Hasil Pencarian  ::  Simpan CSV :: Kembali

"Untuk mengetahui effektivitas dan keamanan injeksi intravitreal gas Sulfur Heksaflorida (SF6) tanpa tissue Plasminogen Activator (tPA) pada perdarahan subhialoid di premakula, 5 mata dari 5 pasen dimasukkan dalam penelitian ini. Setelah parasentesis cairan akuos, 0.3 ml gas sulfur hexafluoride murni disuntikkan intravitreal dan penderita diharuskan mempertahankan posisi muka kebawah selama 5 hari.. Foto fundus dibuat pre injeksi,pada 1 hari dan 7 hari pasca injeksi. Perdarahan subhialoid bergeser pada 4/5 (80%) mata dengan lama perdarahan subhialoid kurang dari 2 minggu. Tajam penglihatan pre-operatif pada ke-lima mata adalah hitung jari, dan mengalami perbaikan pasca-operatif pada 4/5 (80%) mata dalam 3 hari sampai 7 hari.. Tajam penglihatan berkisar antara 6/20 hingga 6/6. Penyakit sistemik yang mendasari, terdiri dari hiperkoagulasi pada 1 pasien, diabetes mellitus pada 2 pasien, hipertensi pada 1 pasien dan tidak ditemukan pada 1 pasien. Komplikasi akibat tindakan tidak ditemukan pada semua mata yang diinjeksi. Sebagai kesimpulan, injeksi gas SF6 tanpa penggunaan tPA ke dalam vitreus mampu menggeser perdarahan subhialoid, bila dilakukan dalam 14 hari, dan dapat menghasilkan perbaikan tajam penglihatan yang cepat. Tindakan ini terbukti aman. (Med J Indones 2007; 16:104-7).

---

To assess the efficacy and safety of intravitreal injection of Sulfur Hexafluoride (SF6) gas without the use of tissue Plasminogen Activator (tPA) in premacular Subhyaloid Hemorrhage ( SHH ), 5 eyes of 5 patients with premacular SHH were enrolled. After performing paracentesis of the anterior chamber, 0.3 ml pure SF6 gas was injected through pars plana with a 30 gauge needle. Facedown position was maintained for 5 days. Subhyaloid Hemorrhage was displaced in 4/5 ( 80% ) eyes with a duration of SHH less than 2 weeks. The pre-injection visual acuity of all 5 eyes was finger counting and improved in 4/5 ( 80% ) eyes within 3 days to 7 days post-injection to 6/20 - 6/6. The underlying disease was hypercoagulation in 1 patient , diabetes mellitus in 2 patients , hypertension in 1 patient and unknown in 1 patient. No complications were encountered. In conclusion, SF6 gas injected into the vitreous without the use of tPA, can displace SHH if performed within 14 days of duration, and results in rapid visual recovery. This procedure is proven to be safe. (Med J Indones 2007; 16:104-7)."

"Obstetric Hemorrhage is one of leading causes for maternal death in developing country and cause for 50% of estimated 500.000 maternal death globally per year. It is known that 7,6% of complications during labor and delivery that happen in Indonesia is postpartum hemorrhage (PPH). The purpose of this study is to examine factors that associated with PPH complication in Indonesia. Research method which is used in this study is cross sectional that analyze Indonesia Demographic and Health Survey (SDKI) 2012?s data source. Population in this study is all woman in age range 15-49 year old that ever gave birth in Indonesia from January 2007 until SDKI 2012 started. This study find that mother with low education (PR=1,248; 95% CI: 1,108 ? 1,405), maternal age <20 and >35 years (PR= 1,157; 95% CI: 1,007 ? 1,329), smoking behavior (PR= 1,991; 95% CI: 1,047 ? 1,425), parity >3 children (PR= 1,221; 95% CI: 1,047 ? 1,425), pregnancy complications (PR= 2,805; 95% CI: 2,477 ? 3,175), past labor complications (PR= 1,765; 95% CI: 1,468 ? 2,123), and completeness of antenatal care (PR= 0,79; 95% CI: 0,664 ? 0,94) are associated with PPH complication. Government commitment is needed to improve health facility?s coverage, train health assistance, and educate people to increase awareness of rights and needs of maternal and newborn health.

---

Perdarahan obstetri adalah salah satu penyebab utama kematian maternal di negara berkembang dan penyebab 50% dari 500.000 kematian maternal yang diperkirakan terjadi per tahun di dunia. Sebesar 7,6% dari komplikasi persalinan yang terjadi di Indonesia adalah komplikasi perdarahan pascapersalinan. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan kejadian komplikasi perdarahan pascapersalinan di Indonesia. Penelitian ini menggunakan desain studi cross sectional dengan analisis data sekunder SDKI 2012. Populasi penelitian adalah seluruh wanita usia 15-49 tahun yang pernah melahirkan di Indonesia dalam kurun waktu Januari 2007 sampai pelaksanaan SDKI 2012. Hasil penelitian menunjukkan bahwa ibu dengan pendidikan rendah (PR=1,248; 95% CI: 1,108 ? 1,405), umur ibu <20 dan >35 tahun (PR= 1,157; 95% CI: 1,007 ? 1,329), perilaku merokok ibu (PR= 1,991; 95% CI: 1,047 ? 1,425), paritas >3 anak (PR= 1,221; 95% CI: 1,047 ? 1,425), komplikasi kehamilan (PR= 2,805; 95% CI: 2,477 ? 3,175), riwayat komplikasi persalinan (PR= 1,765; 95% CI: 1,468 ? 2,123), dan kelengkapan pelayanan antenatal (PR= 0,79; 95% CI: 0,664 ? 0,94) berhubungan dengan kejadian komplikasi perdarahan pascapersalinan. Perlunya komitmen pemerintah untuk memperbaiki cakupan fasilitas kesehatan, pelatihan lebih lanjut pada tenaga kesehatan, dan pemberian edukasi pada masyarakat sehingga menumbuhkan kesadaran hak dan kebutuhan tentang kesehatan ibu dan anak."

"ABSTRAK Latar BelakangPerdarahan pascasalin adalah penyebab 25% kematian ibu diseluruh dunia,bahkan mencapai 60% pada beberapa negara. Sekitar 60-90% disebabkan olehatonia uteri. Berbagai alat ditemukan dan digunakan seperti tamponade balonuterus, NASG (Nonpneumatic Anti Shock Garment), Bakri Balloon dan TheGlenveigh Medical Complete Tamponade System namun memiliki efektifitassekitar 65-87,5% dan potensi komplikasi. Oleh sebab itu diperkenalkanlah suatumetode baru untuk mengontrol perdarahan pascasalin. MetodeTujuan dari penelitian ini adalah untuk melihat keamanan, kemudahan danefektifitas alat InPress mengatasi perdarahan pascasalin karena atonia uteri. AlatInPress menggunakan mesin vakum bertekanan rendah untuk menurunkantekanan atmosfer dalam kavum uteri sehingga uterus menjadi kolaps danmembuat tamponade sehingga perdarahan berhenti. Selain itu secara fisiologis,dapat merangsang kontraksi uterus pascasalin yang normal dan retraksi uterus kebentuk dan ukuran semula. HasilDari sepuluh subyek penelitian menunjukkan bahwa mesin vakum dengan cepatmenciptakan tamponade yang efektif melalui balon pengunci yang berada diostium uteri eksterna. Jumlah perdarahan yang dievakuasi dari kavum uteri sekitar100-250 cc, tertampung dalam kanister. Uterus kolaps dan terjadi tamponadedalam waktu 1-2 menit sehingga perdarahan berhenti. Alat InPress dipasangselama minimal 1 jam dan maksimal 6,5 jam. Repair luka robekan perineum danvagina dapat dilakukan dengan mudah saat alat InPress terpasang di dalam uterus.Pada sepuluh subyek tidak ada tindakan lanjutan untuk mengatasi perdarahansetelah alat InPress dipasang. Tidak ditemukan adanya kelainan pada uterus,serviks dan vagina pada saat dan sesudah pemasangan alat InPress. KesimpulanTamponade uterus yang berasal dari tekanan negatif mesin vakum terbukti aman dan efektif untuk mengatasi perdarahan pascasalin karena atonia uteri.ABSTRACT Background the Treatment of Postpartum Hemorrhage Due To UterineAtonia Postpartum Hemorrhage (PPH) is responsible for +/- 25% of maternal mortalityworldwide, reaching as high as 60% in some countries. Approximately 60-90%caused by uterine atonia. Many devices were invented and applied such as uterineballoon tamponade, NASG (Nonpneumatic Anti Shock Garment), Bakri Balloondan The Glenveigh Medical Complete Tamponade System but the effectivenessonly about 65-87,5% control hemorrhage and have potential complications.Therefor a new method to control PPH has been introduced. MethodThe purpose of this study was to demonstrate patient safety, device efficiency, andease of use, as an overall Proof of Concept with a new device, the InPress Device,for the treatment of primary postpartum hemorrhage (PPH) due to atony.The InPress device uses gentle vacuum force to lower the atmospheric pressurewithin the uterine cavity to collapse the uterus into and onto itself to stophemorrhage through tamponade. It also stimulates normal postpartum uterinecontractions, to effect hemostasis. In this hemostatic state the atonic uterusrecovers, physiologically, and retracts down to its? normal hemostatic postpartumsize. Results Results from our ten trial patients showed that: the vacuum created an immediateeffective tamponade confined to the uterus by our seal situated at the externalcervical ostium, 100-250 milliliters of residual blood were evacuated from theuterine cavity into the vacuum canister. The uterus collapsed and regained tonewithin 1-2 minutes, and hemorrhaging stopped, in all cases. The device stayed inplace while vaginal and perineal lacerations, which occurred during delivery, wereeasily repaired. The device was left in for one-hour minimum up to 6,5 hours. There were no further operative procedures required to stop hemorrhaging in anyof these cases. There was no abnormality of uterus, cervix and vagina while andafter InPress procedur performed. Conclusion Vacuum induced uterine tamponade using physiologic force, is a safe andeffective way to achieve rapid control of PPH due to atony.;Background the Treatment of Postpartum Hemorrhage Due To UterineAtonia Postpartum Hemorrhage (PPH) is responsible for +/- 25% of maternal mortalityworldwide, reaching as high as 60% in some countries. Approximately 60-90%caused by uterine atonia. Many devices were invented and applied such as uterineballoon tamponade, NASG (Nonpneumatic Anti Shock Garment), Bakri Balloondan The Glenveigh Medical Complete Tamponade System but the effectivenessonly about 65-87,5% control hemorrhage and have potential complications.Therefor a new method to control PPH has been introduced. MethodThe purpose of this study was to demonstrate patient safety, device efficiency, andease of use, as an overall Proof of Concept with a new device, the InPress Device,for the treatment of primary postpartum hemorrhage (PPH) due to atony.The InPress device uses gentle vacuum force to lower the atmospheric pressurewithin the uterine cavity to collapse the uterus into and onto itself to stophemorrhage through tamponade. It also stimulates normal postpartum uterinecontractions, to effect hemostasis. In this hemostatic state the atonic uterusrecovers, physiologically, and retracts down to its? normal hemostatic postpartumsize. Results Results from our ten trial patients showed that: the vacuum created an immediateeffective tamponade confined to the uterus by our seal situated at the externalcervical ostium, 100-250 milliliters of residual blood were evacuated from theuterine cavity into the vacuum canister. The uterus collapsed and regained tonewithin 1-2 minutes, and hemorrhaging stopped, in all cases. The device stayed inplace while vaginal and perineal lacerations, which occurred during delivery, wereeasily repaired. The device was left in for one-hour minimum up to 6,5 hours. There were no further operative procedures required to stop hemorrhaging in anyof these cases. There was no abnormality of uterus, cervix and vagina while andafter InPress procedur performed. Conclusion Vacuum induced uterine tamponade using physiologic force, is a safe andeffective way to achieve rapid control of PPH due to atony.;Background the Treatment of Postpartum Hemorrhage Due To UterineAtonia Postpartum Hemorrhage (PPH) is responsible for +/- 25% of maternal mortalityworldwide, reaching as high as 60% in some countries. Approximately 60-90%caused by uterine atonia. Many devices were invented and applied such as uterineballoon tamponade, NASG (Nonpneumatic Anti Shock Garment), Bakri Balloondan The Glenveigh Medical Complete Tamponade System but the effectivenessonly about 65-87,5% control hemorrhage and have potential complications.Therefor a new method to control PPH has been introduced. MethodThe purpose of this study was to demonstrate patient safety, device efficiency, andease of use, as an overall Proof of Concept with a new device, the InPress Device,for the treatment of primary postpartum hemorrhage (PPH) due to atony.The InPress device uses gentle vacuum force to lower the atmospheric pressurewithin the uterine cavity to collapse the uterus into and onto itself to stophemorrhage through tamponade. It also stimulates normal postpartum uterinecontractions, to effect hemostasis. In this hemostatic state the atonic uterusrecovers, physiologically, and retracts down to its? normal hemostatic postpartumsize. Results Results from our ten trial patients showed that: the vacuum created an immediateeffective tamponade confined to the uterus by our seal situated at the externalcervical ostium, 100-250 milliliters of residual blood were evacuated from theuterine cavity into the vacuum canister. The uterus collapsed and regained tonewithin 1-2 minutes, and hemorrhaging stopped, in all cases. The device stayed inplace while vaginal and perineal lacerations, which occurred during delivery, wereeasily repaired. The device was left in for one-hour minimum up to 6,5 hours. There were no further operative procedures required to stop hemorrhaging in anyof these cases. There was no abnormality of uterus, cervix and vagina while andafter InPress procedur performed. Conclusion Vacuum induced uterine tamponade using physiologic force, is a safe andeffective way to achieve rapid control of PPH due to atony."

"ABSTRAKSistektomi radikal merupakan penanganan standar pada pasien tumor buli yang telah menembus otot, Perdarahan merupakan salah satu morbiditas yang ditemukan pada prosedur ini. Tujuan penelitian ini untuk mengetahui rata-rata jumlah kehilangan darah pada prosedur sistektomi radikal. Merupakan penelitian non-eksperimental retrospektif-deskriptif-analitik yang mengambil data Rekam Medis dari Januari 2012 Desember 2015 di RSUP H. Adam Malik Medan. Berdasarkan variable yang diperiksa terdapat perbedaan signifikan pada jumlah perdarahan berdasarkan diversi urin yang digunakan, yaitu ureterocutaneostomy dan neobladder. Diperlukan persiapan darah sekitar 951,5 ml sebagai standar persiapan operasi di radikal sistektomi di RSUP H. Adam Malik Medan"

---

ABSTRACTRadical cystectomy is a standard management for patients with bladder tumor which has penetrated muscles. Bleeding is one of the morbidity associated with the procedure. This study aims to measure mean blood loss during radical cystectomy. This study was a retrospective analytic study, data was collected using medical records from January 2012 to December 2015 At Haji Adam Malik General Hospital Medan. Variables that affected amount of blood loss staging, type of anesthesia used, and urine diversion, there are no significant differences except on amount of blood loss according to urine diversion method used, which were ureterocutaneostomy and neobladder. Blood preparation is needed about 951.5 ml as standard preparation for surgery in radical sistektomi in RSHAM "

"Subarachnoid hemorrhage (SAH) atau perdarahan subarachnoid umumnya disebabkan oleh pecahnya aneurisma yang mengakibatkan darah terserap masuk ke rongga parenkim otak, dan juga mengganggu sirkulasi cairan serebrospinal. Aneurisma otak sendiri biasanya berada pada sirkulus wilisi yang merupakan suatu lingkaran anastomosis berbentuk cincin yang berfungsi untuk mendistribusikan darah ke kedua hemisfer serebral. SAH memiliki angka morbiditas dan mortalitas yang tinggi. Angka kematian yang tinggi erat kaitannya dengan peningkatan tekanan intrakranial. Upaya yang dapat dilakukan untuk menurunkan tekanan intrakranial salah satunya dengan elevasi kepala 30º. Penulisan karya ilmiah akhir ners ini bertujuan untuk menggambarkan asuhan keperawatan pada pasien perdarahan subarakhnoid dengan penerapan intervensi elevasi kepala 30°. Hasil intervensi menunjukkan elevasi kepala 30° terbukti efektif untuk mengurangi risiko peningkatan tekanan intrakranial sebagai upaya meningkatkan venous return pada pasien stroke.

---

Subarachnoid hemorrhage (SAH) is generally caused by rupture of an aneurysm which causes blood to be absorbed into the brain parenchymal cavity, and also interferes with the circulation of cerebrospinal fluid. Brain aneurysms themselves are usually located in the circle of Willis which is a ring-shaped anastomotic circle that serves to distribute blood to both cerebral hemispheres. SAH has a high rate of morbidity and mortality. A high mortality rate is closely related to increased intracranial pressure. One of the efforts that can be done to reduce intracranial pressure is with a head elevation of 30º. The purpose of writing this final scientific paper for nurses is to describe nursing care for patients with subarachnoid hemorrhage with the application of a 30° head elevation intervention. The results of the intervention showed that 30° head elevation was effective in reducing the risk of increased intracranial pressure as an effort to increase venous return in stroke patients."

"Latar belakang: Perdarahan intraventrikular (PIV) menjadi penyebab morbiditas dan mortalitas bayi prematur. Sekitar 27% bayi dengan BB <1.500 gram mengalami PIV pada berbagai derajat (1–4). Faktor risiko PIV dapat berasal dari maternal, seperti preeklamsia, tanpa steroid antenatal, dan persalinan per vaginam serta berasal dari neonatal, seperti usia gestasi lebih muda, berat badan lahir lebih rendah, jenis kelamin lelaki, nilai Apgar rendah, asfiksia, pemberian inotropik, trombositopenia, ventilasi mekanik invasif, sepsis, sindrom distres pernapasan, dan duktus arteriosus persisten. Identifikasi faktor risiko yang berhubungan dengan PIV penting agar penatalaksanaan yang tepat dapat dilakukan dan sebagai evaluasi pencegahan dan tata laksana PIV yang saat ini sudah diterapkan.Metode: Penelitian kasus kontrol ini melibatkan subjek bayi usia gestasi <35 minggu di RSCM yang diambil retrospektif secara consecutive sampling mulai perawatan Agustus 2022 hingga jumlah sampel terpenuhi. Subjek dibagi menjadi kelompok kasus (dengan PIV) dan kontrol (tanpa PIV) berdasarkan hasil USG kepala selama perawatan. Masing-masing kelompok diidentifikasi faktor risiko yang ada dari rekam medis, baik faktor maternal maupun neonatal. Data kemudian dianalisis menggunakan program SPSS.Hasil: Total 220 subjek diteliti terdiri atas kelompok kasus 110 subjek dan kontrol 110 subjek. Dari 110 kasus didapatkan PIV derajat 1 (69,1%), derajat 2 (12,7%), derajat 3 (10%), dan derajat 4 (8,2%). Analisis bivariat menunjukkan terdapat hubungan bermakna antara PIV dengan usia gestasi <28 minggu (OR 5,44; IK 95% 2,23-13,27; p<0,001), berat badan lahir <1.000 gram (OR 6,23; IK 95% 2,87-13,52; p<0,001), berat badan lahir 1.000-1.499 gram (OR 3,04; IK 95% 1,62-5,71; p=0,001), nilai Apgar menit ke-1 (p=0,004), nilai Apgar menit ke-5 (p=0,03), pemberian inotropik (OR 2,47; IK 95% 1,35-4,53; p=0,005), jumlah trombosit <50.000/μL (OR 2,52; IK 95% 1,17-5,42; p=0,018), jumlah trombosit 50.000-99.000/μL (OR 3,42; IK 95% 1,51-7,74; p=0,003), ventilasi mekanik invasif (OR 3,71; IK 95% 2,11-6,53; p<0,001), sepsis (OR 2,84; IK 95% 1,64-4,90; p<0,001), dan DAP (OR 2,01; IK 95% 1,07-3,79; p=0,042). Analisis multivariat menunjukkan hanya berat badan lahir <1.000 gram (OR 3,93; IK 95% 1,71-9,06; p=0,001), berat badan lahir 1.000-1.499 gram (OR 2,57; IK 95% 1,34-4,92; p=0,004), dan penggunaan ventilasi mekanik invasif (OR 2,49; IK 95% 1,34-4,63; p=0,004) yang mempunyai hubungan bermakna dengan PIV.Kesimpulan: Faktor risiko yang mempunyai hubungan bermakna dengan PIV pada bayi usia gestasi <35 minggu adalah berat badan lahir <1.500 gram dan penggunaan ventilasi mekanik invasif.

---

Background: Intraventricular hemorrhage (IVH) is a cause of morbidity and mortality in preterm infants. Approximately 27% of infants weighing <1,500 gram have PIV in various degrees (1-4). Risk factors for IVH can be maternal origin, such as preeclamsia, absence of steroid antenatal, and vaginal delivery; and also from neonatal origin, such as younger gestational age, lower birth weight, male gender, lower Apgar score, asphyxia, inotropic administration, thrombocytopenia, invasive mechanical ventilation, sepsis, respiratory distress syndrome and patent ductus arteriosus (PDA). Identification of risk factors associated with IVH is important so that appropriate management can be carried out and as an evaluation of IVH’s prevention and treatment that are currently being implemented.

Method: This case-control study involved subjects with gestational age <35 weeks at Cipto Mangunkusumo Hospital who were taken retrospectively by consecutive sampling starting from admission in August 2022 until the number of samples were fulfilled. Subjects were divided into case (with IVH) and control (without IVH) groups based on the results of head ultrasound during hospitalization. Each group was identified existing risk factors from medical record, both maternal and neonatal factor. The data were then analyzed using the SPSS program.

Result: A total 220 subjects were studied, consisting 110 subjects in case group and 110 subjects in control group. Of the 110 cases, IVH grade 1 (69.1%), grade 2 (12.7%), grade 3 (10%), and grade 4 (8.2%). Bivariate analysis showed that PIV was significantly associated with gestational age <28 weeks (OR 5.44; 95% CI 2.23-13.27; p<0.001), birth weight <1,000 grams (OR 6.23; 95% CI 2.87-13.52; p<0.001), birth weight 1,000-1,499 grams (OR 3.04; 95% CI 1.62-5.71; p=0.001), 1st minute Apgar score (p=0.004), 5th minute Apgar score (p=0.03), inotropic administration (OR 2.47; 95% CI 1.35-4.53; p=0.005), platelet count <50,000/μL (OR 2.52; 95% CI 1.17-5.42; p=0.018), platelet count 50,000-99,000/μL (OR 3.42; 95% CI 1.51-7.74; p=0.003), invasive mechanical ventilation (OR 3.71; 95% CI 2.11-6.53; p<0.001), sepsis (OR 2.84; 95% CI 1.64-4.90; p<0.001), and PDA (OR 2.01; 95% CI 1.07-3.78; p=0.042). Multivariate analysis showed only birth weight <1,000 grams (OR 3.93; 95% CI 1.71-9.06; p=0.001), birth weight 1,000-1,499 grams (OR 2.57; 95% CI 1.34-4.92; p=0.004), and the use of invasive mechanical ventilation (OR 2.49; 95% CI 1.34-4.63; p=0.004) were significantly associated with IVH.

Conclusion: Risk factors that significantly associated with IVH in baby with gestational age <35 weeks are birth weight <1,500 grams and the use of invasive mechanical ventilation."

"Perawatan pada pasien dengan perdarahan intraserebral pada fase subakut memerlukan pemantauan ketat di ruang rawat ICU. Masalah keperawatan yang terjadi pada pasien meliputi bersihan jalan napas inefektif, perfusi serebral inadekuat, ketidakstabilan glukosa darah, resiko defisit nutrisi, resiko ketidakstabilan cairan dan elektrolit, serta adanya risiko perluasan infeksi. Masalah gastrointestinal pada pasien ICH mengakibatkan gangguan penyerapan nutrisi dengan tingginya GRV yang berisiko terjadinya aspirasi. Salah satu intervensi yang dapat dilakukan untuk mengatasi hal tersebut adalah melalui pijat perut (abdominal massage). Laporan ini disusun untuk memaparkan analisis asuhan keperawatan pada pasien kritis dengan perdarahan intraserebral dalam penerapan abdominal massage untuk mengurangi residu lambung. Asuhan keperawatan diberikan secara menyeluruh sesuai masalah keperawatan pada kasus selama tiga hari. Sebagian intervensi meliputi abdominal massage yang dilakukan selama 20 menit sebanyak dua kali sehari. Setelah asuhan keperawatan diberikan didapatkan bersihan jalan napas yang belum efektif, perfusi serebral belum adekuat, glukosa darah belum stabil, defisit nutrisi tidak terjadi dengan peningkatan asupan, ketidakseimbangan cairan dan elektrolit dan perluasan infeksi masih mungkin terjadi. Residu NGT berkurang hingga 0 cc setelah dilakukan intervensi abdominal massage. Pemberian intervensi abdominal massage sebagai bagian dari keseluruhan asuhan keperawatan dapat diterapkan di berbagai ruang rawat untuk menurunkan GRV dan meningkatkan penyerapan nutrisi pasien dengan NGT.

---

Care for patients with intracerebral hemorrhage in the subacute phase still requires close monitoring in the ICU ward. The nursing problems occurring in the patient include ineffective airway clearance, inadequate cerebral perfusion, blood glucose instability, risk of nutritional deficit, risk of electrolyte and fluid imbalance, and the risk of infection spread. Gastrointestinal problems in ICH patients result in nutrient absorption disorders with high GRV, which poses a risk of aspiration. One of the interventions that can be done to address high gastric residue is through abdominal massage. This report is prepared to present an analysis of nursing care for critically ill patients with intracerebral hemorrhage in the application of abdominal massage to reduce gastric residue. Nursing care was provided comprehensively according to the nursing problems in the case over three days. Some interventions included abdominal massage performed twice a day. After nursing care was provided, it was found that airway clearance was still ineffective, cerebral perfusion was inadequate, blood glucose was unstable, fluid and electrolyte imbalance had not been resolved, and the spread of infection was still possible. GRV decreased to 0 cc after abdominal massage intervention. The provision of abdominal massage intervention as part of overall nursing care can be applied in various wards to reduce GRV and improve nutrient absorption in patients with NGT."

"Lebih dari 20 juta wanita di seluruh dunia memakai kontrasepsi progestin. Metode kontrasepsi ini sangat efektif dan dapat digunakan untuk jangka panjang. Salah satu jenis kontrasepsi progestin yang banyak digunakan adalah kontrasepsi suntik dengan depo-medroxy progesterone asetat (DMPA). Di Indonesia, menurut penelitian The National Social and Economic Survey (1997-1998), akseptor suntik mencapai 21,1% dari total jumlah akseptor KB. Tetapi pada sisi lain, pengguna kontrasepsi ini pada umumnya mengalami gangguan pola perdarahan menstruasi. Gangguan ini menimbulkan ketidaknyamanan bagi pemakainya sehingga mereka memutuskan untuk menghentikan pemakaian kontrasepsi tersebut, Hampir setengah (40-60%) pengguna kontrasepsi progestin memutuskan untuk berhenti menggunakan metode kontrasepsi ini karena gangguan tersebut.Patogenesis perdarahan abnormal uterus pada pengguna metode kontrasepsi ini masih belum diketahui. Pada penelitian sebelumnya telah dilaporkan perubahan pada morfologi endometrium, profil reseptor steroid endometrium, morfologi vaskular endometrium, fungsi dan mekanisme hemostasis pada endometrium. Perdarahan diduga berasal dari kapiler dan venul endometrium dan terjadi peningkatan fragilitas pembuluh darah endometrium pada pengguna kontrasepsi progestin.Matriks metalloproteinase (MMP) adalah suatu protease yang dapat mendegradasi matriks ekstraseluler. MMP terlibat dalam peluruhan endometrium pada saat menstruasi normal dan mendegradasi komponen matriks interstisial dan membran basal pada perimenstruasi yang menyebabkan hilangnya integritas pembuluh darah sehingga terjadi perdarahan menstruasi.MMP-9 adalah 92 k-Da metalloproteinase yang mendegradasi komponen matriks ekstraseluler dan komponen membran basal, khususnya kolagen IV, kolagen V, elastin dan gelatin. Pada fase menstruasi, MMP-9 ditemukan pada neutrofil, eosinofil, makrofag dan terutama di tempat terjadinya peluruhan jaringan.Pada beberapa penelitian, dari biopsi endometrium pengguna kontrasepsi progestin ditemukan peningkatan MMP. Beberapa penelitian melaporkan terdapatnya peningkatan MMP-9 pada endometrium pengguna kontrasepsi progestin yang mengalami gangguan pola perdarahan menstruasi."

"Pemantauan terapi obat (PTO) merupakan suatu prosedur atau kegiatan yang dilakukan untuk memastikan terapi obat yang diberikan kepada pasien bersifat aman, efektif, dan rasional (Departemen Kesehatan RI, 2009). Tujuan penulisan ini adalah untuk melakukan pemantauan terkait pengobatan pasien rawat inap dengan diagnosis Subarachnoid Hemorrhage ec. Vertebral Artery Disecting Aneurysm di RSUP Fatmawati. Metode pelaksanaan dilakukan secara prospektif melalui data sekunder berupa catatan rekam medis pasien, catatan pengobatan, dan hasil laboratorium. Berdasarkan hasil pemantauan terapi obat yang telah dilakukan, dapat disimpulkan bahwa pengobatan yang diterima telah sesuai dengan indikasi dan tidak ditemukan efek samping maupun reaksi obat yang tidak dikehendaki pada pasien.

---

Drug therapy monitoring is a procedure or activity carried out to ensure that the drug therapy given to patients is safe, effective and rational (Indonesian Ministry of Health, 2009). The purpose of this paper is to carry out monitoring regarding the treatment of inpatients with a diagnosis of Subarachnoid Hemorrhage ec. Vertebral Artery Dissecting Aneurysm at Fatmawati General Hospital. The implementation method is carried out prospectively through secondary data such as patient medical records, treatment records and laboratory results. Based on the results of drug therapy monitoring that has been carried out, it can be concluded that the treatment received was in accordance with the indications and no side effects or undesirable drug reactions were found in the patien"