXoQjUWmGLJ8YxbbB_QEridT5OZruIYtPcex1zqBErD/s400/URETRAKU.jpg" width="372" /></a></div><div class="MsoNormal" style="line-height: 150%; tab-stops: 27.0pt; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span>Uretra merupakan saluran sempit yang berpangkal pada vesika urinaria yang berfungsi menyalurkan air kemih ke luar.</span></div><div class="MsoNormal" style="line-height: 150%; tab-stops: 27.0pt; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Pada laki-laki panjangnya kira-kira 13,7-16,2 cm, terdiri dari:</span></div><div class="MsoNormal" style="line-height: 150%; tab-stops: 27.0pt; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">1. Urethra pars Prostatica</span></div><div style="line-height: 150%; text-align: justify;"><span style="font-family: "Book Antiqua","serif";">2. Urethra pars membranosa ( terdapat spinchter urethra externa)</span></div><div style="line-height: 150%; text-align: justify;"><span style="font-family: "Book Antiqua","serif";">3. Urethra pars spongiosa.</span></div><div style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Book Antiqua","serif";">Urethra pada wanita panjangnya kira-kira 3,7-6,2 cm (Taylor), 3-5 cm (Lewis). Sphincter urethra terletak di sebelah atas vagina (antara clitoris dan vagina) dan urethra disini hanya sebagai saluran ekskresi.</span></div><div style="line-height: 150%; text-align: justify;"><span style="font-family: "Book Antiqua","serif";">Dinding urethra terdiri dari 3 lapisan:</span></div><div style="line-height: 150%; margin-left: 36.0pt; mso-list: l19 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif";">Lapisan otot polos, merupakan kelanjutan otot polos dari Vesika urinaria. Mengandung jaringan elastis dan otot polos. Sphincter urethra menjaga agar urethra tetap tertutup</span></div><div style="line-height: 150%; margin-left: 36.0pt; mso-list: l19 level1 lfo2; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif";"><span style="mso-spacerun: yes;"> </span>Lapisan submukosa, lapisan longgar mengandung pembuluh darah dan saraf.</span></div><div style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Book Antiqua","serif"; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">C.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Book Antiqua","serif";">Etiologi</span></b></div><div style="line-height: 150%; text-align: justify; text-indent: 18.0pt;"><span style="font-family: "Book Antiqua","serif";">Penyebab : kuman gonore atau kuman lain, kadang – kadang uretritis terjadi tanpa adanya bakteri. (Anonym 1997)</span></div><div style="line-height: 150%; text-align: justify; text-indent: 18.0pt;"><span style="font-family: "Book Antiqua","serif";">Penyebab klasik dari uretritis adalah infeksi yang dikarenakan oleh Neisseria Gonorhoed. Akan tetapi saat ini uretritis disebabkan oleh infeksi dari spesies Chlamydia, E.Coli atau Mycoplasma<b style="mso-bidi-font-weight: normal;">. (Emanuel Rubin, 1982)</b></span></div><div style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Book Antiqua","serif"; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">D.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Book Antiqua","serif";">Klasifikasi </span></b></div><h3 style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l18 level1 lfo3; page-break-after: avoid; tab-stops: 27.0pt; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">1.</span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"> Uretritis Akut</span></h3><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; tab-stops: 27.0pt; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Penyebab</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">:</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; tab-stops: 27.0pt; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Asending infeksi atau sebaliknya oleh karena prostate mengalami infeksi. Keadaan ini lebih sering diderita kaum pria.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; tab-stops: 54.0pt; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Tanda dan Gejala</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">:</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l13 level1 lfo4; 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: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Mukosa merah udematus</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l13 level1 lfo4; 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: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Terdapat cairan eksudat yang purulent</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l13 level1 lfo4; 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: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Ada ulserasi pada uretra</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l13 level1 lfo4; 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: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Mikroskopis : terlihat infiltrasi leukosit sel – sel plasma dan sel – sel limfosit</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l13 level1 lfo4; 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: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Ada rasa gatal yang menggelitik, gejala khas pada uretritis G.O yaitu morning sickness</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l13 level1 lfo4; 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: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Pada oria : pembuluh darah kapiler, kelenjar uretra tersumbat oleh kelompok pus</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l13 level1 lfo4; 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: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Pada wanita : jarang diketemukan uretritis akut, kecuali bila pasien menderita.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Diagnosa Diferential</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"> :</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l15 level1 lfo5; tab-stops: 90.0pt; 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: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Uretritis GO</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l15 level1 lfo5; tab-stops: 90.0pt; 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: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Amicrobic pyuhria</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l15 level1 lfo5; tab-stops: 90.0pt; 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: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Uretritis karena trichomonas</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l15 level1 lfo5; tab-stops: 90.0pt; 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: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Prostatitis non spesifik</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; tab-stops: 90.0pt; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Pemeriksaan Diagnostik</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; mso-list: l12 level1 lfo6; tab-stops: list 36.0pt; 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: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Dilakukan pemeriksaan terhadap secret uretra untuk mengetahui kuman penyebab.</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; mso-list: l18 level1 lfo3; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Uretritis Kronis</span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Penyebab</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">:</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo6; 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: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Pengobatan yang tidak sempurna pada masa akut</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo6; 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: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Prostatitis kronis</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo6; 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: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Striktura uretra</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; tab-stops: 54.0pt; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Tanda dan Gejala</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">:</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l4 level1 lfo7; 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: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Mukosa terlihat granuler dan merah</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l4 level1 lfo7; 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: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Mikroskopis : infiltrasi dari leukosit, sel plasma, sedikit sel leukosit, fibroblast bertambah</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l4 level1 lfo7; 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: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Getah uretra (+), dapat dilihat pada pagi hari sebelum bak pertama</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l4 level1 lfo7; 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: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Uretra iritasi, vesikal iritasi, prostatitis, cystitis.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; tab-stops: 54.0pt; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">.</span></div><h3 style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l18 level1 lfo3; page-break-after: avoid; tab-stops: 36.0pt 72.0pt; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Uretritis Gonokokus</span></h3><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; tab-stops: 54.0pt; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Penyebab</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">:</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;"></span></div><div class="MsoNormal" style="line-height: 150%; tab-stops: 54.0pt; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Neisseria Gonorhoeoe (gonokokus)</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; tab-stops: 54.0pt; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Tanda dan Gejala</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">:</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;"></span></div><div class="MsoNormal" style="line-height: 150%; tab-stops: 54.0pt 108.0pt; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"><span style="mso-tab-count: 1;"> </span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Sama dengan tanda dan gejala pada uretritis akut, karena uretritis ini adalah bagian dari uretritis akut</span></div><div class="MsoListParagraph" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-add-space: auto; mso-list: l18 level1 lfo3; tab-stops: 36.0pt 45.0pt list 54.0pt; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Uretritis Non Gonokokus (Non Spesifik)</span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Uretritis non gonokokus (sinonim dengan uretritis non spesifik) merupakan penyakit yang ditularkan melalui hubungan seksual yang paling sering diketemukan. Pada pria, lender uretra yang mukopurulen dan disuria terjadi dalam beberapa hari sampai beberapa minggu setelah melakukan hubungan kelamin dengan wanita yang terinfeksi. Lendir mengandung sel nanah tetapi gonokokus tidak dapat di deteksi secara mikroskopis atau kultur<b style="mso-bidi-font-weight: normal;">. (Underwood,1999)</b></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; tab-stops: list 54.0pt; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Etiologi</span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">:</span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;"></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Infeksi hamper selalu didapat selama hubungan seksual. Gonokokus membelah diri pada mukosa yang utuh dari uretra anterior dan setelah itu menginvasi kelenjar peri uretral, dengan akibat terjadinya bakteremia dan keterlibatan limfatik.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; tab-stops: list 54.0pt; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Makroskopik</span></b></div><div class="MsoNormal" style="line-height: 150%; tab-stops: list 54.0pt; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Peradangan akut dari mukosa uretra, dengan eksudat yang purulenta pada permukaan; dapat terjadi ulserasi dari mukosa.</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"></span></div><div class="MsoNormal" style="line-height: 150%; tab-stops: list 54.0pt; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Rabas</span></b><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;"></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Timbul 3-8 hari setelah infeksi dan kental, kuning serta banyak. Apusan memperlihatkan sejumlah besar sel – sel pus (100%), banyak mengandung diplokokus gram negative intraseluler yang difagositosis.</span></div><h3 style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l18 level1 lfo3; page-break-after: avoid; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Uretritis Abakterial Penyakit Reiter</span></h3><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Uretritis yang berkaitan dengan konjunktivitis dan artritis</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; tab-stops: list 54.0pt; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Etiologi</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">:</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;"></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Kemungkinan terdapat organisme dari kelompok chlamydia</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; tab-stops: list 54.0pt; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Hasil</span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Kemungkinan terdapat pemulihan spontan, tetapi sering kali terdapat riwayat yang lama, dengan banyak eksaserbasi klinik. Pada kasus yang berat terdapat ulserasi dari mukosa bukal, kulit kaki, glans penis, uretra dan kandung kemih. Iritis dan keraitis dapat</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"> menjadi penyulit konjunktivitis</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;"></span></div><h2 align="center" style="line-height: 150%; text-align: center;"><span style="color: windowtext; font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">ASUHAN KEPERAWATAN</span></h2><h2 style="line-height: 150%; margin-left: 49.65pt; mso-list: l9 level1 lfo13; text-align: justify; text-indent: -18.0pt;"><span style="color: windowtext; font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">A.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="color: windowtext; font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">PENGKAJIAN</span></h2><h2 style="line-height: 150%; margin-left: 36.0pt; mso-list: l3 level1 lfo8; text-align: justify; text-indent: -18.0pt;"><span style="color: windowtext; font-family: "Book Antiqua","serif"; font-size: 12.0pt; font-weight: normal; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="color: windowtext; font-family: "Book Antiqua","serif"; font-size: 12.0pt; font-weight: normal; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Biodata klien</span></h2><div class="MsoBodyTextIndent" style="line-height: 150%; text-align: justify;"><span lang="EN-US" style="font-family: "Book Antiqua","serif";">Pada biodata perlu adanya pencatatan secara akurat. Pada kasus uretritis 90% dialami oleh pria. Sebaliknya Pada wanita hanya sedikit yang mengalami dan kebanyakan asimptomatik.</span><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN;"></span></div><div class="MsoBodyTextIndent" style="line-height: 150%; mso-list: l3 level1 lfo8; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Book Antiqua","serif"; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Book Antiqua","serif";">Pemeriksaan fisik</span></div><div class="MsoBodyTextIndent" style="line-height: 150%; mso-list: l3 level1 lfo8; tab-stops: 72.0pt list 108.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Book Antiqua","serif"; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Book Antiqua","serif";">Riwayat penyakit sekarang : kali dengan PQRST</span></div><div class="MsoBodyTextIndent" style="line-height: 150%; mso-list: l3 level1 lfo8; tab-stops: 72.0pt list 108.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Book Antiqua","serif"; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Book Antiqua","serif";">Riwayat penyakit terdahulu : Apakah klien pernah atau sedang mengalami penyakit kelamin. Apakah klien pernah mengalami lesi local yang berlokasi dekat uretra.</span></div><div class="MsoBodyTextIndent" style="line-height: 150%; mso-list: l3 level1 lfo8; tab-stops: 72.0pt list 108.0pt; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Book Antiqua","serif"; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Book Antiqua","serif";">Pola aktivitas sehari – hari</span></div><div class="MsoBodyTextIndent" style="line-height: 150%; margin-left: 54.0pt; mso-list: l5 level1 lfo9; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Book Antiqua","serif"; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Book Antiqua","serif";">Nutrisi</span></div><div class="MsoBodyTextIndent" style="line-height: 150%; margin-left: 54.0pt; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-family: "Book Antiqua","serif";">Kaji pola nutrisi klien apakah klien mengalami mual, muntah atau anoreksia berhubungan dengan adanya rasa nyeri dan adanya inflamasi uretra.</span><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN;"></span></div><div class="MsoBodyTextIndent" style="line-height: 150%; margin-left: 54.0pt; mso-list: l5 level1 lfo9; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Book Antiqua","serif"; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Book Antiqua","serif";">Eliminasi</span></div><div class="MsoBodyTextIndent" style="line-height: 150%; margin-left: 54.0pt; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-family: "Book Antiqua","serif";">Perubahan pola eliminasi berkemih biasanya ; terjadi penurunan frekuensi / oliguri </span><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN;"></span></div><div class="MsoBodyTextIndent" style="line-height: 150%; margin-left: 54.0pt; mso-list: l5 level1 lfo9; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: "Book Antiqua","serif"; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Book Antiqua","serif";">Istirahat / tidur</span></div><div class="MsoBodyTextIndent" style="line-height: 150%; margin-left: 78.0pt; mso-list: l21 level1 lfo10; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Book Antiqua","serif";">Apakah klien mengalami gangguan tidur, keletihan, kelemasan, malaise dikarenakan adanya inflamasi uretra dan adanya rasa nyeri.</span><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN;"></span></div><div class="MsoBodyTextIndent" style="line-height: 150%; margin-left: 78.0pt; mso-list: l21 level1 lfo10; text-align: justify; text-indent: -21.3pt;"><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Book Antiqua","serif";">Apakah klien mengalami gangguan tidur karena ansietas / ketakutan terhadap penyakitnya</span><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN;"></span></div><div class="MsoBodyTextIndent" style="line-height: 150%; mso-list: l3 level1 lfo8; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Book Antiqua","serif";">Riwayat psokologis</span><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN;"></span></div><div class="MsoBodyTextIndent" style="line-height: 150%; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-family: "Book Antiqua","serif";">Kaji bagaimana status emosi, gaya komunikasi, konsep diri, dan gambaran diri klien berhubungan dengan penyakityang dideritanya.</span><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN;"></span></div><div class="MsoBodyTextIndent" style="line-height: 150%; mso-list: l3 level1 lfo8; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Book Antiqua","serif";">Riwayat social ekonomi</span><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN;"></span></div><div class="MsoBodyTextIndent" style="line-height: 150%; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-family: "Book Antiqua","serif";">Pengkajian riwayat social ekonomi dapat memberikan sedikit gambaran penyakit klien. Misalnya yang suka berganti – ganti pasangan dapat mudah terkena uretritis karena ia mudah terkena penyakit kelamin.</span><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN;"></span></div><div class="MsoBodyTextIndent" style="line-height: 150%; mso-list: l3 level1 lfo8; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">8.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Book Antiqua","serif";">Pemeriksaan wajah</span><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN;"></span></div><div class="MsoBodyTextIndent" style="line-height: 150%; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-family: "Book Antiqua","serif";">Amati apakah klein mengalami konjunktivitis karena dengan adanya konjunktivitis dapat menunjukkan terjadinya uretritisabakterial – penyakit reiter<span style="mso-spacerun: yes;"> </span></span><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN;"></span></div><div class="MsoBodyTextIndent" style="line-height: 150%; mso-list: l3 level1 lfo8; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">9.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Book Antiqua","serif";">Pemeriksaan abdomen</span><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN;"></span></div><div class="MsoBodyTextIndent" style="line-height: 150%; margin-left: 72.0pt; mso-list: l14 level1 lfo11; tab-stops: 49.65pt; text-align: justify; text-indent: -36.55pt;"><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Book Antiqua","serif";">Inpeksi : Bagaimanakah bentuk abdomen</span><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN;"></span></div><div class="MsoBodyTextIndent" style="line-height: 150%; margin-left: 72.0pt; mso-list: l14 level1 lfo11; tab-stops: 49.65pt; text-align: justify; text-indent: -36.55pt;"><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Book Antiqua","serif";">Palpasi : Adakah nyeri tekan</span><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN;"></span></div><div class="MsoBodyTextIndent" style="line-height: 150%; margin-left: 72.0pt; mso-list: l14 level1 lfo11; tab-stops: 49.65pt; text-align: justify; text-indent: -36.55pt;"><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Book Antiqua","serif";">Auskultasi : Adakah peningkatan bising usus / gangguan kontraksi otot polos ureter yang menyebabkan gangguan miksi</span><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN;"></span></div><div class="MsoBodyTextIndent" style="line-height: 150%; mso-list: l3 level1 lfo8; tab-stops: 49.65pt; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">10.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Book Antiqua","serif";">Pemeriksaan Genetalia</span><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN;"></span></div><div class="MsoBodyTextIndent" style="line-height: 150%; margin-left: 63.8pt; mso-list: l1 level1 lfo12; tab-stops: 49.65pt; text-align: justify; text-indent: -1.0cm;"><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Book Antiqua","serif";">Inpeksi :</span><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN;"></span></div><div class="MsoBodyTextIndent" style="line-height: 150%; margin-left: 63.8pt; tab-stops: 49.65pt; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-family: "Book Antiqua","serif";">Pada penderita uretritis adanya mukosa merah udematus.</span><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN;"></span></div><div class="MsoBodyTextIndent" style="line-height: 150%; margin-left: 63.8pt; tab-stops: 49.65pt; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-family: "Book Antiqua","serif";">Terdapat cairan eksudat purulen.</span><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN;"></span></div><div class="MsoBodyTextIndent" style="line-height: 150%; margin-left: 63.8pt; tab-stops: 49.65pt; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-family: "Book Antiqua","serif";">Ada ulserasi diuretra</span><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN;"></span></div><div class="MsoBodyTextIndent" style="line-height: 150%; margin-left: 63.8pt; tab-stops: 49.65pt; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-family: "Book Antiqua","serif";">Adanya pus.</span><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN;"></span></div><div class="MsoBodyTextIndent" style="line-height: 150%; margin-left: 63.8pt; tab-stops: 49.65pt; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-family: "Book Antiqua","serif";">Peradangan akut uretra</span><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN;"></span></div><div class="MsoBodyTextIndent" style="line-height: 150%; margin-left: 72.0pt; mso-list: l1 level1 lfo12; tab-stops: 49.65pt; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Book Antiqua","serif";">Palpasi</span><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN;"></span></div><div class="MsoBodyTextIndent" style="line-height: 150%; margin-left: 72.0pt; tab-stops: 49.65pt; text-align: justify; text-indent: 0cm;"><span lang="EN-US" style="font-family: "Book Antiqua","serif";">Ada nyeri tekan pada genetalia karena adanya inflamasi</span><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN;"></span></div><div class="MsoBodyTextIndent" style="line-height: 150%; margin-left: 72.0pt; mso-list: l1 level1 lfo12; tab-stops: 49.65pt; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Book Antiqua","serif";">Auskultasi</span><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN;"></span></div><div class="MsoBodyTextIndent" style="line-height: 150%; margin-left: 72.0pt; mso-list: l1 level1 lfo12; tab-stops: 49.65pt; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Book Antiqua","serif";">Adanya gangguan kontraksi otot polos uretra sehingga terjadi kesulitan miksi</span><span style="font-family: "Book Antiqua","serif"; mso-ansi-language: IN;"></span></div><div class="MsoBodyTextIndent" style="line-height: 150%; margin-left: 72.0pt; tab-stops: 49.65pt; text-align: justify; text-indent: 0cm;"><br />
</div><h4 style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l9 level1 lfo13; mso-pagination: widow-orphan; text-align: justify; text-indent: -18.0pt;"><span style="color: windowtext; font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">B.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="color: windowtext; font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">ANALISA DATA</span></h4><h4 style="line-height: 150%; margin-top: 0cm; mso-pagination: widow-orphan; text-align: justify;"><span style="color: windowtext; font-family: "Book Antiqua","serif"; font-size: 12.0pt; font-weight: normal; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Data Subyektif :</span><span style="color: windowtext; font-family: "Book Antiqua","serif"; font-size: 12.0pt; font-weight: normal; line-height: 150%; mso-bidi-font-weight: bold;"></span></h4><h4 style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l10 level1 lfo14; mso-pagination: widow-orphan; text-align: justify; text-indent: -18.0pt;"><span style="color: windowtext; font-family: "Book Antiqua","serif"; font-size: 12.0pt; font-style: normal; font-weight: normal; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-bidi-font-style: italic; mso-bidi-font-weight: bold; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="color: windowtext; font-family: "Book Antiqua","serif"; font-size: 12.0pt; font-style: normal; font-weight: normal; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-style: italic; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Klien mengeluhkan rasa nyeri di daerah uretra dan sekitarnya</span><span style="color: windowtext; font-family: "Book Antiqua","serif"; font-size: 12.0pt; font-style: normal; font-weight: normal; line-height: 150%; mso-bidi-font-style: italic; mso-bidi-font-weight: bold;"></span></h4><h4 style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l10 level1 lfo14; mso-pagination: widow-orphan; text-align: justify; text-indent: -18.0pt;"><span style="color: windowtext; font-family: "Book Antiqua","serif"; font-size: 12.0pt; font-style: normal; font-weight: normal; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-bidi-font-style: italic; mso-bidi-font-weight: bold; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="color: windowtext; font-family: "Book Antiqua","serif"; font-size: 12.0pt; font-style: normal; font-weight: normal; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-style: italic; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Klien mengeluhkan adanya pus dan kemerahan di penis</span><span style="color: windowtext; font-family: "Book Antiqua","serif"; font-size: 12.0pt; font-style: normal; font-weight: normal; line-height: 150%; mso-bidi-font-style: italic; mso-bidi-font-weight: bold;"></span></h4><h4 style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l10 level1 lfo14; mso-pagination: widow-orphan; text-align: justify; text-indent: -18.0pt;"><span style="color: windowtext; font-family: "Book Antiqua","serif"; font-size: 12.0pt; font-style: normal; font-weight: normal; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-bidi-font-style: italic; mso-bidi-font-weight: bold; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="color: windowtext; font-family: "Book Antiqua","serif"; font-size: 12.0pt; font-style: normal; font-weight: normal; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-style: italic; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Klien mengeluhkan nyeri saat BAK</span><span style="color: windowtext; font-family: "Book Antiqua","serif"; font-size: 12.0pt; font-style: normal; font-weight: normal; line-height: 150%; mso-bidi-font-style: italic; mso-bidi-font-weight: bold;"></span></h4><h4 style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 0cm; mso-list: l10 level1 lfo14; mso-pagination: widow-orphan; text-align: justify; text-indent: -18.0pt;"><span style="color: windowtext; font-family: "Book Antiqua","serif"; font-size: 12.0pt; font-style: normal; font-weight: normal; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-bidi-font-style: italic; mso-bidi-font-weight: bold; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="color: windowtext; font-family: "Book Antiqua","serif"; font-size: 12.0pt; font-style: normal; font-weight: normal; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-style: italic; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";">Klien mengatakan kecemasan terhadap penyakitnya</span></h4><div class="MsoNormal" style="line-height: 150%; margin-top: 12.0pt; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Data Obyektif :</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-top: 12.0pt; mso-add-space: auto; mso-list: l7 level1 lfo15; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Mukosa merah </span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-top: 12.0pt; mso-add-space: auto; mso-list: l7 level1 lfo15; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">T</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">e</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">r</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">dapat cairan eksudat</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-top: 12.0pt; mso-add-space: auto; mso-list: l7 level1 lfo15; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Terdapat cairan ulserasi uretra </span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-top: 12.0pt; mso-add-space: auto; mso-list: l7 level1 lfo15; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Mikroskopis : infiltrasi dari leukosit, sel plasma, sedikit sel leukosit, fibroblas bertambah</span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-top: 12.0pt; mso-add-space: auto; tab-stops: list 36.0pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-top: 12.0pt; mso-add-space: auto; mso-list: l9 level1 lfo13; tab-stops: list 36.0pt; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">C.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">DIAGNOSA KEPERAWATAN</span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-top: 12.0pt; mso-add-space: auto; mso-list: l23 level1 lfo16; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span></span></b><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Perubahan pola eliminasi BAK: retensi urine b.d kurang pengetahuan tentang teknik pengosongan kandung kemih akibat penyumbatan sfingter sekrunder terhadap striktuR</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-top: 12.0pt; mso-add-space: auto; mso-list: l23 level1 lfo16; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Nyeri b.d infeksi saluran perkemihan.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-top: 12.0pt; mso-add-space: auto; mso-list: l23 level1 lfo16; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Gangguan nutrisi kurang dari kebutuhan tubuh b.d gangguan gastrointestinal : uremia, anoreksia, mual muntah</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-top: 12.0pt; mso-add-space: auto; mso-list: l23 level1 lfo16; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Resti infeksi b.d adanya faktor resiko nosokomial</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-top: 12.0pt; mso-add-space: auto; mso-list: l23 level1 lfo16; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Resti terhadap ketidakpatuhan b.d kurang pengetahuan tentang kondisi, pemeriksaan diagnostik, pengobatan dan perawatan di rumah.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-top: 12.0pt; mso-add-space: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-top: 12.0pt; mso-add-space: auto; mso-list: l9 level1 lfo13; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">D.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">INTERVENSI KEPERAWATAN</span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 54.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; mso-list: l11 level1 lfo17; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Perubahan pola eliminasi BAK: retensi urine b.d kurang pengetahuan tentang teknik pengosongan kandung kemih akibat penyumbatan sfingter sekrunder terhadap striktur.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 54.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Kriteria hasil: </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 54.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Individu akan mengosongkan kandung kemih menggunakan manuver valsavas dengan residu ( dr 50 cc jika diindikasikan mencapai suatu keadaan kekeringan di mana secara pribadi puas).</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 54.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Intervensi:</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; mso-list: l17 level1 lfo18; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>Ajarkan individu menegangkan abdomen dan melakukan manuver valsavas, jika diindikasikan:</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; mso-list: l17 level1 lfo18; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">sandarkan ke depan pada kedua paha</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; mso-list: l17 level1 lfo18; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">kontrasikan otot abdomen dan regangkan / tahan nafas sambil meregangkan (manuver valsavas)</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; mso-list: l17 level1 lfo18; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Tahan pegangan / nafas sampai aliran urin berhenti, tunggu satu menit dan regangkan sepanjang mungkin.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; mso-list: l17 level1 lfo18; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Lanjutkan sampai tidak ada urin yang keluar</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; mso-list: l17 level1 lfo18; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Catat keluaran urin, selidiki penurunan / penghentian aliran urin.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; mso-list: l17 level1 lfo18; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">g.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Observasi dan catat warna urin</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; mso-list: l17 level1 lfo18; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">h.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Ukur residu pasca berkemih setelah usaha mengosongkan kandung kemih, jika vol residu urin lebih besar dari 100 cc, jadwalkan program kateterisasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 54.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; mso-list: l11 level1 lfo17; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Nyeri b.d infeksi saluran perkemihan.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 54.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Kriteria hasil :</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 54.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>tidak nyeri waktu berkemih, tidak nyeri pada perkusi daerah panggul.<br />
Intervensi :</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; mso-list: l20 level1 lfo19; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Pantu haluaran urine terhadap perubahan warna, bau dan pola berkemih</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Rasional : <span style="mso-spacerun: yes;"> </span>untuk mengidentifikasi indikasi kemajuan atau penyimpangan dari hasil yang diharapkan.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; mso-list: l20 level1 lfo19; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Berikan analgetik sesuai kebutuhan dan evaluasi keberhasilannya.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Rasional : analgetik memblok lintasan nyeri, sehingga mengurangi nyeri.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; mso-list: l20 level1 lfo19; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Berikan antibiotik, buat bervariasi sediaan minum, termasuk air segar di samping tempat tidur dan pemberian air sampai 2400mL/hari.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Rasional:</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>akibat dari peningkatan haluaran urine memudahkan berkemih sering dan membantu membilas saluran perkemihan.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; mso-list: l20 level1 lfo19; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Jika frekuensi menjadi masalah, jamin akses ke kamar mandi, pispot tempat tidur. Anjurkan pasien untuk berkemih kapan saja ada keinginan.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 54.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Rasional:</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 54.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">berkemih yang sering mengurangi statis urine pada kandung kemih dan menghindari pertumbuhan bakteri.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 54.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; mso-list: l11 level1 lfo17; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Resti infeksi b.d adanya faktor resiko nosokomial</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 54.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Kriteria hasil :</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 54.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>berkemih dengan urin jernih tanpa ketidaknyamanan, urinalisis dalam batas normal, kultur urin menunjukkan tak ada bakteri.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 54.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Intervensi:</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; mso-list: l22 level1 lfo20; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Berikan perawatan perineal dengan air sabun setiap shift. Jika pasien inkontinensia, cuci daerah perineal sesegera mungkin.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Rasional : untuk mencegah kontaminasi uretra.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; mso-list: l22 level1 lfo20; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Jika dipasang kateter berikan perawatan kateter 2 kali per hari ( merupakan bagian dari waktu mandi pagi dan pada waktu akan tidur dan setelah buang air besar).</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Rasional :kateter memberikan jalan pada bakteri untuk memasuki kandung kemih dan naik ke saluran perkemihan.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; mso-list: l22 level1 lfo20; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>Ikuti kewaspadaan umum : cuci tangan sebelum dan sesudah kontak langsung, pemakaian sarung tangan / kontak dengan cairan tubuh atau darah.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Rasional :untuk mencegah kontaminasi silang.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; mso-list: l22 level1 lfo20; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>Kecuali dikontraindikasikan ubah posisi pasien setiap dua jam dan anjurkan masukan cairan sekurang-kurangnya 2400 mL/hari. Bantu menglakukan ambulasi sesuai dengan kebutuhan.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Rasional :untuk mencegah statis urine.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; mso-list: l22 level1 lfo20; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Lakukan tindakan untuk memelihara asam urine:</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 90.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; mso-list: l8 level1 lfo21; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">1)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Tingkatkan masukan sari buah berri</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 90.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; mso-list: l8 level1 lfo21; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">2)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Berikan obat-obat untuk meningkatkan asam urine</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 90.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Rasional: <span style="mso-spacerun: yes;"> </span>asam urine menghalangi tumbuhnya kuman. Karena jumlah sari buah berri diperlukan untuk mencapai dan memelihara keasaman urine. Peningkatan masukan cairan sari buah dapat berpengaruh dalam pengobatan infeksi saluran kemih.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 54.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; mso-list: l11 level1 lfo17; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Resti terhadap ketidak patuhan b.d kurang pengetahuan tentang kondisi, pemeriksaan diagnostik, pengobatan dan perawatan di rumah.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 54.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Kriteria hasil : </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 54.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">menyatakan mengerti tentang kondisi, pemeriksaan diagnostik, rencana pengobatan, tindakan perawatan diri preventif.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 54.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Intervensi:</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; mso-list: l0 level1 lfo22; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Berikan informasi tentang sumber infeksi, tindakan untuk mencegah penyebaran atau kekambuhan, penjelasan pemberian antibiotik yang meliputi nama, tujuan, dosisi, jadwal dan catat efek sampingnya.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Rasional: pengetahuan apa yang diharapkan dapat mengurangi ansietas dan membantu mengembangkan kepatuhan klien terhadap rencana terapeutik.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; mso-list: l0 level1 lfo22; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Pastikan pasien atau orang terdekat telah menulis perjanjian untuk perawatan lanjut dan instruksi tertulis untuk tindakan pencegahan</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Rasional: Instruksi verbal dapat dengan mudah dilupakan.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; mso-list: l0 level1 lfo22; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Instruksikan pasien untuk menggunakan seluruh antibiotik yang diresepkan, minum sebanyak delapan gelas per hari, khususnya air dan sari buah berri, dan segera memberitahu dokter bila diduga ada infeksi.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Rasional: Pasien sering menghentikan obat mereka, jika tanda-tanda mereda. Cairan menolong membilas ginjal. Asam piruvat dari sari buah berri membantu mempertahankan keadaan asam urine. Lingkungan asam membantu mencegah pertumbuhan bakteri. Deteksi dini memungkinkan pemberian terapi antibiotik sebelum infeksi menyebar.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 54.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; mso-list: l11 level1 lfo17; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Gangguan nutrisi kurang dari kebutuhan tubuh b.d gangguan gastrointestinal : uremia, anoreksia, mual muntah.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 54.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Kriteria hasil :</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 54.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>pasien akan menunjukkan BB stabil / peningkatan mencapai tujuan dengan normalisasi nilai laboratorium dan bebas dari tanda malnutrisi.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 54.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Intervensi:</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; mso-list: l2 level1 lfo23; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Kaji status nutrisi secara kontinu, selama perawatan setiap hari, perhatikan tingkat energi: kondisi kulit, kuku, rambut, rongga mulut, keinginan untuk makan / anoreksia</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Rasional :memberikan kesempatan untuk mengobservasi penyimpangan dari normal/ dasar pasien dan mempengaruhi pilihan intervensi.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; mso-list: l2 level1 lfo23; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Timbang BB setiap hari dan bandingkan dengan BB saat penerimaan</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Rasional :membuat data dasar, membantu dalam memantau keefektifan aturan terapeutik, dan menyadarkan perawat terhadap ketidaktepatan kecenderungan dalam penurunan/ penambahan BB.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; mso-list: l2 level1 lfo23; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Book Antiqua"; mso-fareast-font-family: "Book Antiqua";"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;"><span style="mso-spacerun: yes;"> </span>Dokumentasikan masukan oral selama 24 jam, riwayat makanan, jumlah kalori dengan tepat.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%;">Rasional :mengidentifikasi ketidakseimbangan antara perkiraan kebutuhan nutrisi dan masukan aktual.</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: 10.0pt; margin-left: 72.0pt; margin-right: 0cm; margin-top: 12.0pt; mso-add-space: auto; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">DAFTAR PUSTAKA</span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Doengos. Marilyn. 2002. <i style="mso-bidi-font-style: normal;">Rencana Asuhan Keperawatan. EGC. Jakarta</i></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><i style="mso-bidi-font-style: normal;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Thomson. AD> 1997. </span></i><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Catatan Kuliah Patologi<i style="mso-bidi-font-style: normal;">. EGC. Jakarta</i></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><i style="mso-bidi-font-style: normal;"><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Underwood. JCE. 1999. </span></i><span style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: Calibri;">Patologi Umum dan Sistematik. EGC. Jakarta</span></div><div style="line-height: 150%; text-align: justify;"><span style="font-family: "Book Antiqua","serif";"><a href="http://obat-penyakit.com/uretritis.html"><span style="color: windowtext; text-decoration: none; text-underline: none;">http://obat-penyakit.com/uretritis.html</span></a></span></div><div style="line-height: 150%; text-align: justify;"><span style="font-family: "Book Antiqua","serif";"><a href="http://aminnasution.blogspot.com/"><span style="color: windowtext; text-decoration: none; text-underline: none;">http://aminnasution.blogspot.com/</span></a></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div style="line-height: 150%; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Book Antiqua","serif"; mso-ansi-language: EN-US;">Diposting Oleh :</span></b></div><div style="line-height: 150%; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Book Antiqua","serif"; mso-ansi-language: EN-US;">Nama<span style="mso-tab-count: 2;"> </span>: </span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Book Antiqua","serif";">Asep Diki Permana</span></b></div><div style="line-height: 150%; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Book Antiqua","serif"; mso-ansi-language: EN-US;">NIM <span style="mso-tab-count: 2;"> </span>:05200ID090</span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Book Antiqua","serif";">06</span></b></div><div style="line-height: 150%; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Book Antiqua","serif"; mso-ansi-language: EN-US;">Kelas<span style="mso-tab-count: 2;"> </span> :2</span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Book Antiqua","serif";">A</span></b></div><div style="line-height: 150%; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Book Antiqua","serif"; mso-ansi-language: EN-US;">Kelompok<span style="mso-tab-count: 1;"> </span> :1</span></b></div><div style="line-height: 150%; margin-left: 54.0pt; mso-list: l16 level1 lfo24; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: Wingdings; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Book Antiqua","serif"; mso-ansi-language: EN-US;">Anisah nur azizah</span></b></div><div style="line-height: 150%; margin-left: 54.0pt; mso-list: l16 level1 lfo24; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: Wingdings; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Book Antiqua","serif"; mso-ansi-language: EN-US;">Asep diki Permana</span></b></div><div style="line-height: 150%; margin-left: 54.0pt; mso-list: l16 level1 lfo24; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: Wingdings; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Book Antiqua","serif"; mso-ansi-language: EN-US;">Lina Ratiana</span></b></div><div style="line-height: 150%; margin-left: 54.0pt; mso-list: l16 level1 lfo24; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: Wingdings; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Book Antiqua","serif"; mso-ansi-language: EN-US;">Farid Maroef Maulana Ishak</span></b></div><div style="line-height: 150%; margin-left: 54.0pt; mso-list: l16 level1 lfo24; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: Wingdings; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Book Antiqua","serif"; mso-ansi-language: EN-US;">Pipit Puspita Permana</span></b></div><div style="line-height: 150%; margin-left: 54.0pt; mso-list: l16 level1 lfo24; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: Wingdings; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Book Antiqua","serif"; mso-ansi-language: EN-US;">Rini yuliani</span></b></div><div style="line-height: 150%; margin-left: 54.0pt; mso-list: l16 level1 lfo24; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: Wingdings; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Book Antiqua","serif"; mso-ansi-language: EN-US;">Susanti</span></b></div><div style="line-height: 150%; margin-left: 54.0pt; mso-list: l16 level1 lfo24; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: Wingdings; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Book Antiqua","serif"; mso-ansi-language: EN-US;">Ucu cahyati</span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-family: "Book Antiqua","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: EN-US;">MAHASISWA AKPER PEMDA GARUT</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;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div><div style="line-height: 150%; text-align: justify;"><br />
</div>TEAM_ONE KMB 2A AKPEM GARUThttp://www.blogger.com/profile/01719877433346227735noreply@blogger.com0tag:blogger.com,1999:blog-1245729285541543255.post-12558156987812013382011-03-31T01:04:00.000-07:002011-03-31T01:04:35.964-07:00TUGAS KMB ke 8 (NEFROTIK SYNDROM)<!--[if !mso]> <style>
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<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: IN;">LAPORAN PENDAHULUAN</span></b><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"></span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: center; text-autospace: none;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">ASUHAN KEPERAWATAN PADA PASIEN</span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: center; text-autospace: none;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: IN;">SINDROM NEFROTIK</span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l10 level1 lfo1; tab-stops: list 0cm; text-align: justify; text-autospace: none; text-indent: -9.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: IN;"><span style="mso-list: Ignore;">A.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="mso-ansi-language: IN;">Pengertian</span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 18.0pt;"><span lang="id" style="color: black; mso-ansi-language: #0021;">Sindrom <span style="mso-bidi-font-weight: bold;">Nefrotik </span>adalah Status klinis yang ditandai dengan peningkatan permeabilitas membran glomerulus terhadap protein, yang mengakibatkan kehilangan protein urinaris yang massif (Donna L. Wong, 2004). </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 18.0pt;"><span lang="id" style="color: black; mso-ansi-language: #0021;">Sindrom </span><span lang="id" style="mso-ansi-language: #0021; mso-bidi-font-weight: bold;">nefrotik </span><span lang="id" style="mso-ansi-language: #0021;">merupakan kumpulan gejala yang disebabkan oleh injuri glomerular yang terjadi pada anak dengan karakteristik; proteinuria, hipoproteinuria, hipoalbuminemia, hiperlipidemia, dan edema (Suriadi dan Rita Yuliani, 2001). </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 18.0pt;"><span lang="id" style="mso-ansi-language: #0021;">Sindrom <span style="mso-bidi-font-weight: bold;">nefrotik </span>(SN) merupakan sekumpulan gejala yang terdiri dari proteinuria massif (lebih dari 50 mg/kgBB/24 jam), hipoalbuminemia (kurang dari 2,5 gr<span style="color: black;">am/100 ml) yang disertai atau tidak disertai dengan edema dan hiperkolesterolemia. (Rauf, 2002). </span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 18.0pt;"><span lang="id" style="color: black; mso-ansi-language: #0021; mso-bidi-font-weight: bold;">Sindrom Nefrotik<b> </b></span><span lang="id" style="mso-ansi-language: #0021;">adalah penyakit dengan gejala edema, proteinuria, hipoalbunemia dan hiperkolesterolemia (Rusepno, H, dkk. 2000, 832).</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 27.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l10 level1 lfo1; tab-stops: list 27.0pt; text-align: justify; text-autospace: none; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-list: Ignore;">B.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="id" style="mso-ansi-language: #0021;">Anatomi</span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none;"><b style="mso-bidi-font-weight: normal;"><span lang="id" style="mso-ansi-language: #0021;"><br />
</span></b></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3BWxnBwLJPNy89Kwb45VPn62I_2DqeQxv033wc8Lt7VuJaytOg_-4QFM7zGD91Rqgd9ofGYZRT5B2K8c1OR_HHEJJX6BUIHQcR-EC_UJ-BQCbrUUzRs0q67AFL7Hs3aSkZQPRED_w-y4q/s1600/NEFRUN.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3BWxnBwLJPNy89Kwb45VPn62I_2DqeQxv033wc8Lt7VuJaytOg_-4QFM7zGD91Rqgd9ofGYZRT5B2K8c1OR_HHEJJX6BUIHQcR-EC_UJ-BQCbrUUzRs0q67AFL7Hs3aSkZQPRED_w-y4q/s1600/NEFRUN.jpg" /></a></div><div class="MsoNormal" style="line-height: 150%; margin: 5pt 0cm; text-align: justify;"><b><span lang="id"><br />
</span></b></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify; text-indent: 18.0pt;"><span lang="id" style="color: black; mso-ansi-language: #0021;">Korteks<span style="mso-spacerun: yes;"> </span>ginjal terdiri atas glomeruli dan tubili, sedangkan pada medula hanya terdapat tubuli. Glomeruli dari tubuli ini akan membentuk Nefron. Satu unit nefron terdiri dari glomerolus, tubulus proksimal, loop of henle, tubulus distal (kadang-kadang dimasukkan pula duktus koligentes). Tiap ginjal mempunyai lebih kurang 1,5-2 juta nefron berarti pula lebih kurang 1,5-2 juta glomeruli.</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify; text-indent: 18.0pt;"><span lang="id" style="color: black; mso-ansi-language: #0021;">Pembentukan urin dimulai dari glomerulus, dimana pada glomerulus ini filtrat dimulai, filtrat adalah isoosmotic dengan plasma pada angka 285 mosmol. Pada akhir tubulus proksimal 80 % filtrat telah di absorbsi meskipun konsentrasinya masih tetap sebesar 285 mosmol. Saat infiltrat bergerak ke bawah melalui bagian desenden lengkung henle, konsentrasi filtrat bergerak ke atas melalui bagian asenden, konsentrasi makin lama makin encer sehingga akhirnya menjadi hipoosmotik pada ujung atas lengkung. Saat filtrat bergerak sepanjang tubulus distal, filtrat menjadi semakin pekat sehingga akhirnya isoosmotic dengan plasma darah pada ujung duktus pengumpul. Ketika filtrat bergerak turun melalui duktus pengumpul sekali lagi konsentrasi filtrat meningkat pada akhir duktus pengumpul, sekitar 99% air sudah direabsorbsi dan hanya sekitar 1% yang diekskresi sebagai </span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify;"><span lang="id" style="color: black; mso-ansi-language: #0021;">urin atau kemih (Price,2001 : 785).</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 7.2pt; margin-right: -7.2pt; margin-top: 0cm; mso-list: l10 level1 lfo1; tab-stops: 4.5pt list 9.0pt; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span lang="id" style="color: black; mso-ansi-language: #0021;"><span style="mso-list: Ignore;">C.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="id" style="color: black; mso-ansi-language: #0021;">Fatofisiologi</span></b></div><div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 18.0pt;"><span lang="id" style="mso-ansi-language: #0021;">Adanya peningkatan permiabilitas glomerulus mengakibatkan proteinuria masif sehingga terjadi hipoproteinemia. Akibatnya tekanan onkotik plasma menurun karean adanya pergeseran cairan dari intravaskuler ke intestisial.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 18.0pt;"><span lang="id" style="mso-ansi-language: #0021;">Volume plasma,curah jantung dan kecepatan filtrasi glomerulus berkurang mengakibatkan retensi natrium. Kadar albumin plasma yang sudah merangsang sintesa protein di hati, disertai peningkatan sintesa lipid, lipoprotein dan trigliserida.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 18.0pt;"><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-spacerun: yes;"> </span>Meningkatnya permeabilitas dinding kapiler glomerular akan berakibat pada hilangnya protein plasma dan kemudian akan terjadi proteinuria. Lanjutan dari proteinuria menyebabkan hipoalbuminemia. Dengan menurunnya albumin, tekanan osmotik plasma menurun sehingga cairan intravaskuler berpindah ke dalam interstitial. Perpindahan cairan tersebut menjadikan volume cairan intravaskuler berkurang, sehingga menurunkan jumlah aliran darah ke renal karena hypovolemi.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 18.0pt;"><span lang="id" style="mso-ansi-language: #0021;">Menurunnya aliran darah ke renal, ginjal akan melakukan kompensasi dengan merangsang produksi renin – angiotensin dan peningkatan sekresi anti diuretik hormon (ADH) dan sekresi aldosteron yang kemudian terjadi retensi kalium dan air. Dengan retensi natrium dan air akan menyebabkan edema.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 18.0pt;"><span lang="id" style="mso-ansi-language: #0021;">Terjadi peningkatan kolesterol dan trigliserida serum akibat dari peningkatan stimulasi produksi lipoprotein karena penurunan plasma albumin dan penurunan onkotik plasma</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 18.0pt;"><span lang="id" style="mso-ansi-language: #0021;">Adanya hiper lipidemia juga akibat dari meningkatnya produksi lipopprtein dalam hati yang timbul oleh karena kompensasi hilangnya protein, dan lemak akan banyak dalam urin (lipiduria)</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 18.0pt;"><span lang="id" style="mso-ansi-language: #0021;">Menurunya respon imun karena sel imun tertekan, kemungkinan disebabkan oleh karena hipoalbuminemia, hiperlipidemia, atau defesiensi seng. (Suriadi dan Rita yuliani, 2001 :217)</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: -14.4pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l10 level1 lfo1; tab-stops: list 1.0cm; text-align: justify; text-autospace: none; text-indent: 21.5pt;"><b style="mso-bidi-font-weight: normal;"><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-list: Ignore;">D.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span lang="id" style="mso-ansi-language: #0021;">Etiologi</span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 36.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: -18.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none;"><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-tab-count: 1;"> </span></span><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;">Berdasarkan etiologinya <span style="color: black; mso-bidi-font-weight: bold;">sindrom nefrotik<b> </b></span>dibagi menjadi 3 yaitu:</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none;"><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;">1.Primer/ Idiopatik</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l4 level1 lfo4; text-align: justify; text-autospace: none; text-indent: -18.0pt;"><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;">Yang berhubungan dengan kelainan primer glomerulus dengn sebab tidak diketahui.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l4 level1 lfo4; text-align: justify; text-autospace: none; text-indent: -18.0pt;"><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;">Banyak terjadi pada usia sekolah (74% pada usia 2 – 7 tahun) </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l4 level1 lfo4; text-align: justify; text-autospace: none; text-indent: -18.0pt;"><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;">Pria dan wanita 2 : 1</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l4 level1 lfo4; text-align: justify; text-autospace: none; text-indent: -18.0pt;"><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;">Diawali dengan infeksi virus pada saluran nafas atas.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none;"><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;">2. Sekunder</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 21.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l12 level1 lfo5; text-align: justify; text-autospace: none; text-indent: -18.0pt;"><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;">Disebabkan oleh kerusakan glomerulus (akut/kronik) karena penyakit tertentu.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 21.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l12 level1 lfo5; text-align: justify; text-autospace: none; text-indent: -18.0pt;"><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;">Karena infeksi, keganasan, obat-obtan, penyakit multisistem dan jaringan ikat, reaksi alergi, bahan kimia, penyakit metabolik, penyakit kolagen, toksin, transplantasi ginjal, trombosis vena renalis, stenosis arteri renalis, obesitas masif, glomerulonefritis akut/kronis.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 21.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l12 level1 lfo5; text-align: justify; text-autospace: none; text-indent: -18.0pt;"><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;">Banyak terjadi pada anak dengan penurunan daya tahan tubuh/ gangguan imunitas, respon alergi, glomerulonefritis. Dikaitkan dengan respon imun (abnormal immunoglobulin)</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 21.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l12 level1 lfo5; text-align: justify; text-autospace: none; text-indent: -18.0pt;"><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;">Pada orang dewasa SN skunder terbanyak disebabkan oleh dibetes melitus</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none;"><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;">3. Kongenital</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 21.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l0 level1 lfo6; text-align: justify; text-autospace: none; text-indent: -18.0pt;"><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;">Diturunkan sebagai resesif autosom atau karena reaksi fetomaternal</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 21.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l0 level1 lfo6; text-align: justify; text-autospace: none; text-indent: -18.0pt;"><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;">Herediter Resisten gen</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 21.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l0 level1 lfo6; text-align: justify; text-autospace: none; text-indent: -18.0pt;"><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;">Tidak resisten terhadap terapi malalui Transplantasi Ginjal</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 21.0pt;"><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;">Beberapa penyakit yang dapat secara spesifik menyebabkan rusaknya glomeruli ginjal dan sering mengakibatkan timbulnya proteinuria tentunya mempercepat timbulnya <span style="color: black; mso-bidi-font-weight: bold;">Nefrotik </span>syndrome:</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l16 level1 lfo7; tab-stops: 13.5pt; text-align: justify; text-autospace: none; text-indent: -13.5pt;"><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;">Amiloidosis </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 4.5pt;"><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;">b. Congenital nephrosis</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 4.5pt;"><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;">c. Focal segmental glomerular sclerosis (FSGS) </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none;"><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;">Terjadi kerusakan pada jaringan glomeruli, sehingga merusak membran pelindung protein </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 4.5pt;"><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;">d. Glomerulonephritis (GN)</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 4.5pt;"><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;">e. IgA nephropathy (Berger's disease) </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 4.5pt;"><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;">f. Minimal change disease (Nil's disease)</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 4.5pt;"><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;">g. Pre-eclampsia</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none;"><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;">Terjadinya Sindroma <span style="color: black; mso-bidi-font-weight: bold;">Nefrotik</span> juga tergantung usia kejadiannya:</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 4.5pt;"><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;">a. Usia kurang dari 1 tahun</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 4.5pt;"><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;">b. Usia kurang dari 15 tahun</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 4.5pt;"><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;">c. Usia 15 sampai 40 tahun</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none;"><span lang="id" style="font-size: 11.0pt; line-height: 150%; mso-ansi-language: #0021;">.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l10 level1 lfo1; tab-stops: 18.0pt list 36.0pt; text-align: justify; text-autospace: none; text-indent: -18.0pt;"><b><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-list: Ignore;">E.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b><span lang="id" style="mso-ansi-language: #0021;">Manifestasi klinik</span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; tab-stops: 18.0pt; text-align: justify; text-autospace: none;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 36.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l3 level1 lfo3; tab-stops: 18.0pt; text-align: justify; text-autospace: none; text-indent: -18.0pt;"><span lang="id" style="mso-ansi-language: #0021; mso-bidi-font-weight: bold;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="mso-ansi-language: #0021;">Manifestasi utama sindrom <span style="mso-bidi-font-weight: bold;">nefrotik<b> </b></span>adalah edema. Edema biasanya bervariasi dari bentuk ringan sampai berat (anasarka). Edema biasanya lunak dan cekung bila ditekan (pitting), dan umumnya ditemukan disekitar mata (periorbital) dan berlanjut ke abdomen daerah genitalia dan ekstermitas bawah.</span></div><ol start="2" style="margin-top: 0cm;" type="1"><li class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l3 level1 lfo3; text-align: justify; text-autospace: none;"><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-spacerun: yes;"> </span>Penurunan jumlah urin : urine gelap, berbusa</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l3 level1 lfo3; text-align: justify; text-autospace: none;"><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-spacerun: yes;"> </span>Pucat Hematuri, azotemeia hipertensi ringan</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l3 level1 lfo3; text-align: justify; text-autospace: none;"><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-spacerun: yes;"> </span>Anoreksia dan diare disebabkan karena edema mukosa usus.</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l3 level1 lfo3; text-align: justify; text-autospace: none;"><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-spacerun: yes;"> </span>Sakit kepala, malaise, nyeri abdomen, berat badan meningkat dan keletihan umumnya terjadi.</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l3 level1 lfo3; text-align: justify; text-autospace: none;"><span lang="id" style="mso-ansi-language: #0021;">Anoreksia dan diare disebabkan karena edema mukosa ususs</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l3 level1 lfo3; text-align: justify; text-autospace: none;"><span lang="id" style="mso-ansi-language: #0021;">.Gagal tumbuh dan pelisutan otot (jangka panjang), (Betz, Cecily L.2002 : 335)</span></li>
</ol><ol start="6" style="margin-top: 0cm;" type="A"><li class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l10 level1 lfo1; tab-stops: list 36.0pt; text-align: justify; text-autospace: none;"><b><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-spacerun: yes;"> </span>Pemeriksaan diagnostik</span></b></li>
</ol><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none;"><span lang="id" style="mso-ansi-language: #0021;">1. <span style="color: black;">Uji urine</span></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 27.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l17 level1 lfo8; text-align: justify; text-autospace: none; text-indent: -18.0pt;"><span lang="id" style="color: black; mso-ansi-language: #0021;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="color: black; mso-ansi-language: #0021;">Protein urin – meningkat</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 27.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l17 level1 lfo8; text-align: justify; text-autospace: none; text-indent: -18.0pt;"><span lang="id" style="color: black; mso-ansi-language: #0021;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="color: black; mso-ansi-language: #0021;">Urinalisis – cast hialin dan granular, hematuria</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 27.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l17 level1 lfo8; text-align: justify; text-autospace: none; text-indent: -18.0pt;"><span lang="id" style="color: black; mso-ansi-language: #0021;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="color: black; mso-ansi-language: #0021;"><span style="mso-spacerun: yes;"> </span>Dipstick urin – positif untuk protein dan darah</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 27.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l17 level1 lfo8; text-align: justify; text-autospace: none; text-indent: -18.0pt;"><span lang="id" style="color: black; mso-ansi-language: #0021;"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="color: black; mso-ansi-language: #0021;">Berat jenis urin – meningkat</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 14.4pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l14 level1 lfo9; text-align: justify; text-autospace: none; text-indent: -7.3pt;"><span lang="id" style="color: black; mso-ansi-language: #0021;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="color: black; mso-ansi-language: #0021;"><span style="mso-spacerun: yes;"> </span>Uji darah</span></div><ol start="1" style="margin-top: 0cm;" type="a"><li class="MsoNormal" style="color: black; line-height: 150%; margin-bottom: 5.0pt; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l9 level1 lfo10; text-align: justify; text-autospace: none;"><span lang="id" style="mso-ansi-language: #0021;">Albumin serum – menurun</span></li>
<li class="MsoNormal" style="color: black; line-height: 150%; margin-bottom: 5.0pt; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l9 level1 lfo10; text-align: justify; text-autospace: none;"><span lang="id" style="mso-ansi-language: #0021;">Kolesterol serum – meningkat</span></li>
<li class="MsoNormal" style="color: black; line-height: 150%; margin-bottom: 5.0pt; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l9 level1 lfo10; text-align: justify; text-autospace: none;"><span lang="id" style="mso-ansi-language: #0021;">Hemoglobin dan hematokrit – meningkat (hemokonsetrasi)</span></li>
<li class="MsoNormal" style="color: black; line-height: 150%; margin-bottom: 5.0pt; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l9 level1 lfo10; text-align: justify; text-autospace: none;"><span lang="id" style="mso-ansi-language: #0021;">Laju endap darah (LED) – meningkat</span></li>
<li class="MsoNormal" style="color: black; line-height: 150%; margin-bottom: 5.0pt; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l9 level1 lfo10; text-align: justify; text-autospace: none;"><span lang="id" style="mso-ansi-language: #0021;">Elektrolit serum – bervariasi dengan keadaan penyakit perorangan.</span></li>
</ol><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l14 level1 lfo9; text-align: justify; text-autospace: none; text-indent: -18.0pt;"><span lang="id" style="color: black; mso-ansi-language: #0021;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="color: black; mso-ansi-language: #0021;">Uji diagnostik</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none;"><span lang="id" style="color: black; mso-ansi-language: #0021;">Biopsi ginjal merupakan uji diagnostik yang tidak dilakukan secara rutin (Betz, Cecily L, 2002 : 335).</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none;"><br />
</div><ol start="7" style="margin-top: 0cm;" type="A"><li class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l10 level1 lfo1; tab-stops: list 36.0pt; text-align: justify; text-autospace: none;"><b><span lang="id" style="mso-ansi-language: #0021;">Penatalaksanaan Medik</span></b></li>
</ol><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l1 level1 lfo11; text-align: justify; text-autospace: none; text-indent: -18.0pt;"><span lang="id" style="mso-ansi-language: #0021; mso-bidi-font-weight: bold;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="mso-ansi-language: #0021;">Istirahat sampai edema tinggal sedikit. Batasi asupan natrium sampai kurang lebih 1 gram/hari secara praktis dengan menggunakan garam secukupnya dan menghindar makanan yang diasinkan. Diet protein 2 – 3 gram/kgBB/hari</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l1 level1 lfo11; text-align: justify; text-autospace: none; text-indent: -18.0pt;"><span lang="id" style="mso-ansi-language: #0021; mso-bidi-font-weight: bold;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="mso-ansi-language: #0021;">.Bila edema tidak berkurang dengan pembatasan garam, dapat digunakan diuretik, biasanya furosemid 1 mg/kgBB/hari. Bergantung pada beratnya edema dan respon pengobatan. Bila edema refrakter, dapat digunakan hididroklortiazid (25 – 50 mg/hari), selama pengobatan diuretik perlu dipantau kemungkinan hipokalemi, alkalosis metabolik dan kehilangan cairan intravaskuler berat.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l1 level1 lfo11; text-align: justify; text-autospace: none; text-indent: -18.0pt;"><span lang="id" style="mso-ansi-language: #0021; mso-bidi-font-weight: bold;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="mso-ansi-language: #0021;">Pengobatan kortikosteroid yang diajukan Internasional Coopertive Study of Kidney<b> </b>Disease in Children (ISKDC), sebagai berikut :</span></div><ol start="1" style="margin-top: 0cm;" type="a"><li class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l5 level1 lfo12; text-align: justify; text-autospace: none;"><span lang="id" style="mso-ansi-language: #0021;">Selama 28 hari prednison diberikan per oral dengan dosis 60 mg/hari luas permukaan badan (1bp) dengan maksimum 80 mg/hari.</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l5 level1 lfo12; text-align: justify; text-autospace: none;"><span lang="id" style="mso-ansi-language: #0021;">Kemudian dilanjutkan dengan prednison per oral selama 28 hari dengan dosis 40 mg/hari/1bp, setiap 3 hari dalam satu minggu dengan dosis maksimum 60 mg/hari. Bila terdapat respon selama pengobatan, maka pengobatan ini dilanjutkan secara intermitten selama 4 minggu</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l5 level1 lfo12; text-align: justify; text-autospace: none;"><span lang="id" style="mso-ansi-language: #0021;">.Cegah infeksi. Antibiotik hanya dapat diberikan bila ada infeksi</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l5 level1 lfo12; text-align: justify; text-autospace: none;"><span lang="id" style="mso-ansi-language: #0021;">Pungsi asites maupun hidrotoraks dilakukan bila ada indikasi vital<br />
(Arif Mansjoer,2000)</span></li>
</ol><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 36.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 57.6pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l10 level1 lfo1; tab-stops: list 36.0pt; text-align: justify; text-autospace: none; text-indent: -18.0pt;"><b><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-list: Ignore;">H.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b><span lang="id" style="mso-ansi-language: #0021;">Komplikasi</span></b></div><ol start="1" style="margin-top: 0cm;" type="a"><li class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l8 level1 lfo2; text-align: justify; text-autospace: none;"><span lang="id" style="mso-ansi-language: #0021;">Infeksi sekunder mungkin karena kadar imunoglobulin yang rendah akibat<b> </b>Hipoalbuminemi</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l8 level1 lfo2; text-align: justify; text-autospace: none;"><span lang="id" style="mso-ansi-language: #0021;">Shock : terjadi terutama pada hipoalbuminemia berat (< 1 gram/100ml) yang menyebabkan hipovolemia berat sehingga menyebabkan shock.</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l8 level1 lfo2; text-align: justify; text-autospace: none;"><span lang="id" style="mso-ansi-language: #0021;">Trombosis vaskuler : mungkin akibat gangguan sistem koagulasi sehingga terjadi peninggian fibrinogen plasma.</span></li>
<li class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l8 level1 lfo2; text-align: justify; text-autospace: none;"><span lang="id" style="mso-ansi-language: #0021;">Komplikasi yang bisa timbul adalah malnutrisi atau kegagalan ginjal.<br />
(Rauf, .2002 : .27-28).</span></li>
</ol><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 36.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none;"><br />
</div><ol start="9" style="margin-top: 0cm;" type="A"><li class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l10 level1 lfo1; tab-stops: list 36.0pt; text-align: justify; text-autospace: none;"><b style="mso-bidi-font-weight: normal;"><span lang="id" style="mso-ansi-language: #0021;">Diagnosa dan Rencana Keperawatan <span style="color: black; mso-bidi-font-weight: bold;">Sindrom Nefrotik</span><span style="mso-bidi-font-weight: bold;"></span></span></b></li>
</ol><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 21.6pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l10 level2 lfo1; tab-stops: 13.5pt; text-align: justify; text-autospace: none; text-indent: -21.6pt;"><span lang="id" style="mso-ansi-language: #0021; mso-bidi-font-weight: bold;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-spacerun: yes;"> </span>Kelebihan volume cairan berhubungan dengan kehilangan protein sekunder<b> </b>terhadap peningkatan permiabilitas glomerulus.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none;"><span lang="id" style="mso-ansi-language: #0021;">Tujuan:</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none;"><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-spacerun: yes;"> </span>volume cairan tubuh akan seimbang dengan kriteria hasil penurunan edema, ascites, kadar protein darah meningkat, output urine adekuat 600 – 700 ml/hari, tekanan darah dan nadi dalam batas normal.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none;"><span lang="id" style="mso-ansi-language: #0021;">Intervensi :</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l7 level1 lfo13; tab-stops: 18.0pt; text-align: justify; text-autospace: none; text-indent: -18.0pt;"><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="mso-ansi-language: #0021;">Catat intake dan output secara akurat. Rasional : Evaluasi harian keberhasilan terapi dan dasar penentuan tindakan</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l7 level1 lfo13; tab-stops: 18.0pt; text-align: justify; text-autospace: none; text-indent: -18.0pt;"><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="mso-ansi-language: #0021;">Kaji dan catat tekanan darah, pembesaran abdomen, BJ urine. Rasional : Tekanan darah dan BJ urine dapat menjadi indikator regimen terapi<i> </i></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l7 level1 lfo13; tab-stops: 18.0pt; text-align: justify; text-autospace: none; text-indent: -18.0pt;"><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="mso-ansi-language: #0021;">Timbang berat badan tiap hari dalam skala yang sama. Rasional : Estimasi penurunan edema tubuh<i> </i></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l7 level1 lfo13; tab-stops: 18.0pt; text-align: justify; text-autospace: none; text-indent: -18.0pt;"><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><i><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-spacerun: yes;"> </span></span></i><span lang="id" style="mso-ansi-language: #0021;">Berikan cairan secara hati-hati dan diet rendah garam. Rasional : Mencegah edema bertambah berat<i> </i></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l7 level1 lfo13; tab-stops: 18.0pt; text-align: justify; text-autospace: none; text-indent: -18.0pt;"><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><i><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-spacerun: yes;"> </span></span></i><span lang="id" style="mso-ansi-language: #0021;">Diet protein 1-2 gr/kg BB/hari. Rasional : Pembatasan protein bertujuan untuk meringankan beban kerja hepar dan mencegah bertamabah rusaknya hemdinamik ginjal.<i> </i></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l10 level2 lfo1; tab-stops: 18.0pt list 54.0pt; text-align: justify; text-autospace: none; text-indent: -18.0pt;"><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="mso-ansi-language: #0021;">Perubahan nutrisi ruang dari kebutuhan berhubungan dengan malnutrisi sekunder terhadap kehilangan protein dan penurunan napsu makan.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; tab-stops: 18.0pt; text-align: justify; text-autospace: none;"><span lang="id" style="mso-ansi-language: #0021;">Tujuan :</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; tab-stops: 18.0pt; text-align: justify; text-autospace: none;"><span lang="id" style="mso-ansi-language: #0021;">kebutuhan nutrisi akan terpenuhi dengan kriteria hasil napsu makan baik, tidak terjadi hipoprtoeinemia, porsi makan yang dihidangkan dihabiskan, edema dan ascites tidak ada.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 9.0pt;"><span lang="id" style="mso-ansi-language: #0021;">Intervensi :</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 27.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l2 level1 lfo14; text-align: justify; text-autospace: none; text-indent: -18.0pt;"><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="mso-ansi-language: #0021;">Catat intake dan output makanan secara akurat. Rasional : Monitoring asupan nutrisi bagi tubuh</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 27.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l2 level1 lfo14; text-align: justify; text-autospace: none; text-indent: -18.0pt;"><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="mso-ansi-language: #0021;">Kaji adanya anoreksia, hipoproteinemia, diare. Rasional : Gangguan nuirisi dapat terjadi secara perlahan Diare<span style="mso-spacerun: yes;"> </span>sebagai reaksi edema intestinal</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 27.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l2 level1 lfo14; text-align: justify; text-autospace: none; text-indent: -18.0pt;"><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="mso-ansi-language: #0021;">Pastikan anak mendapat makanan dengan diet yang cukup. Rasional : Mencegah status nutrisi menjadi lebih buruk.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l10 level2 lfo1; text-align: justify; text-autospace: none; text-indent: -18.0pt;"><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-spacerun: yes;"> </span>Resiko tinggi infeksi berhubungan dengan imunitas tubuh yang menurun.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none;"><span lang="id" style="mso-ansi-language: #0021;">Tujuan:</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none;"><span lang="id" style="mso-ansi-language: #0021;">Tidak terjadi infeksi dengan kriteria hasil tanda-tanda infeksi tidak ada, tanda vital dalam batas normal, ada perubahan perilaku keluarga dalam melakukan perawatan.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 18.0pt;"><span lang="id" style="mso-ansi-language: #0021;">Intervensi :</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 36.75pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l11 level1 lfo15; text-align: justify; text-autospace: none; text-indent: -18.75pt;"><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="mso-ansi-language: #0021;">Lindungi anak dari orang-orang yang terkena infeksi melalui pembatasan pengunjung. Rasional : Meminimalkan masuknya organisme.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 36.75pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l11 level1 lfo15; text-align: justify; text-autospace: none; text-indent: -18.75pt;"><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="mso-ansi-language: #0021;">Tempatkan anak di ruangan non infeksi. Rasional : Mencegah terjadinya infeksi nosokomial.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 36.75pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l11 level1 lfo15; text-align: justify; text-autospace: none; text-indent: -18.75pt;"><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-spacerun: yes;"> </span>Tangan sebelum dan sesudah tindakan. Rasional : Mencegah terjadinya infeksi nosokomial.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 36.75pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l11 level1 lfo15; text-align: justify; text-autospace: none; text-indent: -18.75pt;"><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-spacerun: yes;"> </span>Lakukan tindakan invasif secara aseptik. Rasional : Membatasi masuknya bakteri ke dalam tubuh. Deteksi dini adanya infeksi dapat mencegah sepsis.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l10 level2 lfo1; tab-stops: list 18.0pt; text-align: justify; text-autospace: none; text-indent: -18.0pt;"><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="mso-ansi-language: #0021;">Kecemasan anak berhubungan dengan lingkungan perawatan yang asing (dampak hospitalisasi).</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none;"><span lang="id" style="mso-ansi-language: #0021;">Tujuan:</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 18.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none;"><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-spacerun: yes;"> </span>kecemasan anak menurun atau hilang dengan kriteria hasil kooperatif pada tindakan keperawatan, komunikatif pada perawat, secara verbal mengatakan tidak takut.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; text-align: justify; text-autospace: none; text-indent: 18.0pt;"><span lang="id" style="mso-ansi-language: #0021;">Intervensi :</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 42.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l13 level1 lfo16; text-align: justify; text-autospace: none; text-indent: -24.0pt;"><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="mso-ansi-language: #0021;">Validasi perasaan takut atau cemas. Rasional : Perasaan adalah nyata dan membantu pasien untuk tebuka sehingga dapat menghadapinya</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 42.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l13 level1 lfo16; text-align: justify; text-autospace: none; text-indent: -24.0pt;"><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-spacerun: yes;"> </span>Pertahankan kontak dengan klien. Rasional : Memantapkan hubungan, meningkatan ekspresi perasaan.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 42.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l13 level1 lfo16; text-align: justify; text-autospace: none; text-indent: -24.0pt;"><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-spacerun: yes;"> </span>Upayakan ada keluarga yang menunggu. Rasional : Dukungan yang terus menerus mengurangi ketakutan atau kecemasan yang dihadapi.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: 5.0pt; margin-left: 42.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-layout-grid-align: none; mso-list: l13 level1 lfo16; text-align: justify; text-autospace: none; text-indent: -24.0pt;"><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span lang="id" style="mso-ansi-language: #0021;"><span style="mso-spacerun: yes;"> </span>Anjurkan orang tua untuk membawakan mainan atau foto keluarga. Rasional : Meminimalkan dampak hospitalisasi terpisah dari anggota keluarga.</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-left: 18.0pt; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="mso-ansi-language: EN-US;">DAFTAR PUSTAKA :</span></b></div><div style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo17; text-align: justify; text-indent: -18.0pt;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span>Betz, Cecily L dan Sowden, Linda L. 2002. Pediatrik, Edisi 3,EGC : Jakar<span lang="EN-US" style="mso-ansi-language: EN-US;">ta</span></div><div style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo17; text-align: justify; text-indent: -18.0pt;"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span>.Mansjoer Arif, 2000, Kapita Selekta Kedokteran, Jilid 2, Media Aesculapius : Jakar<span lang="EN-US" style="mso-ansi-language: EN-US;">a</span>.</div><div style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo17; text-align: justify; text-indent: -18.0pt;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span>Wong,L. Donna, 2004, Pedoman Klinis k<span lang="EN-US" style="mso-ansi-language: EN-US;">eperawatan </span>Pediatrik, Edisi 4, EGC : Jakarta</div><div style="line-height: 150%; margin-left: 36.0pt; mso-list: l6 level1 lfo17; text-align: justify; text-indent: -18.0pt;"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span><span lang="EN-US" style="mso-ansi-language: EN-US;"><a href="http://www.asuhankeperawatannefrotiksindrom.com/">http://www.asuhankeperawatannefrotiksindrom.com//</a></span></div><div style="line-height: 150%; text-align: justify;"><br />
</div><div style="line-height: 150%; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="mso-ansi-language: EN-US;">Diposting Oleh :</span></b></div><div style="line-height: 150%; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="mso-ansi-language: EN-US;">Nama<span style="mso-tab-count: 2;"> </span>: Ucu Cahyati</span></b></div><div style="line-height: 150%; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="mso-ansi-language: EN-US;">NIM <span style="mso-tab-count: 2;"> </span>:05200ID09038</span></b></div><div style="line-height: 150%; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="mso-ansi-language: EN-US;">Kelas<span style="mso-tab-count: 2;"> </span> :2a</span></b></div><div style="line-height: 150%; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="mso-ansi-language: EN-US;">Kelompok<span style="mso-tab-count: 1;"> </span> :1</span></b></div><div style="line-height: 150%; margin-left: 54.0pt; mso-list: l15 level1 lfo18; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: Wingdings; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="mso-ansi-language: EN-US;">Anisah nur azizah</span></b></div><div style="line-height: 150%; margin-left: 54.0pt; mso-list: l15 level1 lfo18; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: Wingdings; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="mso-ansi-language: EN-US;">Asep diki Permana</span></b></div><div style="line-height: 150%; margin-left: 54.0pt; mso-list: l15 level1 lfo18; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: Wingdings; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="mso-ansi-language: EN-US;">Lina Ratiana</span></b></div><div style="line-height: 150%; margin-left: 54.0pt; mso-list: l15 level1 lfo18; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: Wingdings; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="mso-ansi-language: EN-US;">Farid Maroef Maulana Ishak</span></b></div><div style="line-height: 150%; margin-left: 54.0pt; mso-list: l15 level1 lfo18; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: Wingdings; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="mso-ansi-language: EN-US;">Pipit Puspita Permana</span></b></div><div style="line-height: 150%; margin-left: 54.0pt; mso-list: l15 level1 lfo18; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: Wingdings; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="mso-ansi-language: EN-US;">Rini yuliani</span></b></div><div style="line-height: 150%; margin-left: 54.0pt; mso-list: l15 level1 lfo18; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: Wingdings; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="mso-ansi-language: EN-US;">Susanti</span></b></div><div style="line-height: 150%; margin-left: 54.0pt; mso-list: l15 level1 lfo18; text-align: justify; text-indent: -18.0pt;"><span lang="EN-US" style="font-family: Wingdings; mso-ansi-language: EN-US; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">Ø<span style="font: 7.0pt "Times New Roman";"> </span></span></span><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="mso-ansi-language: EN-US;">Ucu cahyati</span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span lang="EN-US" style="mso-ansi-language: EN-US;">MAHASISWA AKPER PEMDA GARUT</span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div>TEAM_ONE KMB 2A AKPEM GARUThttp://www.blogger.com/profile/01719877433346227735noreply@blogger.com0tag:blogger.com,1999:blog-1245729285541543255.post-86689326150503529812011-03-30T04:52:00.000-07:002011-03-30T04:52:24.558-07:00TUGAS KMB KE 7 ( PYELONEFRITIS)<!--[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>IN</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> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> <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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<div align="center" class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">LAPORAN PENDAHULUAN</span></b></div><div align="center" class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">ASUHAN KEPERAWATAN PADA PASIEN PYELONEFRITIS</span></b></div><div align="center" class="MsoNormal" style="text-align: center;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="margin-left: 21.3pt; mso-add-space: auto; mso-list: l0 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Definisi</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 21.3pt; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 27.8pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pielonefritis merupakan infeksi bakteri yang menyerang ginjal, yang sifatnya akut maupun kronis. Pielonefritis akut biasanya akan berlangsung selama 1 sampai 2 minggu. Bila pengobatan pada pielonefritis akut tidak sukses maka dapat menimbulkan gejala lanjut yang disebut dengan pielonefritis kronis.</span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 21.3pt; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 27.8pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pielonefritis merupakan infeksi bakteri pada piala ginjal, tunulus, dan jaringan interstinal dari salah satu atau kedua gunjal (Brunner & Suddarth, 2002: 1436).<br />
Pielonefritis merupakan suatu infeksi dalam ginjal yang dapat timbul secara hematogen atau retrograd aliran ureterik (J. C. E. Underwood, 2002: 668)</span></div><div class="MsoListParagraphCxSpLast" style="margin-left: 21.3pt; text-align: justify; text-indent: 27.8pt;"><br />
</div><div class="MsoNormal" style="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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">B. Etiologi</span></div><div class="MsoNormal" style="margin-left: 1.0cm; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -14.15pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">1. Bakteri (Escherichia coli, Klebsielle pneumoniac, Streptococus fecalis, dll). Escherichia coli merupakan penyebab 85% dari infeksi </span></div><div class="MsoNormal" style="margin-left: 1.0cm; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -14.15pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">2. Obstruksi urinari track. Misal batu ginjal atau pembesaran prostat</span></div><div class="MsoNormal" style="margin-left: 1.0cm; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -14.15pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">3. Refluks, yang mana merupakan arus balik air kemih dari kandung kemih kembali ke dalam ureter.</span></div><div class="MsoNormal" style="margin-left: 1.0cm; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -14.15pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">4. Kehamilan</span></div><div class="MsoNormal" style="margin-left: 1.0cm; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -14.15pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">5. Kencing Manis</span></div><div class="MsoNormal" style="margin-left: 1.0cm; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -14.15pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">6. Keadaan-keadaan menurunnya imunitas untuk malawan infeksi.</span></div><div class="MsoNormal" style="margin-left: 1cm; text-align: justify; text-indent: -14.15pt;"><br />
</div><div class="MsoNormal" style="text-align: justify;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;">C. Manifestasi Klinis </span></div><div class="MsoNormal" style="margin-left: 14.2pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 1.0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Gejala yang paling umum dapat berupa demam tiba-tiba. Kemudian dapat disertai menggigil, nyeri punggung bagian bawah, mual, dan muntah. Pada beberapa kasus juga menunjukkan gejala ISK bagian bawah yang dapat berupa nyeri berkemih dan frekuensi berkemih yang meningkat.</span></div><div class="MsoNormal" style="margin-left: 14.2pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 1.0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Dapat terjadi kolik renalis, di mana penderita merasakan nyeri hebat yang desebabkan oleh kejang ureter. Kejang dapat terjadi karena adanya iritasi akibat infeksi. Bisa terjadi pembesaran pada salah satu atau kedua ginjal. Kadang juga disertai otot perut berkontraksi kuat.</span></div><div class="MsoNormal" style="margin-left: 14.2pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 1.0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pada pielonefritis kronis, nyerinya dapat menjadi samar-samar dan demam menjadi hilang timbul atau malah bisa tidak ditemukan demam sama sekali.</span></div><div class="MsoNormal" style="margin-left: 14.2pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 1.0cm;"><br />
</div><div class="MsoNormal" style="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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">D. Pemeriksaan Penunjang</span></div><div class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 14.2pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">1. Whole blood</span></div><div class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 14.2pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">2. Urinalisis</span></div><div class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 14.2pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">3. USG dan Radiologi</span></div><div class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 14.2pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">4. BUN</span></div><div class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 14.2pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">5. creatinin</span></div><div class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 14.2pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">6. serum electrolytes</span></div><div class="MsoNormal" style="text-align: justify; text-indent: 14.2pt;"><br />
</div><div class="MsoNormal" style="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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">E. Komplikasi</span></div><div class="MsoNormal" style="margin-left: 7.1pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 28.9pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Ada tiga komplikasi penting dapat ditemukan pada pielonefritis akut <br />
1. Nekrosis papila ginjal. Sebagai hasil dari proses radang, pasokan darah pada area medula akan terganggu dan akan diikuti nekrosis papila guinjal, terutama pada penderita diabetes melitus atau pada tempat terjadinya obstruksi.</span></div><div class="MsoNormal" style="margin-left: 7.1pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">2. Fionefrosis. Terjadi apabila ditemukan obstruksi total pada ureter yang dekat sekali dengan ginjal. Cairan yang terlindung dalam pelvis dan sistem kaliks mengalami supurasi, sehingga ginjal mengalami peregangan akibat adanya pus.</span></div><div class="MsoNormal" style="margin-left: 7.1pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">3. Abses perinefrik. Pada waktu infeksi mencapai kapsula ginjal, dan meluas ke dalam jaringan perirenal, terjadi abses perinefrik.</span></div><div class="MsoNormal" style="margin-left: 7.1pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 28.9pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Komplikasi pielonefritis kronis mencakup penyakit ginjal stadium akhir (mulai dari hilangnya progresifitas nefron akibat inflamasi kronik dan jaringan parut), hipertensi, dan pembentukan batu ginjal (akibat infeksi kronik disertai organisme pengurai urea, yang mangakibatkan terbentuknya batu) (Brunner&Suddarth, 2002: 1437).</span></div><div class="MsoNormal" style="margin-left: 7.1pt; text-align: justify; text-indent: 28.9pt;"><br />
</div><div class="MsoNormal" style="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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">F. Penatalaksanaan</span></div><div class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 14.2pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">1. Penatalaksanaan medis menurut Barbara K. Timby dan Nancy E. Smith tahun 2007:</span></div><div class="MsoNormal" style="margin-left: 14.2pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">a. <span style="mso-spacerun: yes;"> </span>Mengurangi demam dan nyeri dan menentukan obat-obat antimikrobial seperti trimethroprim-sulfamethoxazole (TMF-SMZ, Septra), gentamycin dengan atau tanpa ampicilin, cephelosporin, atau ciprofloksasin (cipro) selama 14 hari.<br />
b. Merilekskan otot halus pada ureter dan kandung kemih, meningkatkan rasa nyaman, dan meningkatkan kapasitas kandung kemih menggunakan obat farmakologi tambahan antispasmodic dan anticholinergic seperti oxybutinin (Ditropan) dan propantheline (Pro-Banthine)<br />
c. Pada kasus kronis, pengobatan difokuskan pada pencegahan kerusakan ginjal secara progresif.</span></div><div class="MsoNormal" style="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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">2. Penetalaksanaan keperawatan menurut Barbara K. Timby dan Nancy E. Smith tahun 2007:<br style="mso-special-character: line-break;" /> <br style="mso-special-character: line-break;" /> </span></div><div class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 14.2pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">a. Mengkaji riwayat medis, obat-obatan, dan alergi.</span></div><div class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 14.2pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">b. Monitor Vital Sign</span></div><div class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 14.2pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">c. Melakukan pemeriksaan fisik</span></div><div class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 14.2pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">d. Mengobservasi dan mendokumentasi karakteristik urine klien.</span></div><div class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 14.2pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">e. Mengumpulkan spesimen urin segar untuk urinalisis.</span></div><div class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 14.2pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">f. Memantau input dan output cairan.</span></div><div class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 14.2pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">g. Mengevaluasi hasil tes laboratorium (BUN, creatinin, serum electrolytes)</span></div><div class="MsoNormal" style="margin-left: 14.2pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">h. Memberikan dorongan semangat pada klien untuk mengikuti prosedur pengobatan. </span></div><div class="MsoNormal" style="margin-left: 14.2pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">G. Patofisiologi</span></div><div class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 14.2pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Bakteri naik ke ginjal dan pelvis ginjal melalui saluran kandung kemih dan uretra. Flora normal fekal seperti Eschericia coli, Streptococus fecalis, Pseudomonas aeruginosa, dan Staphilococus aureus adalah bakteri paling umum yang menyebabkan pielonefritis akut. E. coli menyebabkan sekitar 85% infeksi.</span></div><div class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 14.2pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pada pielonefritis akut, inflamasi menyebabkan pembesaran ginjal yang tidak lazim. Korteks dan medula mengembang dan multipel abses. Kalik dan pelvis ginjal juga akan berinvolusi. Resolusi dari inflamasi menghsilkan fibrosis dan scarring. Pielonefritis kronis muncul stelah periode berulang dari pielonefritis akut. Ginjal mengalami perubahan degeneratif dan menjadi kecil serta atrophic. Jika destruksi nefron meluas, dapat berkembang menjadi gagal ginjal.</span></div><div class="MsoNormal" style="text-align: justify; text-indent: 14.2pt;"><br />
</div><div class="MsoNormal" style="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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">H. Diagnosa Keperawatan</span></div><div class="MsoNormal" style="margin-left: 36.0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -21.8pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">a. Infeksi yang berhubungan dengan adanya bakteri pada ginjal.</span></div><div class="MsoNormal" style="margin-left: 14.2pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">b. Hipertermi berhubungan dengan respon imunologi terhadap infeksi.</span></div><div class="MsoNormal" style="margin-left: 14.2pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">c. Perubahan pola eliminasi urine (disuria, dorongan, frekuensi, dan atau nokturia) yang berhubungan dengan infeksi pada ginjal.</span></div><div class="MsoNormal" style="margin-left: 14.2pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">d. Nyeri yang berhubungan dengan infeksi pada ginjal.</span></div><div class="MsoNormal" style="margin-left: 14.2pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">e. Kurang pengetahuan yang berhubungan dengan kurangnya informasi tentang proses penyakit, metode pencegahan, dan instruksi perawatan di rumah.</span></div><div class="MsoNormal" style="margin-left: 14.2pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="margin-left: 1.0cm; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -1.0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">I.RencanaKeperawatan</span></div><div class="MsoNormal" style="margin-left: 1cm; text-align: justify; text-indent: -1cm;"><br />
</div><div class="MsoNormal" style="margin-left: 1.0cm; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -1.0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">A.Infeksi yang berhubungan dengan adanya bakteri pada ginjal.</span></div><div class="MsoNormal" style="margin-left: 1.0cm; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -14.15pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">1). Intervensi :Kaji suhu tubuh pasien setiap 4 jam dan lapor jika suhu diatas 38,50 C.<br />
<span style="mso-spacerun: yes;"> </span>Rasional :Tanda vital menandakan adanya perubahan di dalam tubuh</span></div><div class="MsoNormal" style="margin-left: 1.0cm; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -14.15pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">2).Intervensi:Catat karakteristik urine</span></div><div class="MsoNormal" style="margin-left: 1.0cm; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Rasional:Untuk mengetahui/mengidentifikasi indikasi kemajuan atau penyimpangan <span style="mso-spacerun: yes;"> </span>dari hasil yang diharapkan.</span></div><div class="MsoNormal" style="mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 14.2pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">3) Intervensi: Anjurkan pasien untuk minum 2 – 3 liter jika tidak ada kontra indikasi<br />
<span style="mso-spacerun: yes;"> </span>Rasional:Untuk mencegah stasis urine</span></div><div class="MsoNormal" style="margin-left: 14.2pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">4) Intervensi: Monitor pemeriksaan ulang urine kultur dan sensivitas untuk menentukan <span style="mso-spacerun: yes;"> </span>respon terapi.</span></div><div class="MsoNormal" style="margin-left: 14.2pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Rasional :Mengetahui seberapa jauh efek pengobatan terhadap keadaan penderita.</span></div><div class="MsoNormal" style="margin-left: 14.2pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
5) Intervensi: Anjurkan pasien untuk mengosongkan kandung kemih secara komplit setiap kali kemih.</span></div><div class="MsoNormal" style="margin-left: 14.2pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Rasional :Untuk mencegah adanya distensi kandung kemih</span></div><div class="MsoNormal" style="margin-left: 14.2pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">6) Intevensi: Berikan perawatan perineal, pertahankan agar tetap bersih dan kering.<br />
Rasional :Untuk menjaga kebersihan dan menghindari bakteri yang membuat infeksi uretra</span></div><div class="MsoNormal" style="margin-left: 14.2pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">B. Hipertermi berhubungan dengan respon imunologi terhadap infeksi.</span></div><div class="MsoNormal" style="margin-left: 14.2pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
1)Intervensi: Pantau suhu</span></div><div class="MsoNormal" style="margin-left: 14.2pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Rasional:Tanda vital dapat menandakan adanya perubahan di dalam tubuh.<br />
2)Intervensi: Pantau suhu lingkungan</span></div><div class="MsoNormal" style="margin-left: 14.2pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Rasional:Suhu ruangan dan jumlah selimut harus diubah untuk mempertahankan suhu mendekati normal</span></div><div class="MsoNormal" style="margin-left: 14.2pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">3)Intervensi: Lakukan kolaborasi dengan dokter untuk pemberian antipiretik<br />
Rasional:Mengurangi demam dengan aksi sentralnya pada hipotalamus</span></div><div class="MsoNormal" style="margin-left: 14.2pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
4)Intervensi: Catat karakteristik urine</span></div><div class="MsoNormal" style="margin-left: 14.2pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Rasional :Untuk mengetahui/mengidentifikasi indikasi kemajuan atau penyimpangan dari hasil yang diharapkan.</span></div><div class="MsoNormal" style="margin-left: 14.2pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
5)Intervensi:Anjurkan pasien untuk minum 2 – 3 liter jika tidak ada kontra indikasi<br />
Rasional :Untuk mencegah stasis urine</span></div><div class="MsoNormal" style="margin-left: 14.2pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="margin-left: 14.2pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -14.2pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">C. Perubahan pola eliminasi urine (disuria, dorongan, frekuensi, dan atau nokturia) yang berhubungan dengan infeksi pada ginjal.</span></div><div class="MsoNormal" style="margin-left: 14.2pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
1)Intervensi :Ukur dan catat urine setiap kali berkemih</span></div><div class="MsoNormal" style="margin-left: 14.2pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Rasional :Untuk mengetahui adanya perubahan warna dan untuk mengetahui input/out put</span></div><div class="MsoNormal" style="margin-left: 14.2pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">2) Intervensi: Anjurkan untuk berkemih setiap 2 – 3 jam<br />
Rasional :Untuk mencegah terjadinya penumpukan urine dalam vesika urinaria.</span></div><div class="MsoNormal" style="margin-left: 14.2pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
3)Intervensi: Palpasi kandung kemih tiap 4 jam</span></div><div class="MsoNormal" style="margin-left: 14.2pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Rasional :Untuk mengetahui adanya distensi kandung kemih.</span></div><div class="MsoNormal" style="margin-left: 14.2pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
4)Intervensi:Bantu klien ke kamar kecil, memakai pispot/urinal</span></div><div class="MsoNormal" style="margin-left: 14.2pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Rasional :Untuk memudahkan klien di dalam berkemih.</span></div><div class="MsoNormal" style="margin-left: 14.2pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">5)Intervensi:Bantu klien mendapatkan posisi berkemih yang nyaman<br />
Rasional :Supaya klien tidak sukar untuk berkemih.</span></div><div class="MsoNormal" style="margin-left: 14.2pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">D.Nyeri yang berhubungan dengan infeksi pada ginjal.</span></div><div class="MsoNormal" style="margin-left: 14.2pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">1)Intervensi :Kaji intensitas, lokasi, dan factor yang memperberat atau meringankan nyeri.<br />
Rasional :Rasa sakit yang hebat menandakan adanya infeksi</span></div><div class="MsoNormal" style="margin-left: 14.2pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
2) Intervensi: Berikan waktu istirahat yang cukup dan tingkat aktivitas yang dapat di toleran.<br />
Rasional :Klien dapat istirahat dengan tenang dan dapat merilekskan otot-otot</span></div><div class="MsoNormal" style="margin-left: 14.2pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">3) Intervensi: Anjurkan minum banyak 2-3 liter jika tidak ada kontra indikasi<br />
Rasional :Untuk membantu klien dalam berkemih</span></div><div class="MsoNormal" style="margin-left: 14.2pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
4)Intervensi:Berikan obat analgetik sesuai dengan program terapi.</span></div><div class="MsoNormal" style="margin-left: 14.2pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Rasional :Analgetik memblok lintasan nyeri</span></div><div class="MsoNormal" style="margin-left: 14.2pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="margin-left: 14.2pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -14.2pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">E. Kurang pengetahuan yang berhubungan dengan kurangnya informasi tentang proses penyakit, metode pencegahan, dan instruksi perawatan di rumah.</span></div><div class="MsoNormal" style="margin-left: 21.3pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">1)Intervensi :Kaji tingkat kecemasan</span></div><div class="MsoNormal" style="margin-left: 21.3pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Rasional :Untuk mengetahui berat ringannya kecemasan klien</span></div><div class="MsoNormal" style="margin-left: 21.3pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">2)Intervensi: Beri kesempatan klien untuk mengungkapkan perasaannya<br />
Rasional :Agar klien mempunyai semangat dan mau empati terhadap perawatan dan pengobatan</span></div><div class="MsoNormal" style="margin-left: 21.3pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
3)Intervensi:Beri dorongan spiritual</span></div><div class="MsoNormal" style="margin-left: 21.3pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Rasional :Agar klien kembali menyerahkan sepenuhnya kepada Tuhan YME.Beri support pada klien</span></div><div class="MsoNormal" style="margin-left: 21.3pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">5)Intervensi:Beri penjelasan tentang penyakitnya</span></div><div class="MsoNormal" style="margin-left: 21.3pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Rasional :Agar klien mengerti sepenuhnya tentang penyakit yang dialaminya.</span></div><div class="MsoNormal" style="margin-left: 14.2pt; 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: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
Daftar Pustaka</span></b></div><div class="MsoNormal" style="margin-left: 1.0cm; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -14.15pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 115%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-spacerun: yes;"> </span>(<a href="http://www.indonesiaindonesia.com/f/10918-pielonefritis"><span style="color: windowtext; text-decoration: none; text-underline: none;">www.indonesiaindonesia.com/f/10918-pielonefritis</span></a>).</span></div><div class="MsoNormal" style="margin-left: 1.0cm; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -14.15pt;"><cite><span style="font-family: "Calibri","sans-serif"; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-latin;">nurse87.wordpress.com/.../asuhan-keperawatan-<b>pyelonefritis</b></span></cite></div><div class="MsoNormal" style="margin-left: 1.0cm; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -14.15pt;"><cite><span style="font-family: "Calibri","sans-serif"; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-theme-font: minor-bidi; mso-hansi-theme-font: minor-latin;">nurse-ragilliana.blogspot.com/.../askep-<b>pyelonefritis</b>-definisi.html</span></cite></div><div class="MsoNormal" style="margin-left: 1cm; text-align: justify; text-indent: -14.15pt;"><br />
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<div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">Diposting Oleh : </span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12pt; line-height: 115%;"> </span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">Nama <span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>:Susanti</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">NIM<span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>:05200ID09036</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">Kelas<span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>:2A<span style="mso-tab-count: 1;"> </span></span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">Kelompok<span style="mso-tab-count: 1;"> </span>:1</span></b></div><div class="MsoNormal" style="margin-left: 1cm; text-align: justify; text-indent: -14.15pt;"><br />
</div><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span>-Anisah Nur Azizah</span></b><br />
<b><span style="font-family: "Century Schoolbook","serif"; font-size: 12pt; line-height: 115%;"></span></b><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span>-Asep Diki Permana</span></b><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"></span></b><br />
<b><span style="font-family: "Century Schoolbook","serif"; font-size: 12pt; line-height: 115%;"><span style="mso-tab-count: 1;"></span><span style="mso-tab-count: 1;"> </span>-Farid Maroef Maulana Ishak</span></b><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"></span></b><br />
<b><span style="font-family: "Century Schoolbook","serif"; font-size: 12pt; line-height: 115%;"><span style="mso-tab-count: 1;"></span><span style="mso-tab-count: 1;"> </span>-Lina Ratiana</span></b><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"></span></b><br />
<b><span style="font-family: "Century Schoolbook","serif"; font-size: 12pt; line-height: 115%;"><span style="mso-tab-count: 1;"></span><span style="mso-tab-count: 1;"></span>-Pipit Puspita Permana</span></b><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 2;"> </span></span></b><br />
<b><span style="font-family: "Century Schoolbook","serif"; font-size: 12pt; line-height: 115%;"><span> </span>-Rini Yulianai</span></b><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 2;"> </span></span></b><br />
<b><span style="font-family: "Century Schoolbook","serif"; font-size: 12pt; line-height: 115%;"><span> </span>-Susanti</span></b><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"></span></b><br />
<b><span style="font-family: "Century Schoolbook","serif"; font-size: 12pt; line-height: 115%;"><span style="mso-tab-count: 2;"></span>-Ucu Cahyati</span></b><br />
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<div class="MsoNormal"><br />
</div><div align="center" class="MsoNormal" style="text-align: center;"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">MAHASISWA AKPER PEMDA GARUT</span></b></div><div class="MsoNormal" style="margin-left: 1cm; text-align: justify; text-indent: -14.15pt;"><br />
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</div>TEAM_ONE KMB 2A AKPEM GARUThttp://www.blogger.com/profile/01719877433346227735noreply@blogger.com0tag:blogger.com,1999:blog-1245729285541543255.post-65973845232052318782011-03-30T04:27:00.000-07:002011-03-30T04:27:26.344-07:00Tugas KMB ke 5 (CYSTITIS)<!--[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>IN</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> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> <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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<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Century Schoolbook","serif"; font-size: 16.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";">LAPORAN PENDAHULUAN</span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Century Schoolbook","serif"; font-size: 16.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";">ASUHAN KEPERAWATAN PADA PASIEN CYSTITIS</span></b></div><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><br />
</div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 39.3pt; mso-add-space: auto; mso-list: l4 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook";"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";">PENGERTIAN </span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold;">Cystitis</span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"> adalah <a href="http://translate.googleusercontent.com/translate_c?hl=id&sl=es&u=http://es.wikipedia.org/wiki/Inflamaci%25C3%25B3n&prev=/search%3Fq%3Dcistitis%26hl%3Did%26sa%3DX%26biw%3D1360%26bih%3D633%26nfpr%3D1%26prmd%3Divns&rurl=translate.google.co.id&usg=ALkJrhi1H5k1EyjTwsjgot5kUUwxSZYtjA"><span style="color: windowtext; text-decoration: none; text-underline: none;">peradangan</span></a> akut atau kronis <a href="http://translate.googleusercontent.com/translate_c?hl=id&sl=es&u=http://es.wikipedia.org/wiki/Vejiga_urinaria&prev=/search%3Fq%3Dcistitis%26hl%3Did%26sa%3DX%26biw%3D1360%26bih%3D633%26nfpr%3D1%26prmd%3Divns&rurl=translate.google.co.id&usg=ALkJrhg9SVcmPaPmiaInC0krmmGi4GVuMQ"><span style="color: windowtext; text-decoration: none; text-underline: none;">kandung kemih</span></a> dengan <a href="http://translate.googleusercontent.com/translate_c?hl=id&sl=es&u=http://es.wikipedia.org/wiki/Infecci%25C3%25B3n&prev=/search%3Fq%3Dcistitis%26hl%3Did%26sa%3DX%26biw%3D1360%26bih%3D633%26nfpr%3D1%26prmd%3Divns&rurl=translate.google.co.id&usg=ALkJrhhWy8MNxA6aBMA7oAHCRJm1Z5TVbQ"><span style="color: windowtext; text-decoration: none; text-underline: none;">infeksi</span></a> atau tidak.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Cistitis adalah inflamasi kandung kemih yang paling sering disebabkan oleh penyebaran infeksi dari uretra. Hal ini dapat disebabkan oleh aliran balik urine dari uretra ke dalam kandung kemih ( refluks urtrovesikal ), kontaminasi fekal, pemakaian kateter atau sistoskop.(<i>Suzane, C. Smelzer. Keperawatan medikal bedah vol. 2. hal.1432)</i></span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Cistitis adalah inflamasi kandung kemih yang menyerang pada pasien wanita, dimana terjadi infeksi oleh <i>Escherichia Coli.</i>(Lewis<i>.Medical Surgikal Nersing. Hal 1262)</i></span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Beberapa penyelidikan menunjukkan 20% dari wanita-wanita dewasa tanpa mempedulikan umur setiap tahun mengalami disuria dan insidennya meningkat sesuai pertumbuhan usia dan aktifitas seksual, meningkatnya frekwensi infeksi saluran perkemihan pada wanita terutama yang gagal berkemih setelah melakukan hubungan seksual dan diperkirakan pula karena uretra wanita lebih pendek dan tidak mempunyai substansi anti mikroba seperti yang ditemukan pada cairan seminal.</span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"></span></b></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Infeksi ini berkaitan juga dengan penggunaan kontrasepsi spermasida-diafragma karena kontrsepsi ini dapat menyebabkan obstruksi uretra parsial dan mencegah pengosongan sempurna kandung kemih. Cistitis pada pria merupakan kondisi sekunder akibat bebarapa faktor misalnya prostat yang terinfeksi,<b> </b>epididimitis, atau batu pada kandung kemih.</span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"></span></b></div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 39.3pt; mso-add-space: auto; mso-list: l4 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook";"><span style="mso-list: Ignore;">2.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";">ANATOMI FISIOLOGI </span></b></div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 39.3pt; text-align: justify; text-indent: -18pt;"><br />
</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixQNjKkm2oZG9zcgSLqQZWph2ZJuXiWwNGUnc31ISC_OyCw9MPPNY8xp-yuReqe6uDUpw-Lfuf5AbqS2Kr7XqSNsm3_3c6esTywuIh3Cf0tjqMLZOR0_zOhFZQHgr_1DC6UiJvaaBEPc1s/s1600/vesika.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEixQNjKkm2oZG9zcgSLqQZWph2ZJuXiWwNGUnc31ISC_OyCw9MPPNY8xp-yuReqe6uDUpw-Lfuf5AbqS2Kr7XqSNsm3_3c6esTywuIh3Cf0tjqMLZOR0_zOhFZQHgr_1DC6UiJvaaBEPc1s/s1600/vesika.jpeg" /> </a></div><div class="separator" style="clear: both; text-align: center;"><br />
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</div><div class="MsoListParagraph" style="line-height: 150%; margin-left: 39.3pt; text-align: justify; text-indent: -18pt;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";">Vesika urinaria adalah sebuah kantong yang dibentuk oleh jaringan ikat dan otot polos. Vesika urinaria berfungsi untuk tempat penyimpanan urin. Apabila terisi sampai 200 – 300 cm3 maka akan timbul keinginan untuk miksi. Miksi adalah suatu proses yang dapat dikendalikan, kecuali pada bayi dan anak-anak kecil merupakan suatu reflex.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Vesica Urinaria adalah suatu organ yang berfungsi untuk menampung urin. Pada laki – laki, organ ini terletak tepat dibelakang Symphisis Pubis dan didepan Rektum. Pada perempuan, organ ini terletak agak dibawah uterus, di depan vagina. Saat kosong, berukuran kecil seperti buah kenari, dan terletak di pelvis. Sedangkan saat penuh berisi urine, tingginya dapat mencapai um bilicus dan berbentuk seperti buah pir. </span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Dinding Vesica Urinaria memiliki beberapa lapisan : </span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; mso-list: l8 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"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Serosa</span><span style="font-family: Wingdings; mso-ascii-font-family: "Century Schoolbook"; mso-char-type: symbol; mso-fareast-language: IN; mso-hansi-font-family: "Century Schoolbook"; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Lapisan terluar, merupakan perpanjangan dari lapisan<span style="letter-spacing: 15.85pt;"> </span>peritoneal rongga abdominopelvis. Hanya di bagian atas pelvis </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; mso-list: l8 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"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Otot Detrusor</span><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Century Schoolbook"; mso-bidi-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; mso-hansi-font-family: "Century Schoolbook"; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Lapisan tengah. Terdiri dari otot – otot polos yang<span style="letter-spacing: 15.85pt;"> </span>saling membentuk sudut. Berperan penting dalam proses urinasi </span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; mso-list: l8 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"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Submukosa</span><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Century Schoolbook"; mso-bidi-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; mso-hansi-font-family: "Century Schoolbook"; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Lapisan jaringan ikat, menghubungkan antara lapisan<span style="letter-spacing: 15.85pt;"> </span>otot Detrusor dengan lapisan mukosa </span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; mso-list: l8 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"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Mukosa</span><span style="font-family: Wingdings; font-size: 12.0pt; line-height: 150%; mso-ascii-font-family: "Century Schoolbook"; mso-bidi-font-family: "Times New Roman"; mso-char-type: symbol; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN; mso-hansi-font-family: "Century Schoolbook"; mso-symbol-font-family: Wingdings;"><span style="mso-char-type: symbol; mso-symbol-font-family: Wingdings;">à</span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Terdiri dari epitel – epitel transisional. Membentuk lipatan<span style="letter-spacing: 15.85pt;"> </span>saat dalam keadaan relaks, dan akan memipih saat keadaan terisi penuh </span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";">Kandung kemih dapat mengembang dan mengempis seperti balon karet, terletak di belakang simfisis pubis di dalam ronga panggul.</span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";">Bentuk kandung kemih seperti kerucut yang dikelilingi oleh otot yang kuat, berhubungan ligamentum vesika umbikalis medius</span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";">Bagian vesika urinaria terdiri dari :</span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; mso-list: l13 level1 lfo3; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";">Fundus, yaitu bagian yang mengahadap kearah belakang dan bawah, bagian ini terpisah dari rektum oleh spatium rectosivikale yang terisi oleh jaringan ikat duktus deferent, vesika seminalis dan prostate.</span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l13 level1 lfo3; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"><span style="mso-spacerun: yes;"> </span>Korpus, yaitu bagian antara verteks dan fundus.</span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l13 level1 lfo3; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";">Verteks, bagian yang maju kearah muka dan berhubungan dengan ligamentum vesika umbilikalis.</span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; mso-list: l13 level1 lfo3; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";">Dinding kandung kemih terdiri dari beberapa lapisan yaitu, peritonium (lapisan sebelah luar), tunika muskularis, tunika submukosa, dan lapisan mukosa (lapisan bagian dalam).</span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";">Vesica urinaria fungsinya untuk menampung urin yg telah dibentuk oleh ginjal, dalam rangka untuk mengekskresikan sisa metabolismehal ini sangat penting, karena sisa metabolisme ini kemungkinan besar mengandung zat karsinogenik yang akan kontak dengan mukosa vesica urinaria yang berupa epitel transisional sehingga bisa menyebabkan neoplasi. Ditinjau dari fungsi vesika urinaria ini identik dengan rectum dalam sistema alimentary. </span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 39.3pt; mso-add-space: auto; mso-list: l4 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook";"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">KLASIFIKASI </span></b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Cystitis dapat dibagi menjadi dua bagian yaitu;</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; mso-list: l0 level1 lfo4; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Cystitis primer, merupakan radang yang mengenai kandung kemih radang ini dapat terjadi karena penyakit lainseperti batu pada kandung kemih, divertikel, hipertropi prostat dan striktura uretra.</span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; mso-list: l0 level1 lfo4; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Cystitis sekunder, merukan gejala yang timbul kemudian sebagai akibat dari penyakit primer misalnya uretritis dan prostatitis.</span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 54.0pt; mso-add-space: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 39.3pt; mso-add-space: auto; mso-list: l4 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook";"><span style="mso-list: Ignore;">4.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-spacerun: yes;"> </span>ETIOLOGI</span></b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pada umumnya disebabkan oleh basil gram negatif Escheriachia Coli yang dapat menyebabkan kira-kira 90% infeksi akut pada penderita tanpa kelainan urologis atau kalkuli : </span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; mso-list: l1 level1 lfo5; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Batang gram negatif lainnya termasuk proteus, klebsiella, enterobakter, serratea, dan pseudomonas bertanggung jawab atas sebagian kecil infeksitanpa komplikasi.</span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l1 level1 lfo5; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Organisme-organisme ini dapat dapat menjadi bertambah penting pada infeksi-infeksi rekuren dan infeksi-infeksi yang berhubungan langsung dengan manipulsi urologis, kalkuli atau obstruksi.<span style="color: black;"> </span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l1 level1 lfo5; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook";"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-spacerun: yes;"> </span>Pada wanita biasanya karena bakteri-bakteri daerah vagina kearah uretra atau dari meatus terus naik kekandumg kemih dan mungkin pula karena renal infeksi tetapi yang tersering disebabkan karena infeksi E.coli.</span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; mso-list: l1 level1 lfo5; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook";"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pada pria biasanya sebagai akibat dari infeksi diginjal, prostat, atau oleh karena adanya urine sisa(misalnya karena hipertropi prostat, striktura uretra, neurogenik bladder) atau karena infeksi dari usus.</span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Jalur infeksi :</span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"></span></b></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; mso-list: l10 level1 lfo6; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook";"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-spacerun: yes;"> </span>Tersering dari uretra, uretra wanita lebih pendek membuat penyalkit ini lebih sering ditemukan pada wanita</span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l10 level1 lfo6; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook";"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Infeksi ginjalyan sering meradang, melalui urine dapat masuk kekandung kemih.</span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l10 level1 lfo6; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook";"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Penyebaran infeksi secara lokal dari organ laindapat mengenai kandung kemih misalnya appendiksitis</span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-list: l10 level1 lfo6; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook";"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-spacerun: yes;"> </span>Pada laki-laki prostat merupakan sumber infeksi.</span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 39.3pt; mso-add-space: auto; mso-list: l4 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">5.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">PATOFISIOLOGI</span></b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></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 style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Cystitis merupakan infeksi saluran kemih bagian bawah yang secara umum disebabkan oleh bakteri gram negatif yaitu Escheriachia Coli peradangan timbul dengan penjalaran secara hematogen ataupun akibat obstruksi saluran kemih bagian bawah, baik akut maupun kronik dapat bilateral maupun unilateral.Kemudian bakteri tersebut berekolonisasi pada suatu tempat misalkan pada vagina atau genetalia eksterna menyebabkan organisme melekat dan berkolonisasi disuatu tempat di periutenial dan masuk ke kandung kemih.</span></div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><br />
</div><div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36pt;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 39.3pt; mso-add-space: auto; mso-list: l4 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook";"><span style="mso-list: Ignore;">6.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">MANIFESTASI KLINIS </span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 39.3pt; mso-add-space: auto; text-align: justify;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Cistitis biasanya memperlihatkan gejala :</span><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"></span></b></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 57.3pt; margin-right: 0cm; margin-top: 5.0pt; mso-add-space: auto; mso-list: l5 level1 lfo7; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Disuria (nyeri waktu berkemih) karena epitelium yang meradang tertekan</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 57.3pt; margin-right: 0cm; margin-top: 5.0pt; mso-add-space: auto; mso-list: l5 level1 lfo7; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Peningkatan frekuensi berkemih</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 57.3pt; margin-right: 0cm; margin-top: 5.0pt; mso-add-space: auto; mso-list: l5 level1 lfo7; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Perasaan ingin berkemih</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 57.3pt; margin-right: 0cm; margin-top: 5.0pt; mso-add-space: auto; mso-list: l5 level1 lfo7; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Piuria(Adanya sel-sel darah putih dalam urin)</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 57.3pt; margin-right: 0cm; margin-top: 5.0pt; mso-add-space: auto; mso-list: l5 level1 lfo7; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-spacerun: yes;"> </span>Nyeri punggung bawah atau suprapubic</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 57.3pt; margin-right: 0cm; margin-top: 5.0pt; mso-add-space: auto; mso-list: l5 level1 lfo7; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">f.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Demam yang disertai hematuria (danya darah dalam urine) pada kasus yang parah.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 57.3pt; margin-right: 0cm; margin-top: 5.0pt; mso-add-space: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 39.3pt; margin-right: 0cm; margin-top: 5.0pt; mso-add-space: auto; mso-list: l4 level1 lfo1; text-align: justify; text-indent: -18.0pt;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">7.<span style="font: 7.0pt "Times New Roman";"> </span></span></span></b><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-spacerun: yes;"> </span>PEMERIKSAAN DIAGNOSTIK</span></b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 39.3pt; margin-right: 0cm; margin-top: 5.0pt; mso-add-space: auto; mso-list: l14 level1 lfo8; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-spacerun: yes;"> </span>Urinalisis</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-add-space: auto; mso-list: l11 level1 lfo9; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">1)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Leukosuria atau piuria terdapat > 5 /lpb sedimen air kemih</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 54.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-add-space: auto; mso-list: l11 level1 lfo9; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">2)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-spacerun: yes;"> </span>Hematuria 5 – 10 eritrosit/lpb sedimen air kemih.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 39.3pt; margin-right: 0cm; margin-top: 5.0pt; mso-add-space: auto; mso-list: l14 level1 lfo8; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-spacerun: yes;"> </span>Bakteriologis</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 53.85pt; margin-right: 0cm; margin-top: 5.0pt; mso-add-space: auto; mso-list: l7 level1 lfo10; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">1)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Mikroskopis ; satu bakteri lapangan pandang minyak emersi, 102 – 103 organisme koliform/mL urin plus piuria Ê 2 ) </span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 53.85pt; margin-right: 0cm; margin-top: 5.0pt; mso-add-space: auto; mso-list: l7 level1 lfo10; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">2)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Tes kimiawi; tes reduksi griess nitrate berupa perubahan warna pada uji carik.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: justify; text-indent: 27.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">c. <span style="mso-spacerun: yes;"> </span>Pemeriksaan USG abdomen</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">d. Pemeriksaan photo BNO dan BNO IVP</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">8. <span style="mso-spacerun: yes;"> </span><span style="mso-bidi-font-weight: bold;">PENGKAJIAN</span></span></b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></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 style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Dalam melakukan pengkajian pada klien cystitis menggunakan pendekatan bersifat menyeluruh yaitu :</span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; mso-add-space: auto; mso-list: l6 level1 lfo11; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Data biologis meliputi :</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 39.35pt; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">1) Identitas klien</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 39.35pt; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">2) Identitas penanggung</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 39.35pt; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-add-space: auto; mso-list: l6 level1 lfo11; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Riwayat kesehatan :</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">1) Riwayat infeksi saluran kemih</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">2) Riwayat pernah menderita batu ginjal</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">3) Riwayat penyakit DM, jantung.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-add-space: auto; mso-list: l6 level1 lfo11; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pengkajian fisik :</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">1) Palpasi kandung kemih</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">2) Inspeksi daerah meatus</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 17.0pt; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">a) Pengkajian warna, jumlah, bau dan kejernihan urine</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 17.0pt; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 36.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">b) Pengkajian pada costovertebralis</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 17.0pt; mso-add-space: auto; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 36.0pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; mso-add-space: auto; mso-list: l6 level1 lfo11; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Riwayat psikososial :</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 5.0pt; mso-add-space: auto; mso-list: l3 level1 lfo12; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">1)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Usia, jenis kelamin, pekerjaan, pendidikan</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 5.0pt; mso-add-space: auto; mso-list: l3 level1 lfo12; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">2)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-spacerun: yes;"> </span>Persepsi terhadap kondisi penyakit</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 5.0pt; mso-add-space: auto; mso-list: l3 level1 lfo12; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">3)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Mekanisme kopin dan system pendukun</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 49.65pt; margin-right: 0cm; margin-top: 5.0pt; mso-add-space: auto; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 36.0pt; margin-right: 0cm; margin-top: 5.0pt; mso-add-space: auto; mso-list: l6 level1 lfo11; text-align: justify; text-indent: -18.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">e.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Pengkajian pengetahuan klien dan keluarga</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -27.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">1) Pemahaman tentang penyebab/perjalanan penyakit</span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: -27pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12pt; line-height: 150%;">2) Pemahaman tentang pencegahan, perawatan </span></div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 27pt; text-align: justify; text-indent: -27pt;"><br />
</div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 27.0pt;"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">9. <span style="mso-spacerun: yes;"> </span>DIAGNOSA KEPERAWATAN</span></b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-left: 1.0cm; mso-add-space: auto; mso-list: l9 level1 lfo13; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -1.0cm;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">a.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Infeksi yang berhubungan dengan adanya bakteri pada kandung kemih</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 1.0cm; mso-add-space: auto; mso-list: l9 level1 lfo13; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -1.0cm;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">b.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Perubahan pola eliminasi urine (disuria, dorongan, frekuensi, dan atau nokturia) yang berhubungan dengan Inflamasi pada kandung kemih</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 1.0cm; mso-add-space: auto; mso-list: l9 level1 lfo13; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -1.0cm;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">c.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-spacerun: yes;"> </span>Nyeri akut yang berhubungan dengan proses penyakit</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 1.0cm; mso-add-space: auto; mso-list: l9 level1 lfo13; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -1.0cm;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">d.<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-spacerun: yes;"> </span>Kurang pengetahuan yang berhubungan dengan kurangnya informasi tentang proses penyakit, metode pencegahan, dan instruksi perawatan di rumah.</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 1cm; text-align: justify; text-indent: -1cm;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-left: 1.0cm; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">10. PERENCANAAN</span></b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify;"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">a. <span style="mso-spacerun: yes;"> </span>Infeksi yang b.d adanya bakteri pada kandung kemih,</span></b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-margin-top-alt: auto; text-align: justify;"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Tujuan : </span></b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Setelah di lakukan tindakan keperawatan selama 3 x 24 jam pasien memperlihatkan tidak adanya tanda-tanda infeksi.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 5.0pt; text-align: justify; text-indent: -27.0pt;"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Kriteria Hasil :</span></b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -27.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">1) Tanda vital dalam batas normal</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -27.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">2) Nilai kultur urine negative</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -27.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">3) Urine berwarna bening dan tidak bau</span></div><div class="MsoNormal" style="line-height: 150%; margin-left: 27.0pt; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: -27.0pt;"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Intervensi :</span></b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -27.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">1) Kaji suhu tubuh pasien setiap 4 jam dan lapor jika suhu diatas 38,50 C</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;"><i><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">R/:</span></i><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Tanda vital menandakan adanya perubahan di dalam tubuh</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -27.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">2) Catat karakteristik urine</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;"><i><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">R/ :</span></i><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Untuk mengetahui/mengidentifikasi indikasi kemajuan atau penyimpangandari hasil yang diharapkan.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -27.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">3) Anjurkan pasien untuk minum 2 – 3 liter jika tidak ada kontra indikasi</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;"><i><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">R/ :</span></i><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Untuk mencegah stasis urine</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -27.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">4) Monitor pemeriksaan ulang urine kultur dan sensivitas untuk menentukan respon terapi.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify;"><i><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">R/ :</span></i><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Mengetahui seberapa jauh efek pengobatan terhadap keadaan penderita.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -27.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">5) Anjurkan pasien untuk mengosongkan kandung kemih secara komplit setiap kali kemih.<br />
<i>R/ :</i>Untuk mencegah adanya distensi kandung kemih</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -27.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">6) Berikan perawatan perineal, pertahankan agar tetap bersih dan kering.<br />
<i>Rasional :</i>Untuk menjaga kebersihan dan menghindari bakteri yang membuat infeksi uretra</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -27.0pt;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -27.0pt;"><br />
</div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -27.0pt;"><br />
</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;"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">b.Perubahan pola eliminasi urine (disuria, dorongan frekuensi dan atau nokturia) yang berhubungan dengan Inflamasi pada kandung kemih</span></b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Tujuan :</span></b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Setelah dilakukan tindakan keperawatan selama 3 x 24 jam klien dapat mempertahankan pola eliminasi secara adekuat.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Kriteria :</span></b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -27.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">1) Klien dapat berkemih setiap 3 jam</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -27.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">2) Klien tidak kesulitan pada saat berkemih</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -27.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">3) Klien dapat bak dengan berkemih</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -27.0pt;"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Intervensi :</span></b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 38.25pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo14; text-align: justify; text-indent: -20.25pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">1)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Ukur dan catat urine setiap kali berkemih</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 38.25pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;"><i><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">R/ :</span></i><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Untuk mengetahui adanya perubahan warna dan untuk mengetahui input/out put</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 38.25pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo14; text-align: justify; text-indent: -20.25pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">2)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Anjurkan untuk berkemih setiap 2 – 3 jam</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 38.25pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;"><i><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">R/ :</span></i><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Untuk mencegah terjadinya penumpukan urine dalam vesika urinaria.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 38.25pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo14; text-align: justify; text-indent: -20.25pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">3)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Palpasi kandung kemih tiap 4 jam</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 38.25pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;"><i><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">R/ :</span></i><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Untuk mengetahui adanya distensi kandung kemih.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 38.25pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo14; text-align: justify; text-indent: -20.25pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">4)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Bantu klien ke kamar kecil, memakai pispot/urinal</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 38.25pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;"><i><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">R/ :</span></i><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Untuk memudahkan klien di dalam berkemih.</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 38.25pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l12 level1 lfo14; text-align: justify; text-indent: -20.25pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Century Schoolbook"; mso-fareast-font-family: "Century Schoolbook"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">5)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Bantu klien mendapatkan posisi berkemih yang nyaman</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 38.25pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;"><i><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">R/ :</span></i><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Supaya klien tidak sukar untuk berkemih.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 5.0pt; text-align: justify; text-indent: -9.0pt;"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">c. Nyeri akut yang berhubungan dengan proses penyakit</span></b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 5.0pt; text-align: justify; text-indent: -27.0pt;"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Tujuan :</span></b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 0cm; margin-right: 0cm; margin-top: 5.0pt; text-align: justify;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Setelah dilakukan tindakan keperawatan selama 3x 24 jam pasien merasa nyaman dan nyerinya berkurang</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 5.0pt; text-align: justify; text-indent: -27.0pt;"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Kriteria Hasil :</span></b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -27.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">1) Pasien mengatakan / tidak ada keluhan nyeri pada saat berkemih.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -27.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">2) Kandung kemih tidak tegang</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -27.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">3) Pasien nampak tenang</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -27.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">4) Ekspresi wajah tenang</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -27.0pt;"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Intervensi :</span></b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -27.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">1) Kaji intensitas, lokasi, dan factor yang memperberat atau meringankan nyeri.<br />
<i>R/ :</i>Rasa sakit yang hebat menandakan adanya infeksi</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -27.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">2) Berikan waktu istirahat yang cukup dan tingkat aktivitas yang dapat di toleran.<br />
<i>R/ :</i>Klien dapat istirahat dengan tenang dan dapat merilekskan otot-otot</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -27.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">3) Anjurkan minum banyak 2-3 liter jika tidak ada kontra indikasi<br />
<i>R/ :</i>Untuk membantu klien dalam berkemih</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -27.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">4) Berikan obat analgetik sesuai dengan program terapi.<br />
<i>R/ :</i>Analgetik memblok lintasan nyeri</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 5.0pt; text-align: justify; text-indent: -27.0pt;"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">d. Kurang pengetahuan yang berhubungan dengan kurangnya informasi tentang proses penyakit, metode pencegahan, dan instruksi perawatan di rumah.</span></b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 5.0pt; text-align: justify; text-indent: -27.0pt;"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Tujuan : </span></b></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 5.0pt; text-align: justify; text-indent: -27.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Setelah dilakukan tindakan keperawatan klien tidak memperlihatkan tanda- tanda gelisah.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 5.0pt; text-align: justify; text-indent: -27.0pt;"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Kriteria hasil :</span></b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -27.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">1) Klien tidak gelisah</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -27.0pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">2) Klien tenang</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 27.0pt; margin-right: 0cm; margin-top: 5.0pt; text-align: justify; text-indent: -27.0pt;"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Intervensi :</span></b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l2 level1 lfo15; text-align: justify; text-indent: -1.0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">1)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Kaji tingkat kecemasan</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;"><i><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">R/ :</span></i><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Untuk mengetahui berat ringannya kecemasan klien</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l2 level1 lfo15; text-align: justify; text-indent: -1.0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">2)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Beri kesempatan klien untuk mengungkapkan perasaannya</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;"><i><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">R/ :</span></i><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Agar klien mempunyai semangat dan mau empati terhadap perawatan dan pengobatan</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l2 level1 lfo15; text-align: justify; text-indent: -1.0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">3)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Beri support pada klien</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;"><i><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">R/ :</span></i><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Meningkatkan respon fisiologis pada klien</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l2 level1 lfo15; text-align: justify; text-indent: -1.0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">4)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Beri dorongan spiritual</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;"><i><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">R/ :</span></i><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Agar klien kembali menyerahkan sepenuhnya kepada Tuhan YME.Beri support pada klien</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; mso-list: l2 level1 lfo15; text-align: justify; text-indent: -1.0cm;"><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 150%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-list: Ignore;">5)<span style="font: 7.0pt "Times New Roman";"> </span></span></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><span style="mso-spacerun: yes;"> </span>Beri penjelasan tentang penyakitnya</span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; text-align: justify;"><i><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">R/ : </span></i><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Agar klien mengerti sepenuhnya tentang penyakit yang dialaminya.</span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 1.0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: 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;"><br />
</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;"><br />
</div><div class="MsoNormal" style="line-height: 150%; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; text-align: justify; text-indent: 1.0cm;"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">11. DAFTAR PUSTAKA</span></b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 26.95pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -26.95pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Arif Mansjoer dkk .2000. <i>Kapita Selekta Kedokteran</i> <i>, Edisi 3 , Jilid 1</i>.Jakarta: EGC </span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 26.95pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -26.95pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Bruner & Sudarth.2002.<i>Keperwatan Medikal Bedah vol 2 edisi 8. </i>Jakarta : EGC</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Doenges, Marilynn E, dkk. 2000. <i>Penerapan Proses Keperawatan dan Diagnosa Keperawatan</i>. Jakarta : EGC.</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 26.95pt; margin-right: 0cm; margin-top: 0cm; text-align: justify; text-indent: -26.95pt;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Lewis, dkk.2004. <i>Medical Surgical Nursing vol.2</i>. New York : Mosby</span></div><div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: justify;"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"><a href="http://www.scribd.com/"><span style="color: windowtext; text-decoration: none; text-underline: none;">http://www.scribd.com</span></a></span><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman"; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"></span></div><div class="MsoNormal"><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold;"><a href="http://es.wikipedia.org/wiki/"><span style="color: windowtext; text-decoration: none; text-underline: none;">http://es.wikipedia.org/wiki/</span></a></span></div><div class="MsoNormal"><span style="font-family: "Century Schoolbook","serif"; font-size: 13.5pt; line-height: 115%; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><a href="http://azruhi.blogspot.com/"><span style="color: windowtext; text-decoration: none; text-underline: none;">http://azruhi.blogspot.com/</span></a></span></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">Diposting Oleh : </span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">Nama <span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>:Anisah Nur Azizah</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">NIM<span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>:05200ID09005</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">Kelas<span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>:2A<span style="mso-tab-count: 1;"> </span></span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">Kelompok<span style="mso-tab-count: 1;"> </span>:1</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>-Anisah Nur Azizah</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>-Asep Diki Permana</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>-Farid Maroef Maulana Ishak</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>-Lina Ratiana</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 1;"> </span>-Pipit Puspita Permana</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 2;"> </span>-Rini Yulianai</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 2;"> </span>-Susanti</span></b></div><div class="MsoNormal"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><span style="mso-tab-count: 2;"> </span>-Ucu Cahyati</span></b></div><div class="MsoNormal"><br />
</div><div align="center" class="MsoNormal" style="text-align: center;"><b><span style="font-family: "Century Schoolbook","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">MAHASISWA AKPER PEMDA GARUT</span></b></div><div align="center" class="MsoNormal" style="text-align: center;"><br />
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</div><div class="MsoNormal" style="line-height: 150%; text-align: justify;"><br />
</div>TEAM_ONE KMB 2A AKPEM GARUThttp://www.blogger.com/profile/01719877433346227735noreply@blogger.com0tag:blogger.com,1999:blog-1245729285541543255.post-16836992294296149112011-03-24T22:44:00.000-07:002011-03-24T22:44:37.685-07:00TUGAS 4 KMB III<!--[if !mso]> <style>
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</style> <![endif]--> <div align="center" class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: center;"><span style="font-size: small;"><b><span lang="EN-US" style="color: black; line-height: 150%;">Proses</span></b><b><span lang="EN-US" style="line-height: 150%;"> Terbentuknya <span style="color: black;">urine</span></span></b></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">Urin terbentuk setelah melalui proses penyaringan darah di ginjal. </span></span></div><div class="MsoListParagraph" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: -18pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;"><span>1.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> 1. </span></span></span><span lang="EN-US" style="line-height: 150%;">Darah mengalir masuk ke ginjal melalui Arteri Renalis. Arteri bercabang-cabang dan menjadi pembuluh darah yang semakin kecil, disebut arteriole, dan akhirnya berujung pada pembuluh kapiler di glomerulus pada setiap nephron.</span></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuhDyUJBfjZdOysACNcN3tVZ_NQMvnpQKXVjkGpnCUIrm_2PMs7Ko2BCnE2GqfP4tqe2hEy6YMwbHv-WrsY5hQBoKXxagRMectNgvhk0hnU9srcZUq5WpMXhfJeM95WB5huiHqxDlzWBoI/s1600/2+gjl.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuhDyUJBfjZdOysACNcN3tVZ_NQMvnpQKXVjkGpnCUIrm_2PMs7Ko2BCnE2GqfP4tqe2hEy6YMwbHv-WrsY5hQBoKXxagRMectNgvhk0hnU9srcZUq5WpMXhfJeM95WB5huiHqxDlzWBoI/s1600/2+gjl.jpg" /></a></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 21pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;"> </span><b><u><span lang="EN-US" style="line-height: 150%;"><br />
</span></u></b></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvJbyyUjM2pqbXNCuh798ZgKGT_BYArH-WIh4_gKAfntlLh99hiceIrN69Nu4VxTksVwQR9zqoZRfufS1Uh8Ps5zImsWhcj1uN-mNqglDUme1xzgKgrSTRqa14GDJUzrc0kJ8T1tDM0Jn7/s1600/kidney-works.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><br />
</a></div><div class="MsoListParagraph" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;"><span>2.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> 2. </span></span></span><span lang="EN-US" style="line-height: 150%;">Darah yang mengalir ke ginjal, masuk kedalam glomerulus melalui Affarent Arteriole. Di dalam glomerulus, darah mengalir melalui capiler yang berkelok-kelok. Dinding pembuluh kapiler disini agak tipis, dan tekanan darah dalam kapiler tinggi. Hal ini mengakibatkan air, bersama dengan zat-zat yang terlarut di dalamnya–seperti garam, glukosa atau gula, asam amino, dan limbah urea dan asam urat–terdorong keluar melalui dinding kapiler yang tipis, yang kemudian dikumpulkan di Kapsul Bowmen. Partikel yang lebih besar dalam darah, seperti sel darah merah dan molekul protein, terlalu besar untuk melewati dinding kapiler dan mereka tetap berada dalam aliran darah. Darah yang sudah disaring meninggalkan glomerulus melalui Everent Arteriole yang lain, yang bercabang-cabang membentuk suatu jaring pembuluh darah diseputar tubulus renal. Darah kemudian keluar dari ginjal melalui vena renalis. Sekitar 180 liter (±50 galon) darah disaring oleh ginjal setiap harinya, dan sekitar 1,5 liter (1,3 qt) urin diproduksi. </span></span></div><br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvJbyyUjM2pqbXNCuh798ZgKGT_BYArH-WIh4_gKAfntlLh99hiceIrN69Nu4VxTksVwQR9zqoZRfufS1Uh8Ps5zImsWhcj1uN-mNqglDUme1xzgKgrSTRqa14GDJUzrc0kJ8T1tDM0Jn7/s1600/kidney-works.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="263" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvJbyyUjM2pqbXNCuh798ZgKGT_BYArH-WIh4_gKAfntlLh99hiceIrN69Nu4VxTksVwQR9zqoZRfufS1Uh8Ps5zImsWhcj1uN-mNqglDUme1xzgKgrSTRqa14GDJUzrc0kJ8T1tDM0Jn7/s320/kidney-works.gif" width="320" /></a></div><br />
<div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 21pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;"> </span><span lang="EN-US" style="line-height: 150%;"></span></span></div><div class="MsoListParagraph" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;"><span>3.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> 3. </span></span></span><span lang="EN-US" style="line-height: 150%;">Produksi urin diawali dengan zat-zat yang ditinggalkan darah pada saat darah melewati ginjal–seperti air, garam, dan zat-zat lain yang dikumpulkan dari glomerulus dalam kapsul Bowman. Cairan ini, disebut saringan glomerular, bergerak dari kapsul Bowman melewati tubul renalis. Bersamaan dengan mengalirnya cairan tadi sepanjang tubul renalis, jaring pembuluh darah yang menyelubungi tubulus menyerap kembali sebagian air, garam dan semua nutrisi, terutama glukosa dan asam amino, yang terpisah pada saat darah melewati glomerulus. Proses penting ini, disebut penyerapan tubular, membuat tubuh kita secara selektif memilah zat-zat yang masih diperlukan dan membuang limbah dan racun yang tidak bergunal lagi. Pada akhirnya, sekitar 99% dari air, garam dan nutrisi lainnya diserap kembali oleh tubuh.</span></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOCEbddXC2hwUEof6nedl6lQ3-y3oBAvfRms2t6Ld3NSmaXsI-fapQnTEn6vseFkTx7epTjVY8FwSabqHjzMuS36q-Ecy0J7N0GSaFDrVP5fKlPRJracPiKNcp_vfVL4r0pECtZEJk9DqY/s1600/urinflow.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="220" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOCEbddXC2hwUEof6nedl6lQ3-y3oBAvfRms2t6Ld3NSmaXsI-fapQnTEn6vseFkTx7epTjVY8FwSabqHjzMuS36q-Ecy0J7N0GSaFDrVP5fKlPRJracPiKNcp_vfVL4r0pECtZEJk9DqY/s320/urinflow.jpg" width="320" /></a></div><div class="MsoListParagraph" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: -18pt;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-size: small;"><span style="line-height: 150%;"> </span><span lang="EN-US" style="line-height: 150%;"><span>4.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="EN-US" style="line-height: 150%;">Pada saat ginjal melakukan proses penyerapan kembali nutrisi yang masih dibutuhkan dari saringan glomerular, ginjal melakukan suatu pekerjaan yang berlawanan, yang disebut sekresi tubular. Dalam proses ini, zat-zat yang sudah tidak dibutuhkan dari kapiler yang menyelubungi nephron dimasukan dalam saringan glomerular. Zat-zat ini termasuk partikel bermuatan yang disebut ion, termasuk ion ammonium, ion hydrogen, dan potassium.</span></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjrqDdtwgp2czksUa1SUdZxdYsL8FtQ0sOZS1u8U5TENhV5P2E2QeShmVeMCqyUh3aPNCu5lvV7xhyY5adTPt7OLxblXKvBaKfE0d6PiELvfBzQtZ3BDjrfFDt3Ug1ooukhvP9aIo2NblK5/s1600/f4-148.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjrqDdtwgp2czksUa1SUdZxdYsL8FtQ0sOZS1u8U5TENhV5P2E2QeShmVeMCqyUh3aPNCu5lvV7xhyY5adTPt7OLxblXKvBaKfE0d6PiELvfBzQtZ3BDjrfFDt3Ug1ooukhvP9aIo2NblK5/s320/f4-148.jpg" width="304" /></a></div><div class="MsoListParagraphCxSpFirst" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: -18pt;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;"> </span><span lang="EN-US" style="line-height: 150%;"></span></span></div><div class="MsoListParagraphCxSpMiddle" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;"><span>5.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> 5. </span></span></span><span lang="EN-US" style="line-height: 150%;">ketiga proses ini, saringan glomerular, penyerapan tubular dan sekresi tubular; yang kemudian menghasilkan urine, yang mengalir menuju tubulus pengumpul urin. Tubulus pengumpul ini mengalirkan urin ke tubulus mikro pada piramida ginjal. Urin kemudian disimpan dalam sebuah kamar dalam ginjal dan akhirnya dialirkan ke ureter, suatu saluran panjang dan sempit yang berakhir di kandung kemih. Dari sekitar 180 liter darah yang disaring ginjal setiap hari, menghasilkan sekitar 1,5 liter urine.</span></span></div><div class="MsoListParagraphCxSpLast" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: center;"><span style="font-size: small;"><b><span lang="EN-US" style="line-height: 150%;">Secara singkat, pembentukan urine dimulai dengan:</span></b></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">Darah masuk ginjal melalui pembuluh nadi ginjal. Ketika berada di dalam membrane glomenulus, zat-zat yang terdapat dalam darah (air, gula, asam amino dan urea) merembes keluar dari pembuluh darah kemudian masuk kedalam simpai/kapsul bowman dan menjadi urin primer.<span> </span>Proses ini disebut filtrasi.<span style="color: black;"></span></span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">urin primer dari kapsul bowman mengalir melalui saluran-saluran halus (tubulus kontortokus proksimal). Di saluran-saluran ini zat-zat yang masih berguna, misalnya gula, akan diserap kembali oleh darah melalui pembuluh darah yang mengelilingi saluran tersebut sehingga terbentuk urin sekunder. Proses ini disebut reabsorpsi.</span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">urin sekunder yang terbentuk kemudian masuk tubulus kotortokus distal dan mengalami penambahan zat sisa metabolism maupun zat yang tidak mampu disimpan dan akhirnya terbentuklah urnine sesungguhnya yang dialirkan ke kandung kemih melalui ureter. Proses ini disebut augmentasi. Apabila kandung kemih telah penuh dengan urne, tekanan urin pada dinding kandung kamih akan menimbulkan rasa ingin buang air kecil atau kencing.</span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">urin mengandung zat padat sebesar 4 persen dan 96 perse air. Zat-zat padat yang ada dalam urin adalah sebagai berikut :</span></span></div><div class="MsoListParagraphCxSpFirst" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;"><span>a.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="EN-US" style="line-height: 150%;">Urea, air dan ammonia sebagai sisa perombakan protein</span></span></div><div class="MsoListParagraphCxSpMiddle" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;"><span>b.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="EN-US" style="line-height: 150%;">Zat warna empedu yang member warna kuning pada urin</span></span></div><div class="MsoListParagraphCxSpMiddle" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;"><span>c.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="EN-US" style="line-height: 150%;">Zat-zat yang berlebihan dalam darah misalnya vitamin, sisa obatan, hormone dan zat kimia yang berasal dari makanan.</span></span></div><div class="MsoListParagraphCxSpLast" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin: 0cm 0cm 0.0001pt 54pt; text-align: justify; text-indent: -18pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;"><span>d.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="EN-US" style="line-height: 150%;">Garam-garaman khususnya garam dapur.</span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">Banyaknya urin yang dikeluarkan dari dalam tubuh seseorang yang normal sekitar 5 liter setiap hari. Factor yang mempengaruhi pengeluaran urin dari dalam tubuh tergantung dari banyaknya ar yang diminum dan keadaan suhu apabila suhu udara dingin, pembentukan urin meningkat sedangkan jika suhu panas, pembentukan urin sedikit. </span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify; text-indent: 36pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">Pada saat kita minum banyak air, kelebihan air akan dibuang melalui ginjal. Oleh karena itu jika banyak minum akan banyak mengeluarkan urin. Warna urin setiap orang berbeda-beda. Warna urin biasanya dipengaruhi oleh jenis makanan yang dimakan, jenis kegiatan atau dapat pula disebabkan oleh penyakit. Namun biasanya warna urin normal berkisar dari warna bening sampai warna kuning pucat.</span></span></div><div class="MsoListParagraph" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify;"><br />
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</div><div align="center" class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: center;"><span style="font-size: small;"><b><i><span lang="EN-US" style="line-height: 150%;">PROSES MIKSI</span></i></b></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: 18pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">Miksi adalah Proses pengosongan kandung kemih bila kandung kemih terisi. Proses ini terdiri dari dua langkah utama yaitu:</span></span></div><div class="MsoListParagraphCxSpFirst" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;"><span>1.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="EN-US" style="line-height: 150%;">Kandung kemih secara progresif terisi sampai tegangan di dindingnya meningkat di atas nilai ambang.</span></span></div><div class="MsoListParagraphCxSpLast" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;"><span>2.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="EN-US" style="line-height: 150%;">Timbul nilai refleks saraf yang disebut refleks miksi (refleks berkemih) yang berusaha mengosongkan kandung kemih, atau jika ini gagal, setidak – tidaknya menimbulakan kesadaran akan keinginan untuk berkemih.</span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">Mekanisme proses Miksi ( Mikturisi ) Miksi ( proses berkemih ) ialah proses di mana kandung kencing akan mengosongkan dirinya waktu sudah penuh dgn urine. Mikturisi ialah proses pengeluaran urine sebagai gerak refleks yang dapat dikendalikan (dirangsang/dihambat) oleh sistim persarafan dimana gerakannya dilakukan oleh kontraksi otot perut yg menambah tekanan intra abdominalis, dan organ organ lain yang menekan kandung kencing sehigga membantu mengosongkan urine ( Virgiawan, 2008 ).</span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: 18pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">Reflex mikturisi adalah reflex medulla spinalis yang bersifat otonom, yg dikendalikan oleh suatu pusat di otak dan korteks cerebri. Reflex mikturisi merupakan penyebab dasar berkemih, tetapi biasanya pusat yang lebih tinggi yang akan melakukan kendali akhir untuk proses mikturisi sebagai berikut :</span></span></div><ol start="1" style="font-family: Times,"Times New Roman",serif;" type="1"><li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">Pusat yang lebih tinggi menjaga agar reflex mikturisi tetap terhambat sebagian, kecuali bila mikturisi diinginkan</span></span></li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">Pusat yang lebih tinggi dapat mencegah mikturisi, bahkan jika terjadi reflex mikturisi, dengan cara sfingter kandung kemih eksterna terus-menerus melakukan kontraksi tonik hingga saat yang tepat datang dengan sendirinya</span></span></li>
<li class="MsoNormal" style="line-height: 150%; text-align: justify;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">Jika waktu berkemih tiba, pusat kortikal dapat memfasilitasi pusat mikturisi sacral untuk membantu memulai reflex mikturisi dan pada saat yang sama menghambat sfingter eksterna sehingga pengeluaran urin dapat terjadi </span></span></li>
</ol><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 36pt; text-align: justify;"><span style="font-size: small;"><span lang="EN-US"><a href="http://arispurnomo.com/wp-content/uploads/2010/10/ginjal_batu.jpg"><span lang="IN" style="color: blue; line-height: 150%; text-decoration: none;"> </span></a></span><span lang="EN-US" style="line-height: 150%;"></span></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjadiG7V_ysb6o49mEd-2-CZ7NvcOb3eXvWu-ZscBmKjLeFR9Jbc_RPhB9zc829DyIaPz9ZpnEaMEdLB_GLmqKYsB4XoybjO0u08pdsAkh55mOgWgyhIstcz0rxCkDGhTOzg7NRhYUoj9up/s1600/miksi+1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjadiG7V_ysb6o49mEd-2-CZ7NvcOb3eXvWu-ZscBmKjLeFR9Jbc_RPhB9zc829DyIaPz9ZpnEaMEdLB_GLmqKYsB4XoybjO0u08pdsAkh55mOgWgyhIstcz0rxCkDGhTOzg7NRhYUoj9up/s1600/miksi+1.jpg" /></a></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 36pt; text-align: justify;"><br />
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</div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify;"><span style="font-size: small;"><b><i><span lang="EN-US" style="line-height: 150%;">HUBUNGAN<span> </span>SARAF<span> </span>PADA KANDUNG KEMIH DENGAN ANATOMI FISIOLOGI PERKEMIHAN</span></i></b></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0wdzjToGJyqRvnnAqREFseXt0sreagHr4RRytBgdIgFFbXXry9eUlTa1ET-9NPfwa8pfMtS8vWGj4QmTABifrDDg7U2f7aCC56ywMIUCr2KV1mDblXrO1dltUC97nHOacvNLT3eLaajVG/s1600/blader.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0wdzjToGJyqRvnnAqREFseXt0sreagHr4RRytBgdIgFFbXXry9eUlTa1ET-9NPfwa8pfMtS8vWGj4QmTABifrDDg7U2f7aCC56ywMIUCr2KV1mDblXrO1dltUC97nHOacvNLT3eLaajVG/s1600/blader.jpg" /></a></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 36pt; text-align: justify;"><span style="font-size: small;"><span style="line-height: 150%;"> </span><span lang="EN-US" style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">Pada dinding kandung kemih terdapat 2 bagian yang besar ruangan yang berdinding otot polos yaitu:</span></span></div><div class="MsoListParagraphCxSpFirst" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;"><span>1.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="EN-US" style="line-height: 150%;">Badan (korpus) merupakan bagian utama kandung kemih dimana urin berkumpul.</span></span></div><div class="MsoListParagraphCxSpLast" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;"><span>2.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="EN-US" style="line-height: 150%;">Leher (kolum), merupakan lanjutan dari badan yang berbentuk corong, berjalan secara inferior dan anterior ke dalam daerah segitiga urogenital dan berhubungan dengan uretra. Bagian yang lebih rendah dari leher kandung kemih disebut uretra posterior karena hubungannnya dengan uretra.</span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">Otot polos kandung kemih disebut otot detrusor. Serat-seratnya meluas ke segala arah dan, bila berkontraksi, dapat meningkatkan tekanan dalam kandung kemih menjadi 40 sampai 60 mmHg, dengan demikian, kontraksi otot detrusor adalah langkah terpenting unruk mengosongkan kandung kemih. Sel – sel otot polos dari otot detrusor terangkai satu sama lain sehingga timbul aliran listrik berhambatan rendah dari satu sel otot ke sel yang lain. Oleh karena itu, potensial aksi dapat menyebar ke seluruh otot detrusor, dari satu sel otot ke sel otot yang berikutnya, sehingga terjadi kontraksi seluruh kandung kemih.</span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">Pada dinding posterior kandung kemih, tepat di atas bagian leher dari kandung kemih, terdapat daerah segitiga kecil yang disebut trigonum. Bagian terendah dari afeks trigonum adalah bagian kandung kemih yang membuka menuju leher masuk ke dalam uretra posterior, dan kedua ureter memasuki kandung kemih pada sudut tertinggi di trigonum. Trigonum sangat dikenal dengan mukosanya, yaitu lapisan tang paling dalam kandung kemih yang paling lembut di bandingkan dengan lapisan – lapisan yang lainnya berlipat-lipat berbentuk rugae. Masing -masing ureter pada saat memasuki kandung kemih, berjalan secara oblique melalui otot detrusor dan kemudian melewati 1 sampai 2 sentimeter lagi di bawah mukosa kandung kemih sebelum mengosongkan diri ke dalam kandung kemih.</span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">Leher kandung kemih (uretra posterior) panjangnya 2 sampai 3 sentimeter, dan dindingnya terdiri dari otot detrusor yang bersilangan dengan sejumlah besar jaringan elastic. Otot pada derah ini disebut sfingter internal. Sifat tonusnya secara normal mempertahankan leher kandung kemih dan uretra posterior agar kosong dari urin dan, oleh karena itu mencegah pengosongkan kandung kemih sampai tekenan pada daerah utama kandung kemih meningkat di atas ambang kritis.</span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">Setelah uretra posterior, uretra berjalan melewati diafragma urogenital, yang mengandung lapisan otot yang disebut sfingter eksterna kandung kemih. Otot ini merupakan otot lurik yang berbeda dengan otot pada badan dan leher kandung kemih, yang hanya terdiri dari otot polos. Otot sfingter eksterna bekerja dibawah kendali system saraf volunter dan dapat digunakan secara sadar untuk menahan miksi (berkemih) bahkan bila kendali involunter berusaha untuk mengosongkan kandung kemih</span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;"><span>·<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><b><i><span lang="EN-US" style="line-height: 150%;">PERSARAFAN KANDUNG KEMIH.</span></i></b></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><br />
</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiIJk5fGme5a7oTF_rblHQdhq0c3H_YCQyEyCUtPt5Mgw8h0uVGHn_odONqTKmlJRST7XDbbA9pOWHcyIi159kMS9aB7hk46XICBKx3sCfLsTUpBD2luECANt4nT2JgKPA5w3DdpHgNyaHO/s1600/miksi+3.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiIJk5fGme5a7oTF_rblHQdhq0c3H_YCQyEyCUtPt5Mgw8h0uVGHn_odONqTKmlJRST7XDbbA9pOWHcyIi159kMS9aB7hk46XICBKx3sCfLsTUpBD2luECANt4nT2JgKPA5w3DdpHgNyaHO/s320/miksi+3.jpg" width="190" /></a></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><br />
</div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 36pt; text-align: justify;"><span style="font-size: small;"><span lang="EN-US"><a href="http://arispurnomo.com/wp-content/uploads/2010/10/BladderSignals.jpg"><span lang="IN" style="color: blue; line-height: 150%; text-decoration: none;"> </span></a></span><span lang="EN-US" style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">Persarafan utama kandung kemih ialah nervus pelvikus, yang berhubungan dengan medulla spinalis melalui pleksus sakralis, terutama berhunbungan dengan medulla spinalis segmen S2 dan S3. Berjalan melalui nervus pelvikus ini adalah serat saraf motoik. Serat sensorik mendeteksi derajat regangan pada dinding kandung kemih. Tanda – tanda regangan dari uretra posterior bersifat sangat kuat dan terutama bertanggung jawab untuk mencetuskan refleks yang menyebabkan kandung kemih.</span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">Saraf motorik yang menjalar dalam nervus pelvikus adalah serat para simpatis. Serat ini berakhir pada sel ganglion yang terletak dalam dinding kandung kemih, saraf postganglion pendek kemudian mempersarafi otot detrusor.</span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">Selain nervus pelvikus, terdapat dua tipe persarafan lain yang penting untuk fungsi kandumg kemih. Yang terpenting adalah serat otot lurik yang berjalan melalui nervus pudendal menuju sfingter eksternus kandung kemih, yang mempersarafi dan mengontrol otot lurik pada sfingter. Selain itu kandung kemih juga menerima saraf simpatis dari rangkaian simpatis melalui nervus hipogastrikus, terutama hubungan dengan segmen L2 medula spinalis. Serat simpatis ini mungkin terutama merangsang pembuluh darah dan sedikit mempengaruhi kontraksi kandung kemih. Beberapa serat saraf sensorik juga berjalan melalui saraf simpatis dan mungkin penting dalam menimbulkan sensai rasa penuh dan pada beberapa keadaan rasa nyeri.</span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify;"><span style="font-size: small;"><b><i><span lang="EN-US" style="line-height: 150%;">TRANSPOR URIN DARI GINJAL MELALUI URETER DAN MASUK KEDALAM KANDUNGAN KEMIH.</span></i></b><span lang="EN-US" style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">Urin yang keluar dari kandungan kemih mempunyai komposisi utama yang sama dengan cairan yang keluar dari duktus koligentes; tidak ada perubahan yang berarti pada komposisi urin tersebut sejak mengalir melalui kaliks renalis dan ureter sampai kandung kemih.</span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">Urin mengalir dari duktus koligentes masuk ke kaliks renalis, meregangkan kaliks renalis dan meningkatkan aktivitas <i>pacemakernya,</i> yang kemudian mencetuskan kontraksi peristaltik yang menyebar ke pelvis renalis dan kemudian turun sepanjang ureter dangan demikian mendorong urin dari pelvis renalis ke arah kandung kemih. Dinding ureter terdiri dari otot polos dan dipersafari oleh saraf simpatis dan parasimpatis seperti juga neuron-neuron pada pleksus intramular dan serat-saraf yang meluas diseluruh panjang ureter. Seperti hanya otot polos pada organ viscera yang lain, <i>kontraksi perislaltik pada ureter ditingkatkan oleh perangsangan parasimpatis dan dihambat oleh perangsangan simpatis.</i></span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">Ureter memasuki kandung kemih menembus <i>otot detrusor</i> di daerah trigonum kandung kemih. Normalnya ureter berjalan secara oblique sepanjang beberapa sentimeter menembus kandung kemih. Tonus normal dari otot detrusor pada dinding kandung kemih cenderung menekan ureter, dengan demikian mencegah aliran balik urin dari kandung kemih waktu tekanan di kandung kemih. Setiap gelombang peristaltic yang terjadi sepanjang ureter akan meningkatkan tekanan dalam ureter sehingga bagian yang menembus kandung kemih membuka dan memberi kesempatan kandung urin mengalir ke dalam kandung kemih.</span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">Panjang ureter yang menembus kandung kemih kurang dari normal, sehingga kontraksi kandung kemih tidak selalu menimbulkan penutupan ureter secara sempurna. Akibatnya, sejumlah urin dalam kandung kemih terdorong kembali ke dalam ureter ini disebut <i>refluks vesikoureteral</i>. Refluks semacam ini dapat menyebabkan pembesaran ureter dan jika parah dapat meningkatkan tekanan kaliks renalis dan struktur – struktur dan di medula renalis, mengakibatkan kerusakan daerah ini.</span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: 36pt;"><br />
</div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify;"><span style="font-size: small;"><b><i><span lang="EN-US" style="line-height: 150%;">PEMGISIAN KANDUNG KEMIH DAN TONUS DINDING KANDUNG KEMIH;SISTOMETROGRAM</span></i></b><span lang="EN-US" style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">Perubahan tekanan intravesikular sewaktu kandung kemih terisi dengan urin.pada saat tidak ada urin di dalam kandung kemih ,tekanan intravesikuler,sekitar 0,tetapi setela terisi urin sebanyak 30 sampai 50 mililiter,tekanan meningkat menjadi 5sampai 10 sentimeter air.tambahan urin sebanyak 200 sampai 300 mililiter hanya sedikit menambah peningkatan tekanan,nilai tekanan yang konstan ini di sebabkan oleh tonus intrinsic pada dinding kandung kemih sendii.bila urin yang terkumpul di dalam kandung kemih lebih banyak dari 300 sampai 400 mililiter,akan menyebabkan peningkatan tekanan secara cepat.</span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">Punak tekanan dapat meningkat hanya beberapa sentimeter air,atau mungkin meningkat hingga lebih dari 100 sentimeter air.puncak tekanan ini disebut <b><i>gelombang mikturisi</i></b></span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify;"><span style="font-size: small;"><b><i><span lang="EN-US" style="line-height: 150%;">REFLEKS MIKTURISI</span></i></b><span lang="EN-US" style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">seiring dengan pengisian kandung kemih,mulai tampak peningkatan <i>kontraksi mikturisi,</i>seperti yang di tunjukan oleh bentuk runcing terputus putus.kontraksi ini di hasilkan dari reflex regang yang di picu oleh <i>reseptor regang sensorik</i>.didalam kandung kemih yang lebih tinggi,sinyal sensorik dari reseseftor regang kandung kemih di kirimkan ke segmen sakralis dari medulla spinilis melalui saraf velpis,kemudian di kembalikan secara reflex kekandung kemih melalui <i>serabut saraf parasimpatis</i> dengan menggunakan fersarapan yang sama.</span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">Bila kandung kemih hanya terisi sebagian,kontraksi mikturisi ini biasanya akan berelaksasi secara sepontan dalam waktu kurang dari semenit,otot detrusor,berhenti berkontraksi,dan tekanan turun kembali ke nilai dasar.ketika kandung kemih terus terisi,reflex mikturisi menjadi semakin sering dan menyebabkan kontraksi otot detrusor yang lebih kuat.</span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">Jadi,reflex mikturisi merupakan sebuah sikus yang lengkap yang terdiri dari:</span></span></div><div class="MsoListParagraphCxSpFirst" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;"><span>1.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="EN-US" style="line-height: 150%;">Kenaikan tekanan secara cepat dan progresif</span></span></div><div class="MsoListParagraphCxSpMiddle" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;"><span>2.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="EN-US" style="line-height: 150%;">Periode tekanan menetap</span></span></div><div class="MsoListParagraphCxSpLast" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;"><span>3.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="EN-US" style="line-height: 150%;">Kembalinya tekanan kandung kemih ke nilai tonus basal.</span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">Bila reflex mikturisi yang telah terjadi tidak mampu mengosongkan kandung kemih,elemem persarafan pada reflex ini biasanya akan tetapa keadaan terhinhibisi selama beberapa menit hingga 1 jam aytau lebih sebelum terjadi reflex mikturisi berikutnya</span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify;"><span style="font-size: small;"><b><i><span lang="EN-US" style="line-height: 150%;">PERANGSANGAN ATAU PENGHAMBATAN BERKEMIH OLEH OTAK.</span></i></b><span lang="EN-US" style="line-height: 150%;"></span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">Pusat – pusat ini antara lain:<i> </i></span></span></div><div class="MsoListParagraphCxSpFirst" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;"><span>1.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><i><span lang="EN-US" style="line-height: 150%;">Pusat perangsang dan penghambat kuat dalam batang otak, terutama terletak di ponds, dan</span></i><span lang="EN-US" style="line-height: 150%;"></span></span></div><div class="MsoListParagraphCxSpLast" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;"><span>2.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="EN-US" style="line-height: 150%;">beberapa <i>pusat yang terletak korteks serebral </i>yang terutama bekerja penghambat tetapi dapat menjadi perangsang.</span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">Refleks berkemih merupakan dasar penyebab terjadinya berkemih, tetapi pusat yang lebih tinggi normalnya memegang peranan sebagai pengendali akhir dari berkenmih sebangai berikut:</span></span></div><div class="MsoListParagraphCxSpFirst" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;"><span>1.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="EN-US" style="line-height: 150%;">Pusat yang lebih tinggi menjaga secara parsial penghambatan refleks berkemih kecuali jika peristiwa berkemih dikehendaki.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;"><span>2.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="EN-US" style="line-height: 150%;">pusat yang lebih tinggi dapat mecegah berkemih, bahkan jika refleks berkemih timbul, dengan membuat kontraksi tonik terus menerus pada sfingter eksternus kandung kemih sampai mendapatkan waktu yang baik untuk berkemih.</span></span></div><div class="MsoListParagraphCxSpLast" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;"><span>3.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="EN-US" style="line-height: 150%;">Jika tiba waktu berkemih, pusat kortikal dapat merangsang pusat berkemih sacral untuk membantu untuk mencetuskan refleks berkemih dan dalam waktu bersamaan menghambat sfingter eksternus kandung kemih sehingga peristiwa berkemih dapat terjadi.</span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify;"><span style="font-size: small;"><i><span lang="EN-US" style="line-height: 150%;">Berkemih di bawah keinginan </span></i><span lang="EN-US" style="line-height: 150%;">biasanya tercetus dengan cara berikut: Pertama, seseorang secara sadar mengkontraksikan otot – otot abdomennya, yang meningkatkan tekanan dalam kandung kemih dan mengakibatkan urin ekstra memasuki leher kandung kemih dan uretra posterior di bawah tekanan, sehingga meregangkan dindingnya.</span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-size: small;"><b><span lang="EN-US" style="line-height: 150%;"><span> </span>Dapat dijelaskan melalui skema berikut :</span></b></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: 36pt;"><span style="font-size: small;"><b><span lang="EN-US" style="line-height: 150%;">Pertambahan vol urine </span></b><b><span lang="EN-US" style="line-height: 150%;">→</span></b><b><span lang="EN-US" style="line-height: 150%;"> tek intra vesicalis </span></b><b><span lang="EN-US" style="line-height: 150%;">↑</span></b><b><span lang="EN-US" style="line-height: 150%;"> </span></b><b><span lang="EN-US" style="line-height: 150%;">→</span></b><b><span lang="EN-US" style="line-height: 150%;"> keregangan dinding vesicalis (m.detrusor) </span></b><b><span lang="EN-US" style="line-height: 150%;">→</span></b><b><span lang="EN-US" style="line-height: 150%;"> sinyal-sinyal miksi ke pusat saraf lebih tinggi (pusat kencing) </span></b><b><span lang="EN-US" style="line-height: 150%;">→</span></b><b><span lang="EN-US" style="line-height: 150%;"> untuk diteruskan kembali ke saraf saraf spinal </span></b><b><span lang="EN-US" style="line-height: 150%;">→</span></b><b><span lang="EN-US" style="line-height: 150%;"> timbul refleks spinal </span></b><b><span lang="EN-US" style="line-height: 150%;">→</span></b><b><span lang="EN-US" style="line-height: 150%;"> melalui n. Pelvicus </span></b><b><span lang="EN-US" style="line-height: 150%;">→</span></b><b><span lang="EN-US" style="line-height: 150%;"> timbul perasaan tegang pada vesica urinaria shg akibatnya menimbulkan permulaan perasaan ingin berkemih ( Virgiawan, 2008 ).</span></b></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">Daftar pustaka :</span><span lang="EN-US" style="line-height: 150%;"></span></span></div><div class="MsoListParagraphCxSpFirst" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;"><span>1.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="EN-US" style="line-height: 150%;">Guyton.A.C.2006. Buku Ajar Fisiologi Kedokteran.Jakarta:EGC</span></span></div><div class="MsoListParagraphCxSpLast" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify; text-indent: -18pt;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;"><span>2.<span style="font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span lang="EN-US" style="line-height: 150%;">Buku IPA Biologi untuk Kelas VIII SMP, Penerbit Sunda Kepala Pustaka</span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">Diposting Oleh :</span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 18pt; text-align: justify;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">Nama<span> </span>:Farid Ma’roef Maulana Ishak</span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 18pt; text-align: justify;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">Nim<span> </span>:05200ID09011</span></span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; text-indent: 18pt;"><span style="font-size: small;">Kelas<span> </span>:2a</span></div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 18pt; text-align: justify;"><span style="font-size: small;"><span lang="EN-US" style="line-height: 150%;">Kelompok <span> </span>:I</span></span></div><div align="center" class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; margin-left: 18pt; text-align: center;"><span style="font-size: small;"><b><span lang="EN-US" style="line-height: 150%;">MAHASISWA AKPER PEMDA GARUT</span></b></span></div><div align="center" class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: center;"><br />
</div><div align="center" class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: center;"><br />
</div><div class="MsoNormal" style="font-family: Times,"Times New Roman",serif; line-height: 150%; text-align: justify;"><br />
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</div><div style="text-align: center;"><b><span style="font-size: large;">format pengkajian sistem perkemihan</span></b></div><div class="MsoNormal" style="color: black; line-height: 150%; text-align: justify;"><b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><br />
</span></b></div><br style="color: black;" /><div class="MsoNormal" style="color: black; line-height: 150%; text-align: justify;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Pengkajian keperawatan merupakan langkah pertama yang dilakukan oleh perawat untuk mendapatkan data subjektif dan objektif yang dilakukan secara</span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"> </span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">sistematis.</span><span style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoNormal" style="color: black; line-height: 150%; text-align: justify;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Proses Pengkajian meliputi tiga fase, yaitu wawancara, pemeriksaan fisik, dan dokumentasi. Adapun ketiga fase tersebut adalah sebagai berikut :</span><span style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraph" style="color: black; line-height: 150%; margin-left: 39.7pt; text-align: justify; text-indent: -36pt;"><b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>I.<span style="font: 7pt "Times New Roman";"> </span></span></span></b><b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">WAWANCARA</span></b></div><div class="MsoNormal" style="color: black; line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: 18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Tujuan wawancara adalah mendapatkan informasi yang diperlukan dalam mengidentifikasi dan merencanakan tindakan keperawatan, dan memberi kesempatan pada perawat untuk mulai mengembangkan hubungan saling percaya dengan pasien.</span></div><div class="MsoNormal" style="color: black; line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: 18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Adapun data-data yang dikumpulkan selama fase wawancara terkait pengkajiankep kerawatan system perkemihan adalah sebagai berikut :</span></div><div class="MsoListParagraph" style="color: black; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>A.<span style="font: 7pt "Times New Roman";"> </span></span></span></b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span> </span><b>Riwayat kesehatan sekarang</b></span></div><div class="MsoNormal" style="color: black; line-height: 150%; margin-left: 36pt; text-align: justify; text-indent: 18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Disfungsi ginjal dapat menimbulkan serangkaian gejala yang kompleks dan tampak di seluruh tubuh. Riwayat sakit harus mencakup informasi berikut yang berhubungan dengan fungsi renal dan urinarius: </span></div><div class="MsoListParagraphCxSpFirst" style="color: black; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Keluhan utama pasien atau alasan utama mengapa ia datang ke rumah sakit.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Adanya rasa nyeri: kaji lokasi, karakter, durasi, dan hubungannya dengan urinasi; faktor-faktor yang memicu rasa nyeri dan yang meringankannya.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Adanya gejala panas atau menggigil, sering lelah, perubahan berat badan, perubahan nafsu makan, sering haus, retensi cairan, sakit kepala, pruritus, dan penglihatan kabur.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Pola eliminasi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Kaji frekuensi, urgensi, dan jumlah urine output.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Kaji perubahan warna urin.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Kaji adanya darah dalam urin.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Disuria; kapan keluhan ini terjadi : pada saat urinasi, pada awal urinasi, atau akhir urinasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Hesitancy; mengejan : nyeri selama atau sesudah urinasi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>f.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Inkontinensia (stress inkontinensia; urge incontinence; overflow incontinence; inkontinensia fungsional). Adanya inkontinensia fekal menunjukkan tanda neurologik yang disebabkan oleh gangguan kandungkemih.</span></div><div class="MsoListParagraphCxSpLast" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>g.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Konstipasi dapat menyumbat sebagian urethra, menyebabkan tidak adekuatnya pengosongan kandung kemih.</span></div><div class="MsoNormal" style="color: black; line-height: 150%; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="color: black; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span> </span>Pola nutrisi – metabolic</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Kaji jumlah dan jenis cairan yang biasa diminum pasien : kopi, alkohol, minuman berkarbonat. Minuman tersebut sering memperburuk keadaan inflamasi system perkemihan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Kaji adanya dehidrasi ; dapat berkontribusi terjadinya infeksi saluran kemih, pembentukkan batu ginjal, dan gagal ginjal.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Kaji jenis makanan yang sering dikonsumsi pasien. Makanan yang mengandung tinggi protein dapat menyebabkan pembentukkan batu saluran kemih. Makanan pedas memperburuk keadaan inflamasi system perkemihan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Kaji adanya anoreksia, mual, dan muntah. Keadaan tersebut dapat mempengaruhi status cairan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Kaji kebiasaan mengkonsumsi suplemen vitamin, mineral, dan terapi herbal.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 54pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>B.<span style="font: 7pt "Times New Roman";"> </span></span></span></b><b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Riwayat kesehatan masa lalu</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Riwayat infeksi traktur urinarius</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Terapi atau perawatan rumah sakit yang pernah dialami untuk menanggani infeksi traktus urinarius, berapa lama dirawat.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Adanya gejala panas atau menggigil.</span></div><div class="MsoListParagraphCxSpLast" style="color: black; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Sistoskopi sebelumnya, riwayat penggunaan kateter urine dan hasil-hasil pemeriksaan diagnostik renal atau urinarius</span></div><div class="MsoNormal" style="color: black; line-height: 150%; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Riwayat keadaan berikut ini :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Hematuria, perubahan warna, atau volume urin.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Nokturia dan sejak kapan dimulainya.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Penyakit pada usia kanak-kanak (“strep throat”, impetigo, sindrom nefrotik).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Batu ginjal (kalkuli renal), ekskresi batu kemih ke dalam urin.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 90pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Kelainan yang mempengaruhi fungsi ginjal atau traktus urinarius (diabetes mellitus, hipertensi, trauma abdomen, cedera medula spinalis, kelainan neurologi lain, lupus eritematosus sistemik, scleroderma, infeksi streptococcus pada kulit dan saluran napas atas, tuberculosis, hepatitis virus, gangguan kongenital, kanker, dan hyperplasia prostate jinak).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Untuk pasien wanita : kaji jumlah dan tipe persalinan (persalinan pervaginan, sectio caesarea); persalinan dengan forseps; infeksi vagina, keputihan atau iritasi; penggunaan kontrasepsi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Adanya atau riwayat lesi genital atau penyakit menular seksual.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Pernahkah mengalami pembedahan ; pelvis atau saluran perkemihan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Pernahkah menjalani terapi radiasi atau kemoterapi.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>7.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Kaji riwayat merokok. Merokok dapat mengakibatkan risiko kanker kandung kemih. Angka kejadian tumor kandung kemih empat kali lebih tinggi pada perokok daripada bukan perokok.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>C.<span style="font: 7pt "Times New Roman";"> </span></span></span></b><b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Riwayat kesehatan keluarga</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Kaji adanya riwayat penyakit ginjal atau kandung kemih dalam keluarga (polisistik renal, abnormalitas kongenital saluran kemih, sindrom Alport’s / nephritis herediter).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Kaji adanya masalah eliminasi yang dikaitkan dengan kebiasaan keluarga</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>D.<span style="font: 7pt "Times New Roman";"> </span></span></span></b><b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Riwayat kesehatan sosial</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Kaji riwayat pekerjaan, apakah terpapar oleh bahan-bahan kimia seperti phenol dan ethylene glycol. Bau ammonia dan kimia organic dapat meningkatkan risiko kanker kandung kemih. Pekerja tekstil, pelukis, peñata rambut, dan pekerja industri mengalami risiko tinggi terkena tumor kandung kemih. Seseorang yang lebih sering duduk cenderung mengalami statis urin sehingga dapat menimbulkan infeksi dan batu ginjal.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Seseorang yang mengalami demineralisasi tulang dengan keterbatasan aktivitas fisik menyebabkan peningkatan kalsium dalam urin.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Laki-laki cenderung mengalami inflamasi prostat kronik atau epididimis setelah mengangkat barang berat atau mengendarai mobil dengan jarak jauh.</span></div><div class="MsoListParagraphCxSpLast" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Perlu juga informasi tempat tinggal pasien. Dataran tinggi lebih berisiko terjadi batu saluran kemih karena kandungan mineral meningkat dalam tanah dan air di daerah dataran tinggi.</span></div><div class="MsoNormal" style="color: black; line-height: 150%; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="color: black; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>E.<span style="font: 7pt "Times New Roman";"> </span></span></span></b><b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Pengobatan</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Diuretik dapat mengubah kuantitas dan karakter output urin.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Phenazopyridine (pyridium) dan nitrofurantoin (macrodantin) dapat mengubah warna urin.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Anticoagulant dapat menyebabkan hematuria.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Antidepresant, antihistamin, dan obat-obatan untuk mengatasi gangguan neurology dan musculoskeletal, dapat mempengaruhi kemampuan kandung kemih atau sphinter untuk berkontraksi atau relaksasi secara normal.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>F.<span style="font: 7pt "Times New Roman";"> </span></span></span></b><b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Pola persepsi – kognitif</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Apakah gangguan eliminasi urin mempengaruhi perasaan dan kehidupan normal pasien.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Bagaimana perasaan pasien saat menggunakan kateter, kantung urin.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 39.7pt; text-align: justify; text-indent: -36pt;"><b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>II.<span style="font: 7pt "Times New Roman";"> </span></span></span></b><b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">PEMERIKSAAN</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 57.7pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>A.<span style="font: 7pt "Times New Roman";"> </span></span></span><b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Pemeriksaan Fisik</span></b></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 75.7pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Umum : Status kesehatan secara umum : lemah, letarghi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 75.7pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Tanda-tanda vital : tekanan darah, nadi, pernapasan, dan suhu tubuh</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 75.7pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Pemeriksaan fisik system perkemihan</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 75.7pt; text-align: justify;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Teknik pemeriksaan fisik Kemungkinan kelainan yang<br />
ditemukan</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 75.7pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 75.7pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 93.7pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Inspeksi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 4cm; text-align: justify; text-indent: -18pt;"><b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>1)<span style="font: 7pt "Times New Roman";"> </span></span></span></b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Kulit dan membran mukosa. Catat warna, turgor, tekstur, dan pengeluaran keringat.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 4cm; text-align: justify; text-indent: -18pt;"><b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>2)<span style="font: 7pt "Times New Roman";"> </span></span></span></b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span> </span>Mulut</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 4cm; text-align: justify; text-indent: -18pt;"><b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>3)<span style="font: 7pt "Times New Roman";"> </span></span></span></b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span> </span>Wajah</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 4cm; text-align: justify; text-indent: -18pt;"><b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>4)<span style="font: 7pt "Times New Roman";"> </span></span></span></b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span> </span>Abdomen </span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 4cm; text-align: justify;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Pasien posisi terlentang, catat ukuran, kesimetrisan, adanya massa atau pembengkakan, kembung, Kulit dan membran mukosa yang pucat, indikasi gangguan ginjal yang menyebabkan anemia. Tampak ekskoriasi, memar, tekstur kulit kasar atau kering. Penurunan turgor kulit merupakan indikasi dehidrasi. Edema, indikasi retensi dan penumpukkan cairan. Stomatitis, napas bau amonia<br />
Moon face Pembesaran atau tidak simetris, indikasi hernia atau adanya massa. Nyeri permukaan indikasi disfungsi renal.</span></div><div class="MsoListParagraphCxSpLast" style="color: black; line-height: 150%; margin-left: 4cm; text-align: justify; text-indent: -18pt;"><b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>5)<span style="font: 7pt "Times New Roman";"> </span></span></span></b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Distensi atau perut yang nyeri menetap, distensi, kulit mengkilap atau tegang. Meatus urinary<br />
Laki-laki posisi duduk atau berdiri, tekan ujung gland penis dengan memakai sarung tangan untuk membuka meatus urinary. Pada wanita : posisi dorsal litotomi, buka labia dengan memakai sarung tangan. Perhatikan meatus urinary.</span></div><div class="MsoNormal" style="color: black; line-height: 150%; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpFirst" style="color: black; line-height: 150%; margin-left: 93.7pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Palpasi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 4cm; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span> </span>Ginjal</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 136.05pt; text-align: justify; text-indent: -18pt;"><b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>a)<span style="font: 7pt "Times New Roman";"> </span></span></span></b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Ginjal kiri jarang dapat teraba, meskipun demikian usahakan untuk mempalpasi ginjal untuk mengetahui ukuran dan sensasi.<br />
Jangan lakukan palpasi bila ragu karena dapat menimbulkan kerusakan jaringan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 136.05pt; text-align: justify; text-indent: -18pt;"><b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>b)<span style="font: 7pt "Times New Roman";"> </span></span></span></b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Posisi pasien supinasi, palpasi dilakukan dari sebelah kanan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 136.05pt; text-align: justify; text-indent: -18pt;"><b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>c)<span style="font: 7pt "Times New Roman";"> </span></span></span></b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Letakkan tangan kiri dibawah abdomen diantara tulang iga dan lengkung iliaka. Tangan kanan dibagian atas. mengkilap dan tegang, indikasi retensi cairan atau ascites. Distensi kandung kemih, pembesaran ginjal. Kemerahan, ulserasi, bengkak, atau adanya cairan, indikasi infeksi. Pada laki-laki biasanya terdapat deviasi meatus urinary seperti defek kongenital. Jika terjadi pembesaran ginjal, maka dapat mengarah ke neoplasma atau patologis renal yang serius. Pembesaran kedua ginjal, indikasi polisistik ginjal. Tenderness/lembut pada palpasi ginjal maka indikasi infeksi, gagal ginjal kronik.<br />
Ketidaksimetrisan ginjal indikasi hidronefrosis.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 136.05pt; text-align: justify; text-indent: -18pt;"><b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>d)<span style="font: 7pt "Times New Roman";"> </span></span></span></b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Anjurkan pasien nafas dalam dan tangan kanan menekan sementara tangan kiri mendorong ke atas.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 136.05pt; text-align: justify; text-indent: -18pt;"><b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>e)<span style="font: 7pt "Times New Roman";"> </span></span></span></b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Lakukan hal yang sama untuk ginjal kanan</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 4cm; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Kandung kemih</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 4cm; text-align: justify;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Secara normal, kandung kemih tidak dapat dipalpasi, kecuali terjadi distensi urin maka palpasi dilakukan di daerah simphysis pubis dan umbilicus.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 4cm; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Perkusi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 130.4pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Ginjal</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 148.4pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Atur posisi klien duduk membelakangi pemeriksa.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 148.4pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Letakkan telapak tangan tidak dominan diatas sudut kostovertebral (CVA), lakukan perkusi atau tumbukan di atas telapak tangan dengan menggunakan kepalan tangan dominan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 148.4pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Ulangi prosedur untuk ginjal kanan<br />
Jika kandung kemih penuh maka akan teraba lembut, bulat, tegas, dan sensitif.<br />
Tenderness dan nyeri pada perkusi CVA merupakan indikasi glomerulonefritis atau glomerulonefrosis.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 133.25pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Kandung kemih</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 151.25pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Secara normal, kandung kemih tidak dapat diperkusi, kecuali volume urin di atas 150 ml. Jika terjadi distensi, maka kandung kemih dapat diperkusi sampai setinggi umbilicus.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 151.25pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Sebelum melakukan perkusi kandung kemih, lakukan palpasi untuk mengetahui fundus kandung kemih. Setelah itu lakukan perkusi di atas region suprapubic. Jika kandung kemih penuh atau sedikitnya volume urin 500 ml, maka akan terdengar bunyi dullness (redup) di atas simphysis pubis.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 131.4pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Auskultasi<br />
Gunakan diafragma stetoskop untuk mengauskultasi bagian atas sudut kostovertebral dan kuadran atas<br />
abdomen. Jika terdengar bunyi bruit (bising) pada aorta abdomen dan arteri renalis, maka indikasi adanya gangguan aliran darah ke ginjal (stenosis arteri ginjal)</span></div><div class="MsoListParagraphCxSpLast" style="color: black; line-height: 150%; margin-left: 131.4pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="color: black; line-height: 150%; text-align: justify;"><b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">III. PEMERIKSAAN DIAGNOSTIK PADA SISTEM PERKEMIHAN</span></b></div><div class="MsoListParagraph" style="color: black; line-height: 150%; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>A.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Urinalisis </span></div><div class="MsoNormal" style="color: black; line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: 18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Urialisis dapat meberikan informasi klinik yang penting. Urinalisis merupakan pemeriksaan rutin pad sebagian besar kondisi klinis, pemeriksaan urin menangkup evluasi hal-hal berikut:</span></div><div class="MsoListParagraphCxSpFirst" style="color: black; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Observasi warna dan kejernihan urin.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Pengkajian bau urin</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Pengukuran keasaman dan berat jenis urin</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Tes untuk memeriksa keberadaan protein, glukosa, dan badan keton dalam urin (masing-masing untuk proteinuria, glukosuria, da ketonoria)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Pemeriksaan mikroskopik sedimen urin sesudah melakukan pemusingan (centrifuging) untuk mendeteksi sel darah erah (hematuria), sel darah putih, slinder (silindruria), Kristal (kristaluria), pus (piuria) dan bakteri (bakteriuria).</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 54pt; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpLast" style="color: black; line-height: 150%; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>B.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Cara Pengumpulan Sampel Urin</span></div><div class="MsoNormal" style="color: black; line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: 18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Pengumpulan sampel urin dilakukan sewaktu bangun tidur pagi, karena specimen ini lebih pekat dan lebih besar kemungkinannya untuk mengungkapkan abnormalitas. Spesimen tersebut dikumpulkan dalam wadah yang bersih dan dilindungi terhadap kontaminasi bakteri serta perubahan kimiawai. Semua specimen harus diseimpan dalam lemari pendingin. Karena jika dibiarkan dalam suhu kamar urin akan menjadi alkalis akibat kontaminasi bakteri pemecah ureum dari lingkungan sekitarnya. </span></div><div class="MsoListParagraph" style="color: black; line-height: 150%; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>C.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Pemeriksaan Fungsi Ginjal</span></div><div class="MsoNormal" style="color: black; line-height: 150%; margin-left: 18pt; text-align: justify; text-indent: 18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Tes fungsi ginjal dilakukan untuk mengevaluasi beratnya penyakit ginjal dan mengikuti perjlanan klinik. Pemeriksaan ini juga memberikan informasi tentang efektifitas ginjal dalam melaksanakan fungsi ekskresinya. Fungsi ginjal dapat dikaji secara lebih akurat jika dilakukan dibeberapa pemeriksaan dan kemudian asilnya dianalisis bersama. Pemeriksaan fungsi ginjal yang umum dilakukan adalah kemampuan pemekatan ginjal klirens kreatinin, kadar kreatinin serum dan nitrogen urea darah (BUN).</span></div><div class="MsoListParagraphCxSpFirst" style="color: black; line-height: 150%; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>D.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Ultrasound<br />
Ultrasound atau pemeriksaaan USG menggunakan gelombang suara yang dipancarakan ke dalam tubuh untuk mendeteksi abnormalitas. Organ-organ dalam system urinarius akan menghasilkan gambar-gambar ultrasound yang khas. Abnormalitas seperti akumulasi cairan, massa, malformasi, perubahan ukuran organ ataupun obstruksi dapat diidentifikasi. Pemeriksaan USG merupakan teknik noninvasif dan tidak memerlukan persiapan khusus kecuali menjelaskan prosedur serta tujuannya kapada pasien. Karena sensitivitasnya, pemeriksaan USG telah menggantikan banyak prosedur diagnosis lainnya sebagai tindakan diagnostic pendahuluan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>E.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Pemeriksaan Sinar-X dan Pencitraan lainnya<br />
Dalam pemeriksaan ini dibagi ke dalam beberapa macam, yaitu :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Kidney, Ureter and Bladder (KUB)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 54pt; text-align: justify;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Pemeriksaan radiologi abdomen yang dikenal dengan istilah KUB dapat dilaksanakan untuk melihat ukuran, bentuk serta posisi ginjal dan mengidentifikasi semua kelainan seperti batu dalam ginjal atau traktus urinarius, hidronefrosis (distensi pelvis ginjal), kista, tumor atau pergeseran ginjal akibat abnormalitas pada jaringan disekitarnya.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>2.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Pemindai CT dan Magnetic Resonance Imaging (MRI)<br />
Pemeriksaan pemindai CT dan MRI merupakan teknik noninvasive yang akan memberikan gambar penampang ginjal serta saluran kemih yang sangat jelas. Kedua pemeriksaan ini akan memberikan informasi tentang luasnya lesi invasive pada ginjal.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>3.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Urografi Intravena (Ekskretori Urogram atau intravenous pyelogram)<br />
Pemeriksaan urografi intravena yang juga dikenal dengan nama intravenous pyelogaram(IVP) memungkinkan visualisasi ginjal ureter dan kandung kemih. Media kontras radiopaque disuntikan secara intravena dan kemudian dibersihkan dari dalam darah serta dipekatkan oleh ginjal. Tebal nefrotomogram dapat dilaksanakan sebagai bagian dari pemeriksaan untuk melihat berbagai lapisan ginjal serta struktur difus dalam setiap lapisan dan untuk membedakan massa atau lesi yang padat dari kista didalam ginjal atau trakrus urinarius. Pemeriksaaan IVP dilaksanakan sebagai bagian dari penkajian pendahuluan terhadap semua masalah urologi yang dicurigai, khususnya dalam menegakan diagnose lesi pada ginjal dan ureter. Pemeriksaan ini juga memberikan perkiraan kasar terhadap fungsi ginjal. Sesudah media kontras (sodium diatrisoat atau meglumin diatrisoat) disuntikan secara intravena, pembuatan foto rontgen yang multiple dan seril yang dilakukan untuk melihat struktur drainase.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>4.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Pielografi retrograd. Dalam pielografi retrograd, kateter uretra dimasukan lewat ureter ke dalam pelvis ginjal dengan bantuan sistoskopi. Kemudian media kontras dimasukkan dengan gravitasi atau penyuntikan melalui kateter. Pielografi retrograd biasanya dilakukan jika pemeriksaan IVP kurang memperlihatkan dengan jelas system pengumpul. Pemeriksaan pielografi retrograd jarang dilakukan dengan semakin majunya teknik-teknik yang digunakan dalam urografi ekskretorik.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>5.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Infusion drip pyelography merupakan pemberian lewat infuse larutan encer media kontras dengan volume yang besar untuk menghasilkan opasitas parenkim ginjal dan mengisi seluruh traktus urinarius. Metode ini berguna bila teknik urografi yang biasa dikerrjakan tidak berhasil memperlihatkan struktur drainase.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>6.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Sistogram, sebuah kateter dimasukkan kedalam kandung kemih, dan kemudian media kontras disemprotkan untuk mellihat garis besar dinding kandung kemih serta membantu dalam mengevaluasi refluks vesikouretral. Sistogram juga dilakukan bersama dengan perekaman tekanan yang dikerjakan secara bersamaan di dalam kandunng kemih.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>7.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Sistouretrogram menghasilkan visualilsasi uretra dan kandung kemih yang bisa dilakukan melalui penyuntikan retrograde media kontras ke dalam uretra serta kandunng kemih atau dengan pemeriksaan sinar X sementara pasien mengekskresikan media kontras.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>8.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Angiografi renal. Prosedur ini memungkinkan visualisasi arteri renalis. Arteri femoralis atau aksilaris ditusuk dengan jarum khusus dan kemudian sebuah kateter disisipkan melalui arteri femoralis serta iliaka ke dalam aorta atau arteri renalis. Media kontras disuntikkan untuk menghasilkan opasitas suplai arteri renalis. Angiografi memungkinkan evaluasi dinammika aliran darah, memperlihatkan vaskulatur yang abnormal dan membantu membedakan kista renal dengan tumor renal.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 54pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>9.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Endourologi (prosedur endoskopi urologi)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>a.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Pemeriksaan sistoskopi</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">merupakan metode untuk melihat lanngsung uretra dan kandung kemih. Alat sistokop, yang dimasukan melalui uretra ke dalam kandung kemih, memiliki system lensa optis yang sudah ada pada alat itu sendiri sehingga akan meemberikan gambar kandung kemih yang diperbesar dan terang. Sistoskop tersebut dapat dimanipulasi untuk memungkinkan visualisasi uretra dan kandung kemih secara lengkap selain visualisasi orifisium uretra dan uretra pars prostatika. Kateter uretra yang halus dapat dimasukan melalui sistoskop sehingga ureterdan pelvis ginjal dapat dikaji. Sistoskop juga memungkinkanahli urologi untuk mendapatkan spesimen urin dari setiap ginjal guna mengevaluasi fungsi ginjal tersebut. Alat forceps dapat dimasukkan melalui sistoskop untuk keperluan biopsi. Batu dapat dikeluarkan dari uretra, kandung kemih dan ureter melalui sistoskop. Alat endoskop dimasukkan dengan melihatnya secara langsung. Uretra dan kandunng kemih diinspeksi. Larutan irigasi steril disemprotkan untuk menimbulkan distensi kandung kemih dan membilas keluar semua bekuan darah sehinngga visualisasi menjadi lebih baik. Penggunaan cahaya denngan intensitas tinggi dan lensa yang bisa ditukar-tukar memungkinkan visualisasi yang sangat baik serta memudahkan pembuatan gambar-gambar yang diam dan yang bergerak dari struktur ini. Sebelum melaksanakan prosedur pemeriksaan dapat diberikan preparat sedativ. Anestesi topical local disemprotkan kedalam uretra sebelum ahli urologi memasukkan alat sistoskop. Pemberian diazepam (valium) intravena bersama dengan preparat anestesi topical uretra dapat diberikan. Sebagai alternative lain dapat dilakukan anestesi spinal atau umum. Setelah menjalani pemeriksaan sistoskopik, kadang-kadang penderita kelainan patologik obstruktif mengalami retensi urin sebagai akibat dari edema yang disebabkan oleh instrumentasi. Penderita hyperplasia prostat harus dipantau dengan cermat akan adanya kemungkinan retensi urin. Pasien yang menjalani instrumentasi traktus urinarus (yaitu, sistoskopi) perlu dipantau untuk mendeteksi tanda-tanda dan gejala infeksi urinarius. Edema uretra yang terjadi sekunder akibat trauma local dapat menyumbat aliran urin, oleh karena itu pemantauan akan adanya tanda-tanda dan gejala obstruksi pada pasien juga perlu dilakukan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>b.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Brush biopsy ginjal dan uretra</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Teknik brush biopsy akan menghasilkan informasi yang spesifik apabila hasil pemeriksaan radiologi ureter atau pelvis ginjal yang abnormal tidak dapat menunjukan apakah kelainan tersebut merupakan tumor, batu, bekuan darah atau hanya artefak. Pertama-tama dilakukan pemeriksaan sistoskopik. Kemudian dipasang kateter uretra yang di ikuti oleh tindakan memasukkan alat sikat khusus (biopsy brush) melalui kateter tersebut. Kelainan yang dicurigai disikat maju mundur secara teratur untuk mendapatkan sel-sel dan fragmen jaringan permukaan untuk pemeriksaan analisis histology. Setelah prosedur pemeriksaan selesai dilakukan, pemberian cairan infus dapat dilakukan untuk membersihkan ginjal dan mencegah pembentukan bekuan darah. Urin dapat mengandung darah (yang biasanya menjadi jernih dalam waktu 24-48 jam) akibat perembesan pada tempat penyikatan.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>c.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Endoskopi renal (nefroskopi)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Merupakan pemeriksaan dengan cara memasukkan fiberskop kedalam pelvis ginjal melalui luka insisi (pielotomi) atau secara perkkutan untuk melihat bagian dalam pelvis ginjal, mengelluarkan batu, melakukan biopsi lesi yang kecil dan membantu menegakan diagnose hematuria serta tumor renal tertentu.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>d.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Biopsi ginjal</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Bopsi ginjal dilakukan dengan menusukan jarum biopsi melalui kulit kedalam jaringan renal atau dengan melakukan biopsi terbuka melalui luka insisi yang kecil didaerah pinggang. Pemeriksaan ini berguna untuk mengevaluasi perjalanan penyakit ginjal dan mendapatkan specimen bagi pemeriksaan mikroskopik electron serta imunofluoresen, khususnya bagi penyakit glomerulus.Sebelum biopsi dilakukan, pemeriksan koagulasi perlu dilakukan lebih dahulu untuk mengidentifikasi setiap resiko terjadinya perdarahan pascabiopsi.<br />
Prosedur, pasien dipuasakan selama 6 hingga 8 jam sebelum pemeriksaan. Set infuse dipasang. Spesimen urin dikumpulkan dan disimpan untuk dibandingkan dengan specimen pascabiopsi. Jika akan dilakukan biopsi jarum pasien diberitahukan agar menahan nafas ketika jarum biopsi ditusukan. Pasien yang sudah dalam keadaan sedasi di tempatkan dalam posisi berbaring telungkup dengan bantal pasir diletakan dibawah perut. Kulit pada lokasi biopsy diinfiltrasi denngan preparat anestesi local. Lokasi jarum dapat dipastikan melalui fluuoroskopi atau ultrasound dengan menggunakan teknik khusus. Pada biopsi terbuka dilakukan insisi yang kecil didaerah ginjal dapat dilihat secara langsung.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>e.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Pemeriksaan radio isotop</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">erupakan tindakan noninvasive yang tidak mengganggu prosesfisiologik normal dan tidak memerlukan persiapan pasien yang khusus. Preparat radiofarmaseutikal disuntikan intravena. Pemeriksaan dilakukan dengan kamera skintilasi yang ditempatkan disebelah posterior ginjal sementara pasien berada dalam posisi telentang,telungkup atau duduk. Gambar yang dihasilkan (yang disebut pemindai) menunjukan distribusi preparat radiofarmaseutikal didalam ginjal.</span><span style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Pemeriksaan pemindai Tc menghasilkan informasi tentang perfusi ginjal dan sangat berguna untuk menunjukan fungsi ginjal yang buruk. Pemeriksaan pemindai hippurate memberikan informasi tentang fungsi ginjal.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>f.<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Pengukuran urodinamik</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 72pt; text-align: justify;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Pengukuran urodinamik menghasilkan berbagai pemeriksaan fisiologik dan structural untuk mengevaluasi fungsi kandung kemih serta uretra dengan mengukur :</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 3cm; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>1)<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Kecepatan aliran urin</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 3cm; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>2)<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Tekanan kandung kemih pada saat buang air kecil dan saat istiraha</span><span style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">t</span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 3cm; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>3)<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Resitensi uretra internal</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; margin-left: 3cm; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>4)<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Kontras serta relaksasi kandung kemih</span></div><div class="MsoListParagraphCxSpLast" style="color: black; line-height: 150%; margin-left: 3cm; text-align: justify;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Tekanan abdominal , kandung kemih serta detrusor, aktivitas sfingter, inervasi kandung kemih, tonus otot dan reflex sacrum dikaji.</span></div><div class="MsoNormal" style="color: black; line-height: 150%; text-align: justify;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span> </span>Berikut ini merupakan pengukuran urodinamik yang paling sering dilakukan:</span></div><div class="MsoListParagraphCxSpFirst" style="color: black; line-height: 150%; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>1)<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Uroflometri (kecepatan aliran) merupakan rekaman volume urin yang mengalir melalui ureter per satuan waktu (ml/s)</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>2)<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Sistometrogram merupakan rekaman grafik tekanan dalam kadung kemih (intra vesikal) pada berbagai fase pengisian dan pengosongan kandung kemih untukmengkaji fungsinya. Selama prosedur pemeriksaan dilakukan, jumlah cairan yang dimasukan dan dikeluarkandari kandung kemih disamping rasa penuh pada kandung kemih dan keinginan untuk buang air kecil harus dicatat. Kemudian semua hasil ini dibandingkandengan tekanan yang diukur dalam kandung kemih selama pengisian kandung kemih dan berkemih. Pertama-tama pasien diminta untuk berkemih, dan dokter mengamati lamanya waktu yang diperlukan untuk memulai, ukuran, kekuatan serta kontinuitas aliran urin, dan derajat mengajan serta adanya hesitancy. Kateterretensi dimasukan melalui uretra kedalam kandung kemih. Volume sisa diukur dan kateter tersebut dibiarkan pada tempatnya. Kateter uretral dihubungkan dengan manometer air, dan larutan steril dibiarkan mengalir kedalam kandung kemih dengan kecepatan biasanya 1 ml/s. pasien memberitahukan dokter pada saat terasa ingin buang air kecil, dan pada saat kandung kemih terasa penuh. Derajat pengisian kandung kemih pada kedua situasi ini dicatat. Tekanan diatas tingkat nol pada simfisis pubis diukur, dan tekanan serta volume dalam kandung kemih diukur serta dicatat</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>3)<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span> </span>Profil tekanan uretra mengukur resitensi uretra disepanjang uretra. Gas dan cairan dimasukkan melalui sebuah kateter yang ditarik keluar sambil mengukur tekanan disepanjang dinding uretra.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>4)<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Sistouretrogram memungkinkan visualisasi uretra dan kandung kemih yang dapat dilakukandengn penyntikan retrograd atau dengan mengeliminasi media kontras.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>5)<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Pada voiding cystourethogram, kandung kemih diisi dengan media kontras dan pasien berkemih sementara foto-foto spot dibuang dpengn cepat. Ada tidaknnya refluks vesikouretral atau kelainan congenital pada traktus urinarius inferior dapat diperlihatkan. Voidingcystourethrogram juga digunakan untuk menyelidiki kesulitan dalam pengosongan kandung empedu dan inkontinens</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; text-align: justify; text-indent: -18pt;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"><span>6)<span style="font: 7pt "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Elektromiografi meliputi penempatan elektroda dalam otot dasar panggul dan fingter ani untuk mengevaluasi fungsi neuromuskuler traktus urinarius inferior.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; text-align: justify;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Daftar<span> </span>pustaka:</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; text-align: justify;"><span lang="EN-US" style="font-family: "Kristen ITC";">Scanlon,Valerie C dan Sanders Tina.,2006.,BUKU AJAR ANATOMI & FISIOLOGI.,Jakarta :EGC.</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; text-align: justify;"><span lang="EN-US" style="font-family: "Kristen ITC";">Smeltzer,Suzanne C dan Bare Brenda G.,2001.,BUKU AJAR KEPERAWATAN MEDIKAL BEDAH.,Jakarta : EGC.</span><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;"></span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; text-align: justify;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">http://rioaffandy.blogspot.com</span></div><div class="MsoListParagraphCxSpMiddle" style="color: black; line-height: 150%; text-align: justify;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">http://nefrologyners.wordpress.com</span></div><div class="MsoListParagraphCxSpLast" style="color: black; line-height: 150%; text-align: justify;"><br />
</div><div class="MsoNormal" style="color: black; line-height: 150%; margin-left: 18pt; text-align: justify;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">DiPosting Oleh:</span></div><div class="MsoNormal" style="color: black; line-height: 150%; margin-left: 18pt; text-align: justify;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Nama<span> </span>:Pipit Puspita Permana</span></div><div class="MsoNormal" style="color: black; line-height: 150%; margin-left: 18pt; text-align: justify;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Nim<span> </span>:05200ID09026</span></div><div class="MsoNormal" style="color: black; line-height: 150%; margin-left: 18pt; text-align: justify;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Kelas<span> </span>:2A</span></div><div class="MsoNormal" style="color: black; line-height: 150%; margin-left: 18pt; text-align: justify;"><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">Kelompok <span> </span>:I</span></div><div align="center" class="MsoNormal" style="color: black; line-height: 150%; margin-left: 18pt; text-align: center;"><b><span lang="EN-US" style="font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">MAHASISWA AKPER PEMDA GARUT</span></b></div><div class="MsoNormal" style="color: black; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><span lang="EN-US" style="display: none; font-family: "Kristen ITC"; font-size: 12pt; line-height: 150%;">-7.528394 109.294534 </span></div><div class="MsoNormal" style="color: black; line-height: 150%; margin-bottom: 0.0001pt; text-align: justify;"><br />
</div><div class="MsoNormal" style="color: black; line-height: 150%; text-align: justify;"><br />
</div></m:defjc></m:rmargin></m:lmargin></m:dispdef></m:smallfrac>TEAM_ONE KMB 2A AKPEM GARUThttp://www.blogger.com/profile/01719877433346227735noreply@blogger.com0tag:blogger.com,1999:blog-1245729285541543255.post-37976347108524864522011-03-18T01:01:00.000-07:002011-03-18T01:01:01.384-07:00SISTEM PERKEMIHAN<!--[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> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> <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:narylim></m:intlim> </m:wrapindent><!--[endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;"><span style="font-size: xx-small;"><b><span style="color: #444444; font-family: "Comic Sans MS"; line-height: 150%;">FISIOLOGI GINJAL</span></b></span></div><div class="MsoListParagraphCxSpFirst" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><b><span style="color: #444444; font-family: "Comic Sans MS"; line-height: 150%;"><span>A.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="color: #444444; font-family: "Comic Sans MS"; line-height: 150%;">Fungsi ginjal</span></b></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0.75in; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS"; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #444444; font-family: "Comic Sans MS"; line-height: 150%;">Mengekskresikan zat – zat sisa metabolisme yang mengandung nitrogennitrogen, misalnya amonia.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0.75in; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS"; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #444444; font-family: "Comic Sans MS"; line-height: 150%;">Mengekskresikan zat – zat yang jumlahnya berlebihan (misalnya gula dan vitamin) dan berbahaya (misalnya obat – obatan, bakteri dan zat warna).</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0.75in; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS"; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #444444; font-family: "Comic Sans MS"; line-height: 150%;">Mengatur keseimbangan air dan garam dengan cara osmoregulasi.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0.75in; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS"; line-height: 150%;"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #444444; font-family: "Comic Sans MS"; line-height: 150%;"><span> </span>Mengatur tekanan darah dalam arteri dengan mengeluarkan kelebihan asam atau basa.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><b><span style="color: #444444; font-family: "Comic Sans MS"; line-height: 150%;"><span>B.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="color: #444444; font-family: "Comic Sans MS"; line-height: 150%;">Tes Fungsi Ginjal Terdiri Dari :</span></b></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0.75in; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS"; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #444444; font-family: "Comic Sans MS"; line-height: 150%;">Tes untuk protein albumin</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0.75in; text-align: justify;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS"; line-height: 150%;">Bila kerusakan pada glomerolus atau tubulus, maka protein dapat bocor masuk ke dalam urine.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0.75in; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS"; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #444444; font-family: "Comic Sans MS"; line-height: 150%;">Mengukur konsentrasi urenum darah</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0.75in; text-align: justify;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS"; line-height: 150%;">Bila ginjal tidak cukup mengeluarkan urenum maka urenum darah naik di atas kadar normal (20 – 40) mg%.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0.75in; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS"; line-height: 150%;"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #444444; font-family: "Comic Sans MS"; line-height: 150%;"><span> </span>Tes konsentrasi</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0.75in; text-align: justify;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS"; line-height: 150%;">Dilarang makan atau minum selama 12 jam untuk melihat sampai seberapa tinggi berat jenisnya naik.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0.75in; text-align: justify;"><br />
</div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><b><span style="color: #444444; font-family: "Comic Sans MS"; line-height: 150%;"><span>C.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="color: #444444; font-family: "Comic Sans MS"; line-height: 150%;">Peredaran Darah dan Persyarafan Ginjal</span></b></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0.75in; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS"; line-height: 150%;"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #444444; font-family: "Comic Sans MS"; line-height: 150%;">Peredaran Darah</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0.75in; text-align: justify;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS"; line-height: 150%;">Ginjal mendapat darah dari aorta abdominalis yang mempunyai percabangan arteria renalis, yang berpasangan kiri dan kanan dan bercabang menjadi arteria interlobaris kemudian menjadi arteri akuata, arteria interlobularis yang berada di tepi ginjal bercabang menjadi kapiler membentuk gumpalan yang disebut dengan glomerolus dan dikelilingi leh alat yang disebut dengan simpai bowman, didalamnya terjadi penyadangan pertama dan kapilerdarah yang meninggalkan simpai bowman kemudian menjadi vena renalis masuk ke vena kava inferior.</span></span></div><div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-left: 0.75in; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS"; line-height: 150%;"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #444444; font-family: "Comic Sans MS"; line-height: 150%;">Persyarafan Ginjal</span></span></div><div class="MsoListParagraphCxSpLast" style="line-height: 150%; margin-left: 0.75in; text-align: justify;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS"; line-height: 150%;">Ginjal mendapat persyarafan dari fleksus renalis (vasomotor) saraf ini berfungsi untuk mengatur jumlah darah yang masuk ke dalam ginjal, saraf inibarjalan bersamaan dengan pembuluh darah yang masuk ke ginjal. Anak ginjal (kelenjar suprarenal) terdapat di atas ginjal yang merupakan senuah kelenjar buntu yang menghasilkan 2(dua) macam hormon yaitu hormone adrenalin dan hormn kortison.</span></span></div><div style="line-height: 150%; margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><b><span style="color: #444444; font-family: "Comic Sans MS";"><span>D.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span></b><b><span style="color: #444444; font-family: "Comic Sans MS";">Proses Miksi (Rangsangan Berkemih).</span></b></span></div><div style="line-height: 150%; margin-left: 0.5in; text-align: justify;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";">Distensi kandung kemih, oleh air kemih akan merangsang stres reseptor yang terdapat pada dinding kandung kemih dengan jumlah ± 250 cc sudah cukup untuk merangsang berkemih (proses miksi). Akibatnya akan terjadi reflek kontraksi dinding kandung kemih, dan pada saat yang sama terjadi relaksasi spinser internus, diikuti oleh relaksasi spinter eksternus, dan akhirnya terjadi pengosongan kandung kemih.</span></span></div><div style="line-height: 150%; margin-left: 0.5in; text-align: justify;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";">Rangsangan yang menyebabkan kontraksi kandung kemih dan relaksasi spinter interus dihantarkan melalui serabut – serabut para simpatis. Kontraksi sfinger eksternus secara volunter bertujuan untuk mencegah atau menghentikan miksi. kontrol volunter ini hanya dapat terjadi bila saraf – saraf yang menangani kandung kemih uretra medula spinalis dan otak masih utuh.</span></span></div><div style="line-height: 150%; margin-left: 0.5in; text-align: justify;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";">Bila terjadi kerusakan pada saraf – saraf tersebut maka akan terjadi inkontinensia urin (kencing keluar terus – menerus tanpa disadari) dan retensi urine (kencing tertahan).</span></span></div><div style="line-height: 150%; margin-left: 0.5in; text-align: justify;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";">Persarafan dan peredaran darah vesika urinaria, diatur oleh torako lumbar dan kranial dari sistem <span class="apple-converted-space"> </span>persarafan otonom. Torako lumbar berfungsi untuk relaksasi lapisan otot dan kontraksi spinter interna.</span></span></div><div style="line-height: 150%; margin-left: 0.5in; text-align: justify;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";">Peritonium melapis kandung kemih sampai kira – kira perbatasan ureter masuk kandung kemih. Peritoneum dapat digerakkan membentuk lapisan dan menjadi lurus apabila kandung kemih terisi penuh. Pembuluh darah Arteri vesikalis superior berpangkal dari umbilikalis bagian distal, vena membentuk anyaman dibawah kandung kemih. Pembuluh limfe berjalan menuju duktus limfatilis sepanjang arteri umbilikalis.</span></span></div><div style="line-height: 150%; margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";"><span>E.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><b><span style="color: #444444; font-family: "Comic Sans MS";">Urine (Air Kemih)</span></b><span style="color: #444444; font-family: "Comic Sans MS";"></span></span></div><div style="line-height: 150%; margin-left: 0.75in; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";"><span>1.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #444444; font-family: "Comic Sans MS";">Sifat – sifat air kemih</span></span></div><div style="line-height: 150%; margin-left: 1in; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #444444; font-family: "Comic Sans MS";">Jumlah eksresi dalam 24 jam ± 1.500 cc tergantung dari masuknya (intake) cairan serta faktor lainnya.</span></span></div><div style="line-height: 150%; margin-left: 1in; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #444444; font-family: "Comic Sans MS";">Warna bening muda dan bila dibiarkan akan menjadi keruh.</span></span></div><div style="line-height: 150%; margin-left: 1in; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #444444; font-family: "Comic Sans MS";">Warna kuning terantung dari kepekatan, diet obat – obatan dan sebagainya.</span></span></div><div style="line-height: 150%; margin-left: 1in; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #444444; font-family: "Comic Sans MS";">Bau khas air kemih bila dibiarkan terlalu lama maka akan berbau amoniak.</span></span></div><div style="line-height: 150%; margin-left: 1in; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #444444; font-family: "Comic Sans MS";">Berat jenis 1.015 – 1.020.</span></span></div><div style="line-height: 150%; margin-left: 1in; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #444444; font-family: "Comic Sans MS";">Reaksi asam bila terlalu lama akan menjadi alkalis, tergantung pada diet (sayur menyebabkan reaksi alkalis dan protein memberi reaksi asam).</span></span></div><div style="line-height: 150%; margin-left: 0.75in; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";"><span>2.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #444444; font-family: "Comic Sans MS";">Komposisi air kemih</span></span></div><div style="line-height: 150%; margin-left: 1in; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #444444; font-family: "Comic Sans MS";">Air kemih terdiri dari kira – kira 95 % air</span></span></div><div style="line-height: 150%; margin-left: 1in; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #444444; font-family: "Comic Sans MS";">Zat – zat sisa nitrogen dari hasil metabolisme protein asam urea, amoniak dan kreatinin</span></span></div><div style="line-height: 150%; margin-left: 1in; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #444444; font-family: "Comic Sans MS";">Elektrolit, natrium, kalsium, NH3, bikarbonat, fosfat dan sulfat</span></span></div><div style="line-height: 150%; margin-left: 1in; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";"><span>d.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #444444; font-family: "Comic Sans MS";">Pigmen (bilirubin, urobilin)</span></span></div><div style="line-height: 150%; margin-left: 1in; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";"><span>e.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #444444; font-family: "Comic Sans MS";">Toksin</span></span></div><div style="line-height: 150%; margin-left: 1in; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";"><span>f.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #444444; font-family: "Comic Sans MS";">Hormon</span></span></div><div style="line-height: 150%; margin-left: 0.75in; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";"><span>3.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #444444; font-family: "Comic Sans MS";">Mekanisme Pembentukan Urine</span></span></div><div style="line-height: 150%; margin-left: 0.75in; text-align: justify;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";">Dari sekitar 1200ml darah yang melalui glomerolus setiap menit terbentuk 120 – 125ml filtrat (cairan yang telah melewati celah filtrasi). Setiap harinyadapat terbentuk 150 – 180L filtart. Namun dari jumlah ini hanya sekitar 1% (1,5 L) yang akhirnya keluar sebagai kemih, dan sebagian diserap kembali</span></span></div><div style="line-height: 150%; margin-left: 0.75in; text-align: justify;"><br />
</div><div style="line-height: 150%; margin-left: 0.75in; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";"><span>4.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #444444; font-family: "Comic Sans MS";"><span> </span>Tahap – tahap Pembentukan Urine</span></span></div><div style="line-height: 150%; margin-left: 1in; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";"><span>a.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #444444; font-family: "Comic Sans MS";">Proses filtrasi</span></span></div><div style="line-height: 150%; margin-left: 1in; text-align: justify;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";">Terjadi di glomerolus, proses ini terjadi karena permukaan aferent lebih besar dari permukaan aferent maka terjadi penyerapan darah, sedangkan sebagian yang tersaring adalah bagian cairan darah kecuali protein, cairan yang tersaring ditampung oleh simpai bowman yang terdiri dari glukosa, air, sodium, klorida, sulfat, bikarbonat dll, diteruskan ke seluruh ginja.</span></span></div><div style="line-height: 150%; margin-left: 1in; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";"><span>b.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #444444; font-family: "Comic Sans MS";">Proses reabsorpsi</span></span></div><div style="line-height: 150%; margin-left: 1in; text-align: justify;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";">Terjadi penyerapan kembali sebagian besar dari glukosa, sodium, klorida, fosfat dan beberapa ion karbonat. Prosesnya terjadi secara pasif yang dikenal dengan obligator reabsorpsi terjadi pada tubulus atas. Sedangkan pada tubulus ginjal bagian bawah terjadi kembali penyerapan dan sodium dan ion karbonat, bila diperlukan akan diserap kembali kedalam tubulus bagian bawah, penyerapannya terjadi secara aktif dikienal dengan reabsorpsi fakultatif dan sisanya dialirkan pada pupila renalis.</span></span></div><div style="line-height: 150%; margin-left: 1in; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";"><span>c.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #444444; font-family: "Comic Sans MS";">Augmentasi (Pengumpulan)</span></span></div><div style="line-height: 150%; margin-left: 1in; text-align: justify;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";">Proses ini terjadi dari sebagian tubulus kontortus distal sampai tubulus pengumpul. Pada tubulus pengumpul masih terjadi penyerapan ion Na+, Cl-, dan urea sehingga terbentuklah urine sesungguhnya.</span></span></div><div style="line-height: 150%; margin-left: 1in; text-align: justify;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";">Dari tubulus pengumpul, urine yang dibawa ke pelvis renalis lalu di bawa ke ureter. Dari ureter, urine dialirkan menuju vesika urinaria (kandung kemih) yang merupakan tempat penyimpanan urine sementara. Ketika kandung kemih sudah penuh, urine dikeluarkan dari tubuh melalui uretra.</span></span></div><div style="line-height: 150%; margin-left: 0.75in; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";"><span>5.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #444444; font-family: "Comic Sans MS";">Ciri – ciri Urine Normal</span></span></div><div style="line-height: 150%; margin-left: 0.75in; text-align: justify;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";">Rata – rata dalam satu hari 1 – 2 liter, tapi berbeda – beda sesuai dengan jumlah cairan yang masuk. Warnanya bening oranye pucat tanpa endapan, baunya tajam, reaksinya sedikit asam terhadap lakmus dengan pH rata – rata 6.</span></span></div><div style="line-height: 150%; margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";"><span>F.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> </span></span></span><span style="color: #444444; font-family: "Comic Sans MS";">Mikturisi</span></span></div><div style="line-height: 150%; margin-left: 0.5in; text-align: justify;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";">Peristiwa penggabungan urine yang mengalir melui ureter ke dalam kandung kemih., keinginan untuk buang air kecil disebabkan penanbahan tekanan di dalam kandung kemih dimana saebelumnmya telah ada 170 – 23 ml urine.</span></span></div><div style="line-height: 150%; margin-left: 0.5in; text-align: justify;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";">Miktruisi merupakan gerak reflek yang dapat dikendalikan dan dapat ditahan oleh pusat – pusat persyarafan yang lebih tinggi dari manusia, gerakannya oleh kontraksi otot abdominal yang menekan kandung kemih membantu mengosongkannya.</span></span></div><div style="line-height: 150%; margin-left: 0.5in; text-align: justify;"><br />
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</div><div style="line-height: 150%; margin-left: 0.5in; text-align: justify;"><span style="font-size: xx-small;"><b><span style="color: #444444; font-family: "Comic Sans MS";">Daftar Pustaka</span></b></span></div><div style="line-height: 150%; margin-left: 0.5in; text-align: justify;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";">Luvina, Evi Dwisang, (2003), Inti Sari Biologi Untuk SMA, Jakarta : Gramedia.</span><b><span style="color: #444444; font-family: "Comic Sans MS";"></span></b></span></div><div style="line-height: 150%; margin-left: 0.5in; text-align: justify;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";">Prawirohartono Slamet, (1991), IPA Biologi SMP, Jakarta : Gramedia.</span><b><span style="color: #444444; font-family: "Comic Sans MS";"></span></b></span></div><div style="line-height: 150%; margin-left: 0.5in; text-align: justify;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";">Syamsuri Istamar, (2004), Biologi Untuk SMA, Jakarta : Erlangga.</span><b><span style="color: #444444; font-family: "Comic Sans MS";"></span></b></span></div><div style="line-height: 150%; margin-left: 0.5in; text-align: justify;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";">Syarifuddin, (1992),<span class="apple-converted-space"> </span></span><span style="font-family: "Comic Sans MS";">Anatomi dan Fisiologi</span><span class="apple-converted-space"><span style="color: #444444; font-family: "Comic Sans MS";"> </span></span><span style="color: #444444; font-family: "Comic Sans MS";">Untuk Keperawatan, Jakarta : EGC.</span><b><span style="color: #444444; font-family: "Comic Sans MS";"></span></b></span></div><div style="line-height: 150%; margin-left: 0.5in; text-align: justify;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";">Gambar ginjal, (2008), articles-to-share.blogspot.com</span><b><span style="color: #444444; font-family: "Comic Sans MS";"></span></b></span></div><div style="line-height: 150%; margin-left: 0.5in; text-align: justify;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";">Gambar ginjal, (2008), dnwalcer.com</span><b><span style="color: #444444; font-family: "Comic Sans MS";"></span></b></span></div><div style="line-height: 150%; margin-left: 0.5in; text-align: justify;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";">Gambar <span> </span>kandung kencing , dokter-herbal.com</span></span></div><div style="line-height: 150%; margin-left: 0.5in; text-align: justify;"><br />
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</div><div style="line-height: 150%; margin-left: 0.5in; text-align: justify;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";">Posting oleh :</span></span></div><div style="line-height: 150%; margin-left: 0.5in; text-align: justify;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";">Nama <span> </span>: Lina Ratiana</span></span></div><div style="line-height: 150%; margin-left: 0.5in; text-align: justify;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";">Kelompok<span> </span>:1 (satu)</span></span></div><div style="line-height: 150%; margin-left: 0.5in; text-align: justify;"><span style="font-size: xx-small;"><span style="color: #444444; font-family: "Comic Sans MS";">Kelas<span> </span><span> </span>: 2-A </span></span></div><div style="line-height: 150%; margin-left: 0.5in; text-align: justify;"><span style="font-size: xx-small;"><b><span style="color: #444444; font-family: "Comic Sans MS";">MAHASISIWA AKPER PEMDA KAB.GARUT</span></b></span></div><div style="line-height: 150%; margin-left: 0.5in; text-align: justify;"><br />
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</div>TEAM_ONE KMB 2A AKPEM GARUThttp://www.blogger.com/profile/01719877433346227735noreply@blogger.com2tag:blogger.com,1999:blog-1245729285541543255.post-14745271917427064412011-03-18T00:31:00.000-07:002011-03-18T00:31:05.268-07:00SISTEM PERKEMIHAN<!--[if !mso]> <style>
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<div align="center" class="MsoNormal" style="line-height: 15pt; text-align: center;"><b><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 14pt;">ANATOMI SISTEM PERKEMIHAN</span></b></div><div align="center" class="MsoNormal" style="line-height: 15pt; text-align: center;"><br />
</div><div style="line-height: 15pt; margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><b><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"><span>A.<span style="font: 7pt "Times New Roman";"> </span></span></span></b><b><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Pengertian Sistem Urinaria</span></b></div><div style="line-height: 15pt; margin-left: 0.5in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Sistem Urinaria</span><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"> atau<span class="apple-converted-space"> </span><span>Sistem perkemihan</span> adalah suatu<span class="apple-converted-space"> sistem </span>dimana terjadinya proses penyaringan darah sehingga darah bebas dari zat-zat yang tidak dipergunakan oleh tubuh dan menyerap zat-zat yang masih di pergunakan oleh tubuh. Zat-zat yang tidak dipergunakan oleh tubuh larut dalam air dan dikeluarkan berupa urin (air kemih).</span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjni27sWJB1nTuEnC4lIjZlWqmlKdaHtovRuEXHwauDUUIvwy_zaOfx4bNFuYvkU4Y0OXTwN07gIHowq2aRKfZ-xMWOXzk2zePE0SBUImr5QoYNOHyFRR1twzs1b_DYix-63B6aWC6sEDHf/s1600/ginjal.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjni27sWJB1nTuEnC4lIjZlWqmlKdaHtovRuEXHwauDUUIvwy_zaOfx4bNFuYvkU4Y0OXTwN07gIHowq2aRKfZ-xMWOXzk2zePE0SBUImr5QoYNOHyFRR1twzs1b_DYix-63B6aWC6sEDHf/s1600/ginjal.jpg" /></a></div><div style="line-height: 15pt; margin-left: 0.5in; text-align: justify;"><br />
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</span><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"></span></div><div style="line-height: 15pt; margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><b><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"><span>B.<span style="font: 7pt "Times New Roman";"> </span></span></span></b><b><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">anatomi<span class="apple-converted-space"> </span>Sistem Urinaria atau<span class="apple-converted-space"> </span></span></b><span class="apple-converted-space"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">sistem<b> </b></span></span><b><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">perkemihan :</span></b><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"></span></div><div style="line-height: 15pt; margin-left: 0.75in; text-align: justify; text-indent: -0.25in;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"><span>1.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">GINJAL<a href="" name="more"></a></span></div><div style="line-height: 15pt; margin-left: 0.5in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Kedudukan ginjal terletak dibagian belakang dari kavum abdominalis di belakang peritonium pada kedua sisi vertebra lumbalis III, dan melekat langsung pada dinding abdomen.</span></div><div style="line-height: 15pt; margin-left: 0.5in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Bentuknya seperti biji buah kacang merah (kara/ercis), jumlahnaya ada 2 buah kiri dan kanan, ginjal kiri lebih besar dari pada ginjal kanan.</span></div><div style="line-height: 15pt; margin-left: 0.5in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Pada orang dewasa berat ginjal ± 200 gram. Dan pada umumnya ginjal laki – laki lebih panjang dari pada ginjal wanita.</span></div><div style="line-height: 15pt; margin-left: 0.5in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Satuan struktural dan fungsional ginjal yang terkecil di sebut nefron. Tiap – tiap nefron terdiri atas komponen vaskuler dan tubuler. Komponen vaskuler terdiri atas pembuluh – pembuluh darah yaitu glomerolus dan kapiler peritubuler yang mengitari tubuli. Dalam komponen tubuler terdapat kapsul Bowman, serta tubulus – tubulus, yaitu tubulus kontortus proksimal, tubulus kontortus distal, tubulus pengumpul dan lengkung Henle yang terdapat pada medula.</span></div><div style="line-height: 15pt; margin-left: 0.5in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Kapsula Bowman terdiri atas lapisan parietal (luar) berbentuk gepeng dan lapis viseral (langsung membungkus kapiler golmerlus) yang bentuknya besar dengan banyak juluran mirip jari disebut podosit (sel berkaki) atau pedikel yang memeluk kapiler secara teratur sehingga celah – celah antara pedikel itu sangat teratur.</span></div><div style="line-height: 15pt; margin-left: 0.5in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Kapsula bowman bersama glomerolus disebut korpuskel renal, bagian tubulus yang keluar dari korpuskel renal disabut dengan tubulus kontortus proksimal karena jalannya yang berbelok – belok, kemudian menjadi saluran yang lurus yang semula tebal kemudian menjadi tipis disebut ansa Henle atau loop of Henle, karena membuat lengkungan tajam berbalik kembali ke korpuskel renal asal, kemudian berlanjut sebagai tubulus kontortus distal.</span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWb7-eFA__625cGVx3RS5wSoUAjhdqjDJY7xFzkVlLQyyg1hgzA8cRGwtOnGSaLm4bTD1BoJ2-5KY2_wC_eh7g5hyphenhyphenJgcPgz1p_ezoaVd8sP8F23ekPCC11sGQOuzHPBXEyeVQbYgAwVKVz/s1600/2+kidne.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWb7-eFA__625cGVx3RS5wSoUAjhdqjDJY7xFzkVlLQyyg1hgzA8cRGwtOnGSaLm4bTD1BoJ2-5KY2_wC_eh7g5hyphenhyphenJgcPgz1p_ezoaVd8sP8F23ekPCC11sGQOuzHPBXEyeVQbYgAwVKVz/s1600/2+kidne.jpg" /></a></div><div style="line-height: 15pt; margin-left: 0.5in; text-align: justify;"><br />
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</span><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"></span></div><div style="line-height: 15pt; margin-left: 0.75in; text-align: justify; text-indent: -0.25in;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"><span>a.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Bagian – Bagian Ginjal</span></div><div style="line-height: 15pt; margin-left: 0.75in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Bila sebuh ginjal kita iris memanjang, maka aka tampak bahwa ginjal terdiri dari tiga bagian, yaitu bagian kulit (korteks), sumsum ginjal (medula), dan bagian rongga ginjal (pelvis renalis).</span></div><div style="line-height: 15pt; margin-left: 1in; text-align: justify; text-indent: -0.25in;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"><span>1)<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Kulit Ginjal (Korteks)</span></div><div style="line-height: 15pt; margin-left: 1in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Pada kulit ginjal terdapat bagian yang bertugas melaksanakan penyaringan darah yang disebut nefron. Pada tempat penyarinagn darah ini banyak mengandung kapiler – kapiler darah yang tersusun bergumpal – gumpal disebut glomerolus. Tiap glomerolus dikelilingi oleh simpai bownman, dan gabungan antara glomerolus dengan simpai bownman disebut badan malphigi</span></div><div style="line-height: 15pt; margin-left: 1in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Penyaringan darah terjadi pada badan malphigi, yaitu diantara glomerolus dan simpai bownman. Zat – zat yang terlarut dalam darah akan masuk kedalam simpai bownman. Dari sini maka zat – zat tersebut akan menuju ke pembuluh yang merupakan lanjutan dari simpai bownman yang terdapat di dalam sumsum ginjal.</span></div><div style="line-height: 15pt; margin-left: 1in; text-align: justify;"><br />
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</div><div style="line-height: 15pt; margin-left: 1in; text-align: justify; text-indent: -0.25in;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"><span>2)<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Sumsum Ginjal (Medula)</span></div><div style="line-height: 15pt; margin-left: 1in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Sumsum ginjal terdiri beberapa badan berbentuk kerucut yang disebut piramid renal. Dengan dasarnya menghadap korteks dan puncaknya disebut apeks atau papila renis, mengarah ke bagian dalam ginjal. Satu piramid dengan jaringan korteks di dalamnya disebut lobus ginjal. Piramid antara 8 hingga 18 buah tampak bergaris – garis karena terdiri atas berkas saluran paralel (tubuli dan duktus koligentes). Diantara pyramid terdapat jaringan korteks yang disebut dengan kolumna renal. Pada bagian ini berkumpul ribuan pembuluh halus yang merupakan lanjutan dari simpai bownman. Di dalam pembuluh halus ini terangkut urine yang merupakan hasil penyaringan darah dalam badan malphigi, setelah mengalami berbagai proses.</span></div><div style="line-height: 15pt; margin-left: 1in; text-align: justify; text-indent: -0.25in;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"><span>3)<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Rongga Ginjal (Pelvis Renalis)</span></div><div style="line-height: 15pt; margin-left: 1in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Pelvis Renalis adalah ujung ureter yang berpangkal di ginjal, berbentuk corong lebar. Sabelum berbatasan dengan jaringan ginjal, pelvis renalis bercabang dua atau tiga disebut kaliks mayor, yang masing – masing bercabang membentuk beberapa kaliks minor yang langsung menutupi papila renis dari piramid. Kliks minor ini menampung urine yang terus kleuar dari papila. Dari Kaliks minor, urine masuk ke kaliks mayor, ke pelvis renis ke ureter, hingga di tampung dalam kandung kemih (vesikula urinaria).</span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtusBF1A3zRbq2DqdDDkDoNG3Qibh3eNTo42RfphE5iRSWMFm580e_MWdx4ajRchQdvNfua4Sh-x0sejoqL9ya50K_Le58jK7WKPM984_X_M4lY3gcgxam-oCuk9EhVVYTBGu6byDsA-Ht/s1600/nefron.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtusBF1A3zRbq2DqdDDkDoNG3Qibh3eNTo42RfphE5iRSWMFm580e_MWdx4ajRchQdvNfua4Sh-x0sejoqL9ya50K_Le58jK7WKPM984_X_M4lY3gcgxam-oCuk9EhVVYTBGu6byDsA-Ht/s320/nefron.jpg" width="320" /></a></div><div style="line-height: 15pt; margin-left: 1in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"><br />
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2. URETER</span></div><div style="line-height: 15pt; margin-left: 1in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Terdiri dari 2 saluran pipa masing – masing bersambung dari ginjal ke kandung kemih (vesika urinaria) panjangnya ± 25 – 30 cm dengan penampang ± 0,5 cm. Ureter sebagian terletak dalam rongga abdomen dan sebagian terletak dalam rongga pelvis.<br />
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Lapisan dinding ureter terdiri dari :</span></div><div style="line-height: 15pt; margin-left: 1.25in; text-align: justify; text-indent: -0.25in;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"><span>a.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Dinding luar jaringan ikat (jaringan fibrosa)</span></div><div style="line-height: 15pt; margin-left: 1.25in; text-align: justify; text-indent: -0.25in;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"><span>b.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Lapisan tengah otot polos</span></div><div style="line-height: 15pt; margin-left: 1.25in; text-align: justify; text-indent: -0.25in;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"><span>c.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Lapisan sebelah dalam lapisan mukosa</span></div><div style="line-height: 15pt; margin-left: 1in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Lapisan dinding ureter menimbulkan gerakan – gerakan peristaltik tiap 5 menit sekali yang akan mendorong air kemih masuk ke dalam kandung kemih (vesika urinaria).<br />
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Gerakan peristaltik mendorong urin melalui ureter yang dieskresikan oleh ginjal dan disemprotkan dalam bentuk pancaran, melalui osteum uretralis masuk ke dalam kandung kemih.<br />
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Ureter berjalan hampir vertikal ke bawah sepanjang fasia muskulus psoas dan dilapisi oleh pedtodinium. Penyempitan ureter terjadi pada tempat ureter terjadi pada tempat ureter meninggalkan pelvis renalis, pembuluh darah, saraf dan pembuluh sekitarnya mempunyai saraf sensorik.</span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirPlRjSwAl7PVr7A6if9U9u54KW_v4Sth6e5XNWGb6BYVG8A4MR6Jd1yaBVT-RATMzrrvtwS9ckP9fgXQdVK39sNNUqFg9_75NieljcpnifsiQkwZchkdcvW-loFsWNmseGQlasnogm3T7/s1600/index+uret.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirPlRjSwAl7PVr7A6if9U9u54KW_v4Sth6e5XNWGb6BYVG8A4MR6Jd1yaBVT-RATMzrrvtwS9ckP9fgXQdVK39sNNUqFg9_75NieljcpnifsiQkwZchkdcvW-loFsWNmseGQlasnogm3T7/s1600/index+uret.jpg" /></a></div><div style="line-height: 15pt; margin-left: 1in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"></span><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"><br />
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3. VESIKA URINARIA ( Kandung Kemih )</span></div><div style="line-height: 15pt; margin-left: 1in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Kandung kemih dapat mengembang dan mengempis seperti balon karet, terletak di belakang simfisis pubis di dalam ronga panggul.</span></div><div style="line-height: 15pt; margin-left: 1in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Bentuk kandung kemih seperti kerucut yang dikelilingi oleh otot yang kuat, berhubungan ligamentum vesika umbikalis medius.</span></div><div style="line-height: 15pt; margin-left: 1in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Bagian vesika urinaria terdiri dari :</span></div><div style="line-height: 15pt; margin-left: 1.25in; text-align: justify; text-indent: -0.25in;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"><span>a.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Fundus, yaitu bagian yang mengahadap kearah belakang dan bawah, bagian ini terpisah dari rektum oleh spatium rectosivikale yang terisi oleh jaringan ikat duktus deferent, vesika seminalis dan prostate.</span></div><div style="line-height: 15pt; margin-left: 1.25in; text-align: justify; text-indent: -0.25in;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"><span>b.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Korpus, yaitu bagian antara verteks dan fundus.</span></div><div style="line-height: 15pt; margin-left: 1.25in; text-align: justify; text-indent: -0.25in;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"><span>c.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Verteks, bagian yang maju kearah muka dan berhubungan dengan ligamentum vesika umbilikalis.</span></div><div style="line-height: 15pt; margin-left: 1in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Dinding kandung kemih terdiri dari beberapa lapisan yaitu, peritonium (lapisan sebelah luar), tunika muskularis, tunika submukosa, dan lapisan mukosa (lapisan bagian dalam).<span> </span></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjiCoPgxERXljNchSEuh-qpNCZTRdKATo2h13IZiXZAtwGnCY1is8rt9H6PeK2v_ciod76anWRqjPBaDOTKRp7ccC23RROx8KlhIZm-uvM0ttEjmubYOlxT809fsPHHbSzl7DKM4qjwUIf7/s1600/kandung+kencing.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjiCoPgxERXljNchSEuh-qpNCZTRdKATo2h13IZiXZAtwGnCY1is8rt9H6PeK2v_ciod76anWRqjPBaDOTKRp7ccC23RROx8KlhIZm-uvM0ttEjmubYOlxT809fsPHHbSzl7DKM4qjwUIf7/s320/kandung+kencing.jpg" width="320" /></a></div><div style="line-height: 15pt; margin-left: 1in; text-align: justify;"><br />
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</span></div><div style="line-height: 15pt; margin-left: 0.5in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">4. URETRA</span></div><div style="line-height: 15pt; margin-left: 0.5in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Uretra merupakan saluran sempit yang berpangkal pada kandung kemih yang berfungsi menyalurkan air kemih keluar.</span></div><div style="line-height: 15pt; margin-left: 0.5in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Pada laki- laki uretra bewrjalan berkel ok – kelok melalui tengah – tengah prostat kemudian menembus lapisan fibrosa yang menembus tulang pubis kebagia penis panjangnya ± 20 cm.</span></div><div style="line-height: 15pt; margin-left: 0.5in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Uretra pada laki – laki terdiri dari :</span></div><div style="line-height: 15pt; margin-left: 0.7in; text-align: justify; text-indent: -0.25in;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"><span>a.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"><span> </span>Uretra Prostaria</span></div><div style="line-height: 15pt; margin-left: 0.7in; text-align: justify; text-indent: -0.25in;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"><span>b.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Uretra membranosa</span></div><div style="line-height: 15pt; margin-left: 0.7in; text-align: justify; text-indent: -0.25in;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"><span>c.<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Uretra kavernosa</span></div><div style="line-height: 15pt; margin-left: 0.7in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Lapisan uretra laki – laki terdiri dari lapisan mukosa (lapisan paling dalam), dan lapisan submukosa.</span></div><div style="line-height: 15pt; margin-left: 0.7in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Uretra pada wanita terletak dibelakang simfisis pubisberjalan miring sedikit kearah atas, panjangnya ± 3 – 4 cm. Lapisan uretra pada wanita terdiri dari Tunika muskularis (sebelah luar), lapisan spongeosa merupakan pleksus dari vena – vena, dan lapisan mukosa (lapisan sebelah dalam).Muara uretra pada wanita terletak di sebelah atas vagina (antara klitoris dan vagina) dan uretra di sini hanya sebagai saluran ekskresi. </span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_56A1ojYmUC16OpY_DfMic3ttT-jiO8-0w2_gG5Pi3AoczoxRx32YVdlMVLmR5pqPBpajwo8ObhZtX6qsGEPGOedhp74XOGs0uW4e9zOJXlYUNf5Aigf6_sJB1KrqDapA5xrUfIpv9C3V/s1600/uti.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="267" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_56A1ojYmUC16OpY_DfMic3ttT-jiO8-0w2_gG5Pi3AoczoxRx32YVdlMVLmR5pqPBpajwo8ObhZtX6qsGEPGOedhp74XOGs0uW4e9zOJXlYUNf5Aigf6_sJB1KrqDapA5xrUfIpv9C3V/s320/uti.jpg" width="320" /></a></div><div style="line-height: 15pt; margin-left: 0.7in; text-align: justify;"><br />
</div><div style="line-height: 15pt; margin-left: 0.7in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"></span></div><div style="line-height: 15pt; margin-left: 0.7in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"></span></div><div style="line-height: 15pt; margin-left: 0.7in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"></span></div><div style="line-height: 15pt; margin-left: 0.7in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"></span></div><div style="line-height: 15pt; margin-left: 0.7in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"></span></div><div style="line-height: 15pt; margin-left: 0.7in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"></span></div><div style="line-height: 15pt; margin-left: 0.7in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"></span></div><div style="line-height: 15pt; margin-left: 0.7in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"></span></div><div style="line-height: 15pt; margin-left: 0.7in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"></span></div><div style="line-height: 15pt; margin-left: 0.7in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"></span></div><div style="line-height: 15pt; margin-left: 0.7in; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"><span></span></span></div><div style="line-height: 15pt; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"><br />
</span><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Daftar Pustaka</span></div><div style="line-height: 15pt; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Luvina, Evi Dwisang, (2003), Inti Sari Biologi Untuk SMA, Jakarta : Gramedia.</span></div><div style="line-height: 15pt; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Prawirohartono Slamet, (1991), IPA Biologi SMP, Jakarta : Gramedia.</span></div><div style="line-height: 15pt; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Syamsuri Istamar, (2004), Biologi Untuk SMA, Jakarta : Erlangga.</span></div><div style="line-height: 15pt; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Syarifuddin, (1992),<span class="apple-converted-space"> </span></span><span class="apple-converted-space"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Anatomi dan Fisiologi u</span></span><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">ntuk Keperawatan, Jakarta : EGC.</span></div><div style="line-height: 15pt; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Gambar ginjal, (2008), articles-to-share.blogspot.com</span></div><div style="line-height: 15pt; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Gambar ginjal, (2008), dnwalcer.com</span></div><div style="line-height: 15pt; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Gambar <span> </span>kandung kencing , dokter-herbal.com</span></div><div style="line-height: 15pt; text-align: justify;"><br />
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</div><div style="line-height: 15pt; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;"> Posting oleh :RINI YULIANI </span></div><div style="line-height: 15pt; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Kelompok :1</span></div><div style="line-height: 15pt; text-align: justify;"><span style="color: #444444; font-family: "Arial","sans-serif"; font-size: 10pt;">Kelas :2A</span></div><div style="line-height: 15pt; text-align: justify;"><br />
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</div>TEAM_ONE KMB 2A AKPEM GARUThttp://www.blogger.com/profile/01719877433346227735noreply@blogger.com0