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"Penyakit jantung dan pembuluh darah masih menjadi penyebab kematian nomer satu di dunia saat ini, sehingga memerlukan tindakan yang tepat dan komprehensif untuk meningkatkan harapan hidupnya. Tindakan mengatasi masalah penyakit jantung koroner salah satunya dengan pembedahan. Bedah jantung pada pasien dapat menimbulkan  respon pasien secara fisik dan  psikologis pada tahapan pra, intra, dan pasca-operasi yang masing masing berbeda intervensinya. Model intervensi keperawatan perioperatif DOE EXHIS diharapkan mampu mengatasi masalah nyeri, kecemasan dan imobilisasi pada tahapan bedah jantung. Penelitian ini bertujuan menciptakan model intervensi keperawatan perioperatif berbasis smartphone yang mampu menurunkan nyeri, kecemasan, dan meningkatkan mobilisasi dini pasien bedah jantung. Penelitian ini terdiri dari 3 tahap. Desain penelitian tahap pertama research and development, tahap kedua true eksperiment design dan tahap ketiga cross sectional. Besar sampel 86 responden, 43 kelompok perlakuan, 43 kelompok kontrol. Intervensi model intervensi berupa terapi doa, edukasi, exercise therapy, hipnosis dan musik diberikan pada kelompok perlakuan, sedangkan kelompok kontrol diberikan gold standard intervensi sesuai clinical pathway di rumah sakit. Hasil penelitian sebagian besar responden berusia dewasa, berjenis kelamin laki-laki, tingkat pendidikan menengah pada kelompok intervensi dan S1 pada kelompok kontrol, Suku Jawa, jenis operasi CABG, ada riwayat nyeri, ada dukungan keluarga, ada penyebab stress, penghasilan diatas UMK, tingkat pengetahuan sedang, maturasi emosional matur, dan seluruh responden tidak ada riwayat trauma. Model intervensi keperawatan perioperatif DOE EXHIS berbasis smartphone berpengaruh secara signifikan dalam menurunkan skor nyeri, kecemasan dan meningkatkan mobilisasi dini (p<0,05). Model intervensi keperawatan perioperatif DOE EXHIS berbasis smartphone berpengaruh secara langsung terhadap nyeri dan kecemasan, tetapi tidak berpengaruh langsung terhadap mobilisasi dini. Model intervensi keperawatan perioperatif DOE EXHIS berbasis smartphone berpengaruh tidak langsung terhadap mobilisasi dini yang di mediasi oleh kecemasan. Model intervensi keperawatan perioperatif DOE EXHIS berbasis smartphone dapat digunakan oleh perawat untuk menurunkan nyeri nyeri, kecemasan dan meningkatkan mobilisasi dini pasien bedah jantung.

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The heart and blood vessel disease is still the number one cause of death in the world today, so it requires appropriate and comprehensive intervention to increase life expectancy. One of the measures to overcome coronary heart disease is surgery. Cardiac surgery in patients can cause the patient's physical and psychological responses in the pre, intra, and postoperative stages, each of which has different interventions. The DOE EXHIS perioperative nursing intervention model is expected to be able to overcome the problems of pain, anxiety and immobilization at the cardiac surgery stage. This study aims to create a smartphone-based perioperative nursing intervention model that is able to reduce pain, anxiety, and increase early mobilization of cardiac surgery patients. This research consisted of 3 stages. The first stage of the research design is research and development, the second stage is true experimental design and the third stage is cross sectional. The sample size was 86 respondents, 43 treatment groups, 43 control groups. Intervention model interventions in the form of prayer therapy, education, exercise therapy, hypnosis and music were given to the treatment group, while the control group was given the gold standard of intervention according to the clinical pathway in the hospital. The results of the study most of the respondents were adult, male, secondary education level in the intervention group and S1 in the control group, Javanese, type of CABG operation, there was a history of pain, there was family support, there were causes of stress, income was above the minimum wage, level of moderate knowledge, mature emotional maturation, and all respondents had no history of trauma. The smartphone-based DOE EXHIS perioperative nursing intervention model significantly reduced pain scores, anxiety and increased early mobilization (p <0.05). The smartphone-based DOE EXHIS perioperative nursing intervention model directly affects pain and anxiety, but does not directly affect early mobilization. The smartphone-based DOE EXHIS perioperative nursing intervention model has an indirect effect on anxiety-mediated early mobilization. The smartphone-based DOE EXHIS perioperative nursing intervention model can be used by nurses to reduce pain, anxiety and increase early mobilization of cardiac surgery patients."

"Malnutrisi energi dan protein merupakan suatu masalah umum yang ditemukan pada pasien rawat inap di rumah sakit. Berbagai studi menunjukkan sebanyak 40% pasien bedah sudah mengalami malnutrisi pada saat masuk ke rumah sakit. Studi tersebut menunjukkan terdapat hubungan langsung antara penurunan berat badan pra bedah dengan laju mortalitas pasca bedah. Terapi nutrisi perioperatif yang adekuat telah dilaporkan dapat menurunkan laju morbiditas dan menurunkan masa rawat inap secara bermakna. Serial kasus ini terdiri atas empat kasus terapi nutrisi perioperatif pada pasien malnutrisi dengan kanker periampular yang menjalani pembedahan pankreatikoduodenektomi. Pasien adalah laki-laki, berusia antara 40-60 tahun, dengan kanker periampular (pankreas dan ampula Vateri). Keempat pasien kasus ini mengalami sindrom kaheksia-kanker, yaitu ditemukan penurunan BB sebesar 10-15% dalam ena bulan terakhir, anemia, fatigue, dan hipoalbuminemia. Kebutuhan energi total dihitung dengan menggunakan persamaan Harris-Bennedict dengan menambahkan faktor stres sebesar 1,5. Pemberian kalori dan nutrisi dilakukan secara bertahap dan ditingkatkan sesuai dengan perbaikan keadaan klinis, gastrointestinal, dan toleransi asupan pasien. Pemantauan dan evaluasi pasien dilakukan sesuai dengan perubahan subyektif dan obyektif. Selain itu, konseling dan edukasi mengenai terapi nutrisi diberikan setiap hari pada pasien. Selama perawatan, keempat pasien serial kasus ini menunjukkan perbaikan, baik secara subyektif maupun obyektif. Kebutuhan energi total tercapai selama periode pra bedah dan tujuh hingga sembilan hari pasca bedah. Masa rawat pasien ini adalah 12-20 hari. Perbaikan status nutrisi tidak tercapai pada pasien ini, namun terjadi perbaikan kapasitas fungsional dan proses penyembuhan luka yang adekuat. Terapi nutrisi perioperatif yang diberikan diharapkan mampu meningkatkan atau mempertahankan status nutrisi pasien, prognosis pasca bedah, serta meningkatkan kapasitas fungsional dan kualitas hidup pasien secara keseluruhan.

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Energy and protein malnutrition are common issues in hospitalized patient worldwide. Various studies had reported that 40% of surgical patient were already malnutrition when admitted to the hospital. The study reported that there were direct relationships between lost of body weight with mortality rate post surgery. Adequate perioperative nutritional therapy had been reported could decrease the morbidity rate and length of stay significantly. This case series consist of four perioperative nutritional management cases in malnourished patients with periampullary cancer that undergone pancreaticoduodenectomy surgery. Patients were male, age between 40-60 years, with periampullary cancer (pancreas & ampulla of Vatery). This four patients were having cancer-cahexia syndrome, which was characterized by lost of body weight 10-15% in the last six months, anemia, fatigue, and hypoalbuminemia. Total energy requirement were calculated with Harris-Bennedict equation with stress factor equal to 1,5. Energy and nutrition were given gradually and increased according to the improvement of clinical & gastrointestinal condition, and food intake tolerance of the patients. Monitoring and evaluation of the patients were applied according to the changes of subjective and objective parameter. Besides that, counseling and education were also given everyday to all of the patients. During the hospitalization, this four case series patients showed improvement, in both subjective and objective parameter. Total energy requirement was achieved in preoperative periode and seven until nine days postoperative in all of this patients. Length of stay of this patients were 12-20 days. Improvement of nutritional status were not found in this patients, but there were significant improvement of functional capacity and wound healing happened in them. Perioperative nutritional management applied to the patients were expected could increase or maintain the patiens’ nutritional status, improve prognosis post surgery functional capacity, and eventually leads to improvement of overall quality of life of the patients."

"This handbook is aimed at first-line health care providers involved in the perioperative care of adult and pediatric neurosurgical patients. It is unique in its systematic focus on how to deal with common and important clinical challenges encountered in day-to-day practice in the OR, the PACU, and the ICU and is designed as a problem-solving tool for all members of the perioperative medicine team: trainees and faculty in anesthesiology, neurosurgery, and critical care; nurses; nurse anesthetists; and physician’s assistants. • Encompasses clinical continuum from neurosurgical pre-op to critical care – plus anesthesia in neuroradiology• Adult and pediatric care• Structured algorithmic approach supports clinical decision-making• Succinct presentation of clinically relevant basic science• End-of-chapter summaries, with suggestions for further reading• Collaborative approach and multidisciplinary nature of perioperative medicine emphasized• Extensive summary tables• Portable and formatted for quick retrieval of information• Ideal for use in the OR, the PACU, and the ICU"

"Ulkus diabetikum merupakan kerusakan integritas kulit dengan erosi jaringan subkutan di bawahnya. Ulkus terjadi akibat adanya gangguan mikrovaskular dari saraf pada penderita diabetes melitus. Ulkus yang tidak kunjung sembuh dipengaruhi karena vaskularisasi yang buruk. Salah satunya dikarenakan penyakit arteri perifer seperti aortoiliac disease. Asuhan keperawatan perioperatif yang diberikan pada pasien aortoiliac disease bertujuan untuk mempertahankan perfusi jaringan perifer atau kecukupan aliran darah melalui pembuluh kecil di ujung kaki dan tangan untuk mempertahankan fungsi jaringan. Melalui tindakan latihan kaki diabetes pada pasien pre maupun post thromboendarterectomy artery dapat meningkatkan sirkulasi sehingga perbaikan luka menjadi lebih baik.

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Diabetic ulcers are damage to the integrity of the skin with erosion of the underlying subcutaneous tissue. Ulcers occur due to microvascular disorders of the nerves in people with diabetes mellitus. Ulcers that do not heal are affected due to poor vascularization. One of them is due to peripheral artery disease such as aortoiliac disease. Perioperative nursing care given to patients with aortoiliac disease aims to maintain peripheral tissue perfusion or adequate blood flow through the small vessels at the ends of the feet and hands to maintain tissue function. Through the action of diabetic foot exercises in patients pre and post thromboendarterectomy arteries can increase circulation so that wound repair becomes better."