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"Community acquired pneumonia (CAP) adalah inflamasi yang menyerang parenkim sistem pernapasan bagian bawah. Penyakit ini banyak menyerang individu dari segala tahapan perkembangan. Penyakit ini rentan terjadi pada wilayah perkotaan diakibatkan oleh tingkat polusi udara di wilayah perkotaan yang tinggi. Pada pasien CAP terjadi perubahan pada alveolar sehingga terdapat konsolidasi yang menyebabkan perubahan pola napas. Pursed lip breathing adalah salah satu bentuk intervensi keperawatan yang dapat dilakukan untuk mengatasi manifestasi yang ditimbulkan berupa hiperventilasi. Karya Ilmiah Akhir Ners ini bertujuan untuk menganalisis asuhan keperawatan yang diberikan pada pasien CAP dan penerapan pursed lip breathing. Hasil Analisa yang didapat dari penerapan pursed lip breathing adalah masalah ketidakefektifan pola napas teratasi ditandai dengan frekuensi napas dalam rentang normal dan tidak ada sesak.

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Community acquired pneumonia (CAP) is an inflammation that occurred on lower respiratory system especially lung parenchyma. CAP can occur in all development stage. People who live in urban area are vulnerable to get CAP because the level of air pollution in urban area is higher than rural area. People with CAP will have dyspnea and increase of respiratory rate because there consolidation occurred in alveolus which cause ineffective breathing pattern. Pursed lip breathing is one of the intervention that nurse can do to solve ineffective breathing pattern related to hyperventilation. This nursing Scientific work aims to analyze nursing process on patient with CAP and application of pursed lip breathing. The result of applicating pursed lip breathing on CAP patient are decrease of dyspnea and decrease of respiratory "

"Praktik keperawatan residensi yang dilakukan di rumah sakit Persahabatan dengan kekhususan respirasi diharapkan dapat mengatasi masalah pernapasan. Disamping itu juga selama proses residensi residen harus memiliki kemampuan menerapkan intervensi berdasarkan evidence base nursing (EBN), mampu menjadi seorang Clinical Care Manajer (CCM) yang bertugas sebagai konsultan keperawatan bagi staf keperawatan dan pemberi terapi keperawatan kepada pasien dalam rangka pemberi asuhan keperawatan untuk meningkatan mutu pada layanan asuhan keperawatan yang diberikan. Dalam memberikan asuhan kepeawatan pada kasus kelolaan pasien dengan CAP dan 30 kasus resume menggunakan teori Virginia Henderson 14 kebutuhan dasar manusia yang menunjukkan peran perawat sebagai pemberi asuhan keperawatan dalam membantu individu baik dalam keadaan sehat maupun sakit, melalui usahanya melakukan berbagai aktivitas guna mendukung kesehatan dan penyembuhan individu secara mandiri atau proses meninggal dengan damai. Masalah keperawatan yang banyak muncul yaitu tentang pemenuhan kebutuhan bernapas normal. Penerapan EBN Buteyko Breathing Techinque (BBT) pada pasien asma yang mengalami hiperventilasi. Hasil analisis praktik residensi keperawatan didapatkan bahwa asuhan keperawatan menggunakan pendekatan teori Henderson bertujuan untuk sesegera mungkin membantu kemandirian pasien. Penerapan BBT dapat meningkatkan nilai Peak Expiratory Flow Rate (PEFR) pada pasien asma. Proyek inovasi Pengembangan self managemen dengan video latihan breathing exercise : ACBT dalam meningkatkan airway clearance pada pasien PPOK.

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Residency nursing practice which is carried out at the Persahabatan Hospital with a specialization in respiration is expected to be able to overcome respiratory problems. Besides that, during the residency process, residents must have the ability to apply interventions based on evidence-based nursing (EBN), be able to become a Clinical Care Manager (CCM) who serves as a nursing consultant for nursing staff and provides nursing therapy to patients in order to provide nursing care to improve quality of nursing care services provided. In providing nursing care to cases managed by patients with CAP and 30 resume cases using Virginia Henderson's theory of 14 basic human needs which shows the role of nurses as providers of nursing care in helping individuals both in health and illness, through their efforts to carry out various activities to support health and healing individual independently or the process of dying peacefully. Nursing problems that arise are about meeting the needs of normal breathing. Application of EBN Buteyko Breathing Techinque (BBT) in hyperventilating asthma patients. The results of the analysis of nursing residency practice found that nursing care using the Henderson theory approach aims to help the patient's independence as soon as possible. The application of BBT can increase the Peak Expiratory Flow Rate (PEFR) value in asthma patients. Innovation project Development of self-management with videos of breathing exercise exercises: ACBT in increasing airway clearance in COPD patients."

"Community-Acquired Pneumonia CAP adalah penyakit sistem pernapasan yang menyerang jaringan parenkim paru. Penyakit ini banyak mengancam individu dewasa dengan penurunan sistem imun. Penderita CAP mengalami peningkatan setiap tahunnya akibat peningkatan polusi udara yang berada di wilayah perkotaan, terutama pada kawasan industri. Penderita CAP akan mengalami peningkatan produksi sputum yang berujung pada kesulitan dalam mengeluarkan sputum. Pasien dengan CAP sering mengalami penurunan refleks batuk yang membuat sputum terakumulasi di jalan napas sehingga menyebabkan peningkatan usaha untuk bernapas. Fisioterapi dada merupakan salah satu teknik pembersihan jalan napas pada pasien dengan penurunan refleks batuk. Karya Ilmiah Akhir Ners ini bertujuan untuk menganalisis intervensi fisioterapi dada untuk mengurangi gejala serta mencegah perburukan pada pasien dengan CAP. Metodologi yang digunakan adalah metode studi kasus dan analisa penelitian yang telah ada. Hasil analisa yang didapatkan menunjukkan fisioterapi dada dapat menurunkan usaha napas pasien, pengurangan episode demam, perubahan karakteristik sputum, serta penuruan persentase mortalitas melalui skoring CURB-65.

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Community Acquired Pneumonia CAP is a respiratory disease that attacks the pulmonary parenchymal tissue. This disease threatens many adults with decreased immune system. CAP sufferers are increasing every year due to increasing air pollution in urban areas, especially in industrial areas. CAP sufferers will experience an increase in sputum production that leads to difficulties in removing sputum. Patients with CAP often have decreased cough reflexes that make sputum accumulate in the airway causing increased effort to breathe. Chest physiotherapy is one of the airway cleansing techniques in patients with decreased cough reflexes.

This Final Scientific Work of Ners aims to analyze the interventions of chest physiotherapy to reduce symptoms and prevent worsening of patients with CAP. The methodology used is the case study method and the existing research analysis. The results obtained showed chest physiotherapy can decrease the patient 39 s breathing effort, reduction of febrile episodes, changes in sputum characteristics, as well as the percentage of mortality by scoring CURB 65."

"Latar Belakang: Community Acquired Pneumonia (CAP) merupakan salah satu penyebab utama morbiditas dan mortalitas di dunia. Bakteri atipikal (Chlamydia pneumoniae, Mycoplasma pneumaniae, Legionella pneumophila) sebagai penyebab penting CAP. Sejauh ini belum ada pemeriksaan mikrobiologi yang rutin dilakukan sehingga perlu pengembangan uji, salah satunya metode molekuler multiplex real time PCR. .Tujuan: Melakukan optimasi uji multiplex real time PCR untuk mendeteksi secara simultan dan cepat C.pneumoniae, L.pneumophila dan M.pneumoniae pada sputum pasien CAP.Metode: Penelitian ini merupakan uji eksperimental laboratorium yang terdiri atas 3 tahap. Tahap 1 meliputi optimasi suhu penempelan, primer, probe, volume elusi akhir dan cetakan DNA. Tahap 2 untuk menentukan batas ambang deteksi DNA dan reaksi silang. Tahap 3 adalah penerapan uji multiplex real time PCR pada spesimen sputum pasien CAP.Hasil: Uji multiplex real time PCR telah berhasil dioptimasi dengan ambang batas minimal deteksi DNA untuk Chlamydia pneumoniae, Legionella pneumophila dan Mycoplasma pneumaniae adalah 1855, 3185 dan 130 kopi DNA. Uji ini tidak bereaksi silang dengan mikroorganisme yang berpotensi menimbulkan reaksi positif palsu. Sebanyak 134 sputum telah diuji dan ditemukan positif M.pneumoniae sebanyak 1 spesimen (0,74 %).Kesimpulan: Uji multiplex real time PCR dapat mendeteksi C.pneumoniae, M.pneumoniae, dan L.pneumophila secara simultan pada sputum pasien CAP.

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Background: Community Acquired Pneumonia (CAP) is one of the leading causes of morbidity and mortality in the world. Atypical bacteria (Chlamydia pneumoniae, Legionella pneumophila, Mycoplasma pneumaniae) are the important causes of CAP. In daily clinical practice, detection of atypical bacteria are sometimes neglected due to the limited standard test available. The real time multiplex PCR methode can be used as an alternative test for the detection of atypical bacteria.Objective: Optimization of the multiplex real time PCR test to simultaneously detect C.pneumoniae, L.pneumophila and M.pneumoniae in CAP patients.Methods: This study is experimental laboratory test that conducted in three phases. The first is optimization of annealing temperature, primers dan probe concentration, final elution of DNA extraction and volume of PCR templete. The second is determination of minimal detection of DNA and cross reaction of optimized real time PCR multiplex. The third is application of real time PCR multiplex in sputum clinical specimen patient with CAP.Results: The multiplex real time PCR test was successfully optimized for annealing temperature, concentration of primer both forward and reverse, probes concentration and inhibitor. Limit detection of the DNA Chlamydia pneumoniae, Legionella pneumophila and Mycoplasma pneumaniae were 1855 copies, 3185 copies and 130 copies DNA. This test also showed no cross reaction to microorganisms that have potential to cause false positives. A total of 134 sputum clinical specimens have been tested with this method and only one sample (0,74%) was positive M.pneumoniae.Conclusion: The multiplex real time PCR assay can detect C. pneumoniae, M. pneumoniae, and L. pneumophila simultanously in sputum of patients with Community Acquired Pneumonia (CAP)"

"Community-acquired pneumonia (CAP) adalah suatu peradangan akut pada parenkim paru yang disebabkan oleh mikroorganisme dan didapat dari masyarakat. Terapi optimal antibiotik extended empiric sering diperdebatkan sehingga penatalaksanaan CAP merupakan tantangan besar bagi para klinisi. Penelitian ini bertujuan menganalisis perbandingan luaran terapi, efektivitas biaya dan pilihan terapi antibiotik yang baik serta hubungan ketepatan penggunaan dengan biaya antibiotik extended empiric monoterapi dan dualterapi CAP. Desain penelitian ini adalah kohort prospektif dengan waktu pengambilan sampel Juni-September 2018 di ruang boarding IGD RSUP Fatmawati Jakarta. Diperoleh hasil dualterapi tertinggi diberikan pada komorbid gangguan kesadaran. Nilai P=0,643 untuk perbaikan klinis setelah hari ke-5 pemberian antibiotik extended empiric monoterapi dengan dualterapi. Nilai ACER monoterapi lebih rendah (Rp.256.896,36) dibandingkan dualterapi (Rp.609.505,56) dengan antibiotik terbaik yaitu seftriakson serta kombinasi siprofloksasin dan seftriakson. Terdapat hubungan antara ketepatan penggunaan dengan biaya antibiotik extended empiric (r=0,282;P=0,005). Dari hasil penelitian tersebut dapat disimpulkan bahwa antara penggunaan antibiotik monoterapi dengan dualterapi tidak berbeda signifikan dalam luaran klinis setelah hari ke-5 pemberian antibiotik extended empiric, efektivitas biaya monoterapi lebih baik dibandingkan dualterapi dengan pilihan monoterapi terbaik adalah seftriakson dan dapat dipertimbangkan pemberian kombinasi siprofloksasin dan seftriakson pada komorbid gangguan kesadaran serta terdapat kekuatan hubungan sedang antara ketepatan penggunaan dengan biaya antibiotik extended empiric.

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Community-acquired pneumonia (CAP) is an acute inflammation of the pulmonary parenchyme caused by microorganisms and obtained from community. Optimal therapy for extended empirical antibiotics is debated so CAP management is still a major challenge. This study aims to analyze the comparison of therapeutic outcomes, cost effectiveness and the best choice of antibiotic therapy also the correlation between the accuracy of use and cost of monotherapy and dualtherapy extended empirical antibiotics in prospective cohort. The sampling time was June-September 2018 in the ED boarding room Fatmawati Hospital, Jakarta. Highest dualtherapy results for unconsciousness comorbid. P value=0,643 for clinical improvement after the 5th day of extended empiric monotherapy and dualtherapy. Monotherapy ACER is lower (Rp 256.896,36) than dualtherapy (Rp.609.505,56), the best antibiotics are ceftriaxone and ciprofloxacin-ceftriaxone. There is a relationship between the accuracy of use and cost of extended empiric antibiotics (r=0,282;P=0,005). It can be concluded that between the use of monotherapy and dualtherapy did not differ significantly in clinical outcomes after the 5th day, cost effectiveness of monotherapy was better than dualtherapy with the best choice was ceftriaxone and consideration of ciprofloxacin-ceftriaxone for unconsciousness comorbid, there is a moderate relationship between the accuracy of use and cost of extended empirical antibiotics."

"Latar belakang : Pneumonia komunitas (PK) merupakan penyakit dengan angka kejadian morbiditas dan mortalitas yang tinggi secara global. Sebagai penyakit infeksi maka respons inflamasi bisa diukur melalui beberapa serum biomarker yang bisa digunakan sebagai prediktor untuk lama rawat. Identifikasi pasien risiko tinggi lama rawat yang panjang dengan menggunakan kombinasi beberapa serum biomarker diharapkan bisa menjadi acuan dalam intervensi yang cepat dan tepat termasuk didalamnya penggunaan antibiotik sehingga berpengaruh pada luaran klinis pasien PK.Tujuan : Studi ini bertujuan untuk mendapat sistem skoring dengan menggunakan beberapa serum biomarker seperti prokalsitonin, C-reactive protein (CRP), leukosit, asam laktat, D-dimer dan albumin terhadap lama rawat pasien PK sedang beratMetode : Studi ini menggunakan desain kohort prospektif pasien PK sedang berat yang dirawat di IGD/ICU/HCU RSUPN dr. Cipto Mangunkusumo periode Mei 2022 s/d Juli 2023. Variabel-variabel prediktor lama rawat pasien PK sedang berat didapatkan dari hasil analisis multivariat dengan regresi logistik.Hasil : Dari total 360 subjek yang memiliki lama rawat > 14 hari sebanyak 204 subjek (56,67%) dan ≤ 14 hari sebanyak 156 subjek (44,44%). Variabel prediktor yang secara konsisten mempengaruhi lama rawat adalah asam laktat dengan RR 1,305 (IK 95% 1,097 – 1,551, p=0,003) dan albumin dengan RR 2,234 (IK 95% 1,164– 2,156, p=0,003). Performa determinan dengan analisis kurva ROC menunjukkan kemampuan prediksi lemah (AUC=0,629). Performa kalibrasi dengan uji Hosmer-Lemeshow test menunjukkan validasi baik (0,562). Biomarker lain yang dianggap signifikan dalam analisis bivariat yaitu prokalsitonin dengan RR 1,481 (IK 95% 1,121-1,954, p=0,006) dan C-reactive protein RR 2,465 (IK 95% 1,141-5,326). Leukosit dan D-dimer tidak dinilai signifikan sebagai biomarker PK sedang berat (p = 0,947).Simpulan : Terdapat hubungan antara asam laktat dan albumin dengan lama rawat pasien PK sedang berat. Tidak terdapat model skoring lama rawat pasien PK sedang berat.

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Background: Community-acquired pneumonia (CAP) is a disease with a high global incidence of morbidity and mortality. As an infectious disease, the inflammatory response can be measured through several serum biomarkers that can be used as predictors for the length of hospital stay (LOS). The identification of patients at high risk for prolonged hospitalization using a combination of several serum biomarkers is expected to serve as a reference for prompt and accurate interventions, including the use of antibiotics, thereby influencing the clinical outcomes of CAP patients.

Objective: This study aims to establish a scoring system using several serum biomarkers such as procalcitonin, C-reactive protein (CRP), leukocytes, lactic acid, D-dimer, and albumin for the length of hospital stay in patients with moderate to severe CAP.

Method: This study employs a prospective cohort design involving patients with moderate to severe CAP treated in the Emergency Department (ED), Intensive Care Unit (ICU), and High-Care Unit (HCU) at RSUPN dr. Cipto Mangunkusumo from May 2022 to July 2023. Variables to predict for the length of hospital stay in patients with moderate to severe CAP were obtained from multivariate analysis using logistic regression.

Results: A total of 360 subjects were included in this study, including 204 subjects (56.67%) with LOS more than 14 days, while 156 subjects (44.44%) had LOS of 14 days or less. The consistently influencing predictor variables for the length of hospital stay were lactate with RR 1.305 (95% CI 1.097–1.551, p=0.003) and albumin with RR 2.234 (95% CI 1.164–2.156, p=0.003). Determinant performance with ROC curve analysis showed weak predictive ability (AUC=0.629). Calibration performance with the Hosmer-Lemeshow test indicated good validation (0.562). Other biomarkers considered significant only in bivariate analysis were procalcitonin with RR 1.481 (95% CI 1.121–1.954, p=0.006) and C-reactive protein with RR 2.465 (95% CI 1.141–5.326). Leukocytes an D-dimer were not considered significant as a biomarker for moderate to severe CAP (p=0.947).

Conclusion: There is a relationship between lactate and albumin with the length of hospital stay in patients with moderate to severe CAP. However, there is no scoring model for the length of hospital stay in these patients."

"ABSTRAKPendahuluan: Pneumonia komunitas CAP salah satu penyebab kematian tertinggi. Tujuan mengetahui respons pengobatan selama perawatan pasien CAP secara empiris serta faktor yang berkaitan dengan pola kuman, respons pengobatan, gejala klinis, laboratorium, foto toraks, lama rawat dan faktor komorbid di RS persahabatan.Metode: Kohort prospektif pasien pneumonia komunitas rawat inap di RS Persahabatan selama 15 bulan terkumpul 47 pasien. Gejala klinis, hasil laboratorium, foto toraks dan hasil mikrobiologi. Sampel mirkobiologi dikumpulkan sebelum dan sesudah pemberian antibiotik.Hasil: Terkumpul 47 pasien. laki-laki 74,5% dan perempuan 25,5%. Rerata umur 61 tahun. Gejala klinis awal paling banyak sesak napas 51% berkurang 27,7% dan batuk 32% berkurang 23,4%. Nilai awal leukosit rerata 15,27. sel/mm3 berkurang 12,0. sel/mm3. Foto toraks awal infiltrat 89,3% menurun 38,3%. Patogen pada sputum sebelum penggobatan Klebseiella pneumonia 34,0%. Hasil sputum pasca terapi empiris eradikasi 91.5%. Pengobatan antibiotik tersering seftriakson. Faktor komorbid tersering keganasan rongga toraks. Lama rawat minimal 4 hari dengan terapi sulih minimal 3 hari.Kesimpulan: Pasien CAP paling dominan menunjukan gejala klinis sesak napas dan batuk, gambaran infiltrat pada foto toraks dan gram-negatif Klebsiella pneumonia pada sputum. Terjadi penurunan leukosit setelah pemberian antibiotik. Terapi empiris dengan antibiotik tunggal masih sensitif.

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ABSTRACTIntroduction : Pneumonia is the first leading disease with the highest mortality in hospitalized patients. The purpose of this study is to determine treatment response for the empirical treatment of CAP patients and factors associated with patterns of bacteria, treatment response, clinical symptoms, laboratory and chest X-ray, length of stay and comorbidities in Persahabatan Hospital, Jakarta. Methods : Prospective cohort study in hospitalized community acquired pneumonia patients at Persahabatan Hospital while 15 month. Clinical symptoms, laboratory findings, chest x-ray and microbiologic. Microbiologic sample is before and after antibiotic administration.Results : There were 47 patients. Male accounted 74,5% and female 25,5%. The average age was 61 years old. Clinical symptoms before treatment were dyspnea 51% decreased to 27,7% and cough 32% decreased to 23,4%. Leukocytes count was 15,27 cell/mm3 decreased to 12,0 cell/mm3. Chest x-ray infiltrates 89,3% decreased to 38,3%. Before-treatment microbiological patterns were K. pneumoniae 34,0%. Result after empirical treatment was eradication 91,5%. The most frequent innitial antibiotic administration was ceftriaxone.The most frequent comorbidity was thoracic malignancy. The patients were hospitalized at least for 4 days with replacement therapy at least for 3 days.Conclusion: Patients with CAP predominantly showed symptoms of dypnea and cough, infiltrates on chest x-ray and gram-negative Klebsiella pneumonia in sputum samples. There were resolution of leucocyte counts after antibiotic administration. Empirical antibiotic treatments with single drug were still sensitive."

"Community acquired pneumonia (CAP) oleh patogen resisten obat (PRO) memiliki tingkat keparahan yang tinggi. CAP akibat PRO memerlukan terapi antibiotik spektrum luas, skor Drugs Resistance in Pneumonia (DRIP) mampu memprediksi kasus tersebut. Penggunaan skor DRIP dapat mencegah kegagalan terapi antibiotik empirik dan mempersingkat lama rawatan, untuk itu diperlukan validasi. Penelitian ini merupakan studi Cohort Retrospektif pada pasien CAP yang dirawat inap selama periode Januari 2019 hingga Juni 2020. Data diambil dari rekam medis, kegagalan antibiotik bila terdapat kematian, pindah rawat ICU dan eskalasi antibiotik. Performa skor DRIP dianalisis dengan menentukan nilai kalibrasi dan diskriminasi, uji Hosmer-Lemeshow dan Area Under Curve (AUC). Diperoleh 480 pasien yang telah memenuhi kriteria. Terdapat 331 pasien (69%) dengan skor DRIP <4 dan 149 pasien (31%) dengan skor DRIP ≥4, dengan jumlah kegagalan antibiotik sebesar 283 pasien (59%), 174 pasien (61,4%) skor DRIP <4 dan 109 pasien (38,5%) skor DRIP ≥4. Kalibrasi DRIP menggunakan uji Hosmer-Lemeshow diperoleh p-value = 0,667 (p>0,05), diskriminasi AUC pada kurva ROC diperoleh 0,651 (IK 95%; 0,601-0,700). Skor DRIP menunjukkan performa yang cukup baik dalam memprediksi kegagalan antibiotic empiric pada pasien CAP yang terinfeksi PRO. Skor DRIP tidak berhubungan dengan lama rawatan di Rumah Sakit.

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Community-acquired pneumonia (CAP) caused by drug resistant pathogens (DRP) has a high level of severity. The incidence of CAP due to DRP requires broad spectrum antibiotic therapy, the Drugs Resistance in Pneumonia (DRIP) score is able to predict these cases. The use of the DRIP score can prevent antibiotic failure and minimize length of hospitalization, but validation is needed . This research is a retrospective cohort study in CAP patients who were hospitalized during the period January 2019 to June 2020. Data were taken from patient medical records, and failure of empiric antibiotics occurs when one of this criteria are found: patient mortality, ICU transfer and escalation of antibiotics as well as length of stay. Furthermore, the performance of the DRIP score was analyzed by determining the calibration and discrimination, using the Hosmer-Lemeshow test and the Area Under Curve (AUC). There were 480 patients who met the criteria. There were 331 patients (69%) with a DRIP score <4 and 149 patients (31%) with a DRIP score ≥4, with a total of 283 patients (59%) of antibiotic failures which were detailed in 174 patients (61.4%) with a DRIP score <4 and 109 patients (38.5%) DRIP score ≥4. DRIP calibration using the Hosmer-Lemeshow test obtained p-value=0.667 (p>0.05), AUC observations on the ROC curve obtained 0.651 (95% CI; 0.601-0.700). The DRIP score showed good performance in predicting failure of empiric antibiotics in infected CAP patients. PRO. The DRIP score is not related to the length of stay in the hospital."

"Latar Belakang. Hipoalbuminemia sudah diketahui merupakan faktor prediktor morbiditas dan mortalitas pada pasien usia lanjut dengan pneumonia dan CRP merupakan petanda klinis yang penting pada pneumonia. Namun hubungan antara kadar CRP dengan penurunan kadar albumin, sebagai protein fase akut negatif, saat infeksi akut belum pernah diteliti sebelumnya.Tujuan. Mendapatkan: (1) perbedaan kadar CRP awal perawatan antara pasien dengan daa tanpa penurunan albumin, (2) perbedaan risiko teradinya penurunan albumin antara pasien dengan kadar CRP awal tinggi dan rendah, dan (3) korelasi antara kadar CRP dan albumin saat awal perawatan pada pasien-pasien usia lanjut dengan pneumonia komunitas yang dirawat di rumah sakit.Metodalogi. Stuart potong-lintang dan kohort-prospektif dilakukan pada pasien-pasien usia lanjut (>60 tahun) dengan diagnosis pneumonia komunitas yang dirawat di RSCM, untuk diamati penurunan kadar albuminnya selama 5 hari perawatan. Pasien-pasien dengan keadaan-keadaan yang dapat mempengaruhi kadar albumin dan CRP, serta infeksi selain pn nimcnia komunitas dieksklusi dari penelitian. Penilaian kadar CRP dilakukan pada hari pertama perawatan (cut-off 20 mg/L), sementara penurunan albumin ditentukan dari perubahan kadar albumin selama 5 hari perawatan (cut-off 10%). Analisis statistik dilakukan dengan uji-t independen, uji chi-square, dan uji korelasi sesuai dengan tujuan penelitian.Hasil Utama. Selama periode April-Juni 2005 terkumpul 26 pasien usia lanjut dengan pneumonia komunitas yang masuk perawatan di RSCM. Hanya 23 pasien yang menyelesaikan penelitian sampai 5 hari dengan 17 pasien memiliki kadar CRP awal tinggi, dan didapatkan penurunan albumin >10% pada 7 pasien setelah 5 hari perawatan. Terdapat perbedaan rerata kadar CRP hari-1 diantara kedua kelompok (175,36 mgfL vs 75,67 mg/L; P = 0,026; 1K95% 13,25-186,13 mgfL). Namun tidak didapatkan perbedaan risiko bermakna antara pasien dengan kadar CRP tinggi dengan pasien dengan kadar CRP rendah scat awal dengan terjadinya penurunan albumin saat awal perawatan (RR = 2,12; P = 0,621; 11(95% 0,256-29,07). Tidak didapatkan pula korelasi antara kadar CRP dan albumin saat awal perawatan (r = 0,205, P = 0,314)Kesimpulan. Tingginya kadar CRP awal perawatan berhubungan dengan terjadinya penurunan kadar albumin selama perawatan, namun tidak ada perbedaan risiko terjadinya penurunan albumin selama perawatan antara pasien dengan CRP awal tinggi dan CRP awal rendah, serta tidak ada korelasi antara kadar CRP dan albumin scat awal perawatan pada pasien-pasien usia lanjut dengan pneumonia komunitas yang dirawat di rumah sakit.

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Backgrounds. Hypoalbuminemia widely known as a predictive factor for increasing morbidity and mortality in elderly patients, including with pneumonia; while CRP has known as a clinical marker for pneumonia. But relationship between CRP level with decrease of serum albumin level, as a negative acute-phase protein, during acute infection has never been studied before.

Objectives. To found: (1) CRP level difference between patient with and without decreased of serum albumin level, (2) risk for developing decreased of serum albumin level in patients with high CRP compared to patients with low CRP level, and (3) correlation between CRP and albumin level on admission in hospitalized elderly patients with community-acquired pneumonia.

Methods. Cross-sectional and prospective-cohort studies was conducted in hospitalized elderly patients with community-acquired pneumonia that admitted to RSCM, to observed the decreased of serum albumin level in five days of hospitalization. Conditions that known could influence CRP and albumin consentration have been excluded, and other infections as well. CRP level was determined on admission (cut-off 20 mgfL), while decreased of serum albumin was observed for 5 days of hospitalization (cu[-off 10%). Statistical analysis was done by using independent t-test, chi-square test, and correlation test appropriately accord-ing to the objectives of the study.

Main Results. During study period (April to June, 2005) 26 hospitalized elderly patients with community-acquired pneumonia had been included into study, but only 23 of them that finished the study for 5 days. There were 17 patients that have high level of CRP on admission, and 7 patiens that developing decreased of serum albumin level more than 10% in fifth day compared to their serum albumin level on admission. There was significant mean CRP difference among 2 groups (175,36 mgfL vs 75,67 mg/L; P = 0,026; 95%CI 13,25-186,13 mgfL), but there was no risk difference between patients with high and low CRP level on admission for developing decreased albumin level on fifth day of hospitalization (RR = 2,12; P = 0,621; 95%CI 0,256-29,07). And there was no correlation between CRP and albumin level on admission (r = 0,205, P = 0,314)

Conclusions. Patients with high CRP level on admission tend to have decreased of serum albumin level during hospitalization, but there was no risk difference for developing decreased of serum albumin level between patients with high and low CRP level, and there was no correlation between CRP and albumin level on admission in hospitalized elderly patients with community-acquired pneumonia."

"ABSTRAKPneumonia adalah penyakit infeksi yang menular melalui udara. Karakteristik kota yang memiliki kepadatan penduduk, pemukiman dan transportasi, membuat penyebaran pneumonia menjadi lebih mudah. Salah satu masalah keperawatan pada pneumonia adalah ketidakefektifan bersihan jalan nafas. Studi kasus ini bertujuan untuk menganalisis pemberian intervensi yaitu batuk efektif, positioning, dan inhalasi pada klien dengan Closed Pathological Fracture Bilateral dengan Community Acquired Pneumonia. Hasil yang diperoleh yaitu pengeluaran sekret yang kurang maksimal berhubungan dengan keterbatasan pasien dalam melakukan mobilisasi dan positoning karena nyeri akibat fraktur. Rekomendasi untuk intervensi selanjutnya adalah pemberian posisi semi fowler 45 atau tegak lurus harus diupayakan agar terjadi pengembangan ekspansi paru yang dapat meningkatkan tekanan ekspirasi maksimum yang memudahkan dalam pengeluaran sekret.

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ABSTRACTPneumonia is an airbone infectious disease. Urban is characterized by its density of residents, living area and transportation which make the spreading of infectious disease is easier. One of the nursing problem of Pneumonia is Ineffective Airway Clearance. This case study was conducted to analyze the intervention of the effective cough, positioning and inhalation for client who had closed pathological bilateral fracture with community acquired pneumonia. The results of the intervention showed less optimal in mucous secretion related to client rsquo s immobilization and position because of pain due to fractures. This study recommend nurses should give positioning for 45 semi fowler or sit to maximize the pulmonary expansion which may increase the maximum expiratory pressure which facilitates the discharge of secretions."