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"Tuberkulosis merupakan penyakit menular yang disebabkan oleh bakteri mycobacterium tuberculosis. Salah satu penyebab perburukan dan kematian pada pasien dengan tuberkulosis paru adalah adanya sepsis. Sepsis merupakan disfungsi organ mengancam nyawa yang disebabkan oleh disregulasi respon host terhadap infeksi. Syok sepsis akibat tuberkulosis dapat menyebabkan beberapa gejala yang umum pada tuberkulosis, seperti demam dan sesak napas hingga disfungsi multiorgan. Angka kematian yang tinggi dan kesalahan diagnosis sepsis pada tuberkulosis masih umum terjadi. Oleh karena itu, perawat berperan penting dalam pengenalan dini dan perawatan pada pasien dengan sepsis. Penulisan karya ilmiah ini bertujuan untuk memaparkan hasil praktik mengenai pemberian asuhan keperawatan pada pasien tuberkulosis paru dengan sepsis. Analisis asuhan keperawatan dilakukan pada pasien laki-laki berusia 49 tahun yang mengalami tuberkulosis paru disertai dengan sepsis di ruang rawat inap. Masalah keperawatan yang dapat diangkat pada kasus pasien dengan sepsis, antara lain bersihan jalan napas tidak efektif, ketidakseimbangan nutrisi: kurang dari kebutuhan tubuh, dan risiko syok. Penerapan intervensi pada karya ilmiah ini khususnya berfokus untuk menangani risiko syok dengan menggunakan bundel yang disertai dengan perawatan terperinci pada pasien. Intervensi diberikan selama empat hari kepada pasien. Intervensi yang diterapkan efektif dalam meningkatkan kondisi klinis pasien ketika dilakukan penerapan, namun tidak berdampak signifikan pada peningkatan kondisi klinis pasien secara kumulatif.

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Tuberculosis is an infectious disease caused by the bacteria mycobacterium tuberculosis. One of the causes of deterioration and death in patients with pulmonary tuberculosis is sepsis. Sepsis is a life-threatening organ dysfunction caused by dysregulation of the host response to infection. Septic shock due to tuberculosis can cause several symptoms common to tuberculosis, such as fever and shortness of breath to multiorgan dysfunction. The high mortality rate and misdiagnosis of sepsis in tuberculosis are still common. Therefore, nurses play an important role in early recognition and treatment of patients with sepsis. The aim of writing this scientific work is to present practical results regarding the provision of nursing care to pulmonary tuberculosis patients with sepsis. Analysis of nursing care was carried out on a 49 year old male patient who experienced pulmonary tuberculosis accompanied by sepsis in the inpatient room. Nursing problems that can be raised in cases of patients with sepsis include ineffective airway clearance, imbalanced nutrition: less than body requirements, and risk of shock. The implementation of interventions in this scientific work specifically focuses on managing the risk of shock using a bundle accompanied by detailed patient care. The intervention was given for four days to the patient. The intervention implemented was effective in improving the patient's clinical condition when implemented, but did not have a significant impact on improving the patient's clinical condition cumulatively."

"Pendahuluan: Tuberkulosis adalah penyakit menular yang disebabkan oleh kuman Mycobacterium tuberculosis melalui transmisi udara (airborne disease), sedangkan Ca paru merupakan pertumbuhan sel-sel kanker yang tidak dapat terkendali dalam jaringan paru yang menyebabkan adanya massa abnormal paru. Gejala yang timbul pada pasien TB dengan riwayat Ca paru dapat terjadi bervariasi, yaitu batuk berdahak selama 2 minggu atau lebih, batuk darah, sesak napas, nyeri dada. Sesak napas yang dirasakan pasien dapat menganggu kenyamanan dan aktivitas pasien. Karya Ilmiah Akhir Ners ini bertujuan untuk menganalisis latihan pernapasan diafragma dan posisi semiflower 30o dalam mengatasi masalah pola napas tidak efektif pada pasien tuberculosis dengan riwayat Ca paru pada ruang isolasi lantai 14 RSUI. Ilustrasi kasus: Pasien datang dengan keluhan sesak napas yang semakin memberat 2 miggu sebelum masuk rumah sakit. Sesak dirasakan semakin memberat. Pasien didiagnosis tuberculosis dan memiliki riwayat Ca Paru. Hasil pengkajian mendapatkan pasien tampak sesak, terapat penggunaan otot bantu napas, dan peningkatan frekuensi napas. Tindakan mandiri keperawatan yang dilakukan adalah mengajarkan latihan pernapasan diafragma dan pemberian posisi semiflower 30o. Hasil: latihan pernapasan diafragma dan posisi semiflower 30o selama 3-4 menit dengan 1 set/hari membantu pasien mengurangi sesak napas dan meningkatkan rasa nyaman yang dirasakan pasien. Kesimpulan: Hasil evaluasi yang dilakukan pada pasien menunjukan bahwa penerapan latihan pernapasan diafragma dan posisi semiflower 30o dapat membentu pasien mengurangi sesak napas diniliai dari penurunan frekuensi napas, usaha napas dengan observasi pengunaan otot bantu napas, dan peningkatan saturasi pasien.

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Introduction: Tuberculosis is an infectious disease caused by the bacterium Mycobacterium tuberculosis which is transmitted through airborne transmission (airborne disease), while lung Ca is the uncontrolled growth of cancer cells in lung tissue that causes abnormal lung masses. Symptoms in TB patients with a history of pulmonary Ca are coughing up phlegm for 2 weeks or more, coughing up blood, dyspenea, chest pain. Dyspnea felt by the patient can disturbing the patient's comfort and activities. This KIAN aims to analyze diaphragmatic breathing exercises and the 30o semiflower position in overcoming the problem of ineffective breathing patterns in tuberculosis patients with a history of pulmonary Ca in the isolation room on the 14th floor of RSUI.

Case illustration: The patient came with complaints of shortness of breath which was getting worse 2 weeks before admission to the hospital. The feeling of tightness is getting worse. The patient was diagnosed with tuberculosis and had a history of lung cancer. The results of the study found that the patient appeared dyspnea, the use of accessory muscles of breathing was tight, and the frequency of breathing increased. The independent nursing intervention taken was diaphragmatic breathing excercise and giving the 30o semiflower position.

Results: diaphragm breathing and 30o semiflower position for 3-4 minutes with 1 set/day help patients reduce dyspnea and increase patient comfort.

Conclusion: The results of the evaluation carried out on the patient showed that the application of diaphragm breathing and the 30o semiflower position could help the patient reduce dyspnea judged by a decrease in respiratory rate, use of accessory muscles for breathing, and an increase oxygen saturation."

"Praktik keperawatan residensi yang dilakukan di Rumah Sakit Persahabatan dengan kekhususan respirasi diharapkan dapat mengatasi masalah pernapasan. Selama menjalani proses residensi, residen berperan menjadi seorang Clinical Care Manajer (CCM) yang bertugas sebagai konsultan keperawatan bagi staf keperawatan dan pemberi terapi keperawatan kepada pasien, sebagai peneliti serta pendidik dalam rangka pemberi asuhan keperawatan untuk meningkatkan mutu atau kualitas asuhan keperawatan. Dalam memberikan asuhan keperawatan, residen menerapkan model adaptasi Roy baik pada kasus kelolaan dengan diagnosa TB paru On OAT bulan ke-2 maupun pada 30 kasus resume, pada kasus resume ini didapatkan diagnosa medis terbanyak adalah kanker paru, diagnosa keperawatan terbanyak pola napas tidak efektif dan intervensi keperawatan yang paling banyak adalah manajemen airway. Penerapan model adaptasi Roy menunjukkan peran perawat sebagai pemberi asuhan keperawatan dalam membantu individu, baik dalam kondisi sakit maupun pada proses penyembuhan dan peningkatan pemeliharaan kesehatan di setiap mode fisiologis, konsep diri, fungsi peran dan interdependen. Selama melakukan asuhan keperawatan, masalah keperawatan yang banyak muncul yaitu pada mode fisiologis berupa masalah gangguan oksigenasi. Hasil analisis praktik residensi keperawatan didapatkan bahwa asuhan keperawatan menggunakan pendekatan model adaptasi Roy bertujuan untuk membantu individu sesegera mungkin beradaptasi terhadap stimulus baik stimulus internal maupun stimulus eksternal. Pada penerapan Evidence Base Nursing (EBN), residen melakukan penerapan foot massage yang bertujuan untuk mengurangi kecemasan dan parameter fisiologis pada pasien yang akan menjalani tindakan bronkoksopi. Hasil penerapan EBN menunjukan bahwa ada pengaruh pemberian foot massage dalam mengurangi kecemasan dan parameter fisiologis. Pada proyek inovasi, dilakukan program peningkatan kemampuan perawat dalam melakukan perawatan pada pasien yang terpasang WSD yang mencakup skrining awal, sebelum pemasangan WSD, saat pemasangan WSD, selama terpasang WSD, saat pencabutan dan perawatan luka WSD yang telah terstandar, berbasis bukti, sistematis dan terstruktur. Tujuan dari inovasi ini untuk meningkatkan kemampuan dan pengetahuan perawat dalam melakukan perawatan WSD dan terciptanya booklet sebagai pedoman standar intervensi perawatan WSD.

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Residency nursing practice carried out at Persahabatan Hospital with a respiratory specialty is expected to be able to overcome respiratory problems. During the residency process, the resident plays the role of a Clinical Care Manager (CCM) who serves as a nursing consultant for nursing staff and provides nursing therapy to patients, as a researcher and educator in the context of providing nursing care to improve the quality of nursing care. In providing nursing care, residents apply Roy's adaptation model both in cases managed with a diagnosis of pulmonary TB On OAT in the 2nd month and in 30 resume cases, in these resume cases the most medical diagnoses were lung cancer, the most nursing diagnoses were ineffective breathing patterns and The most common nursing intervention is airway management. The application of Roy's adaptation model shows the role of nurses as providers of nursing care in helping individuals, both in sick conditions and in the healing process and improving health maintenance in every physiological, self-concept, role and interdependent mode. During nursing care, nursing problems that often arise are in the physiological mode in the form of problems with oxygenation disorders. The results of the analysis of nursing residency practice showed that nursing care using the Roy adaptation model approach aims to help individuals adapt as quickly as possible to stimuli, both internal and external stimuli.

In implementing Evidence Base Nursing (EBN), residents apply foot massage which aims to reduce anxiety and physiological parameters in patients who will undergo bronchoscopy. The results of applying EBN show that there is an effect of giving foot massage in reducing anxiety and physiological parameters. In the innovation project, a program was carried out to increase the ability of nurses to provide care for patients with WSDs which included initial screening, before installing the WSD, during the installation of the WSD, during the installation of the WSD, during extraction and standard, evidence-based, systematic and structured WSD wound care. . The aim of this innovation is to increase nurses' abilities and knowledge in carrying out WSD care and to create a booklet as a standard guide for WSD care interventions.

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"Tuberkulosis adalah penyakit yang sering muncul pada masyarakat miskin perkotaan. Spondilitis Tuberkulosis merupakan komplikasi dari TB yang dapat menyebabkan perubahan struktur dan kekuatan tulang belakang dengan resiko kelumpuhan dan cedera tulang belakang dan biasanya ditandai dengan gejala awal nyeri. Nyeri tersebut diakibatkan pertumbuhan abnormal kuman Tuberkulosis yang menjadi massa pada tulang belakang dan menyebabkan tertekannya jaringan saraf spinal. Treatment Operasi debridemen akan mengakibatkan nyeri pasca operasi dilakukan. Peran perawat dalam mengatasi masalah nyeri tersebut adalah dengan edukasi manfaat pemasangan spinal brace, sehingga klien tidak takut akan terjadi nyeri saat melakukan mobilisasi. Setelah dilakukan intervensi, pengetahuan klien bertambah, nyeri klien berkurang dan dapat melakukan mobilisasi.

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Tuberculosis is a disease that often occurs in the poor urban. Spondylitis tuberculosis a complication of of TB that can cause the sea and strength of the spine with risk paralysis and spinal cord injury and usually characterized by the initial symptoms of pain. The pain caused by an abnormal growth germ tuberculosis who into a mass on the spinal cord and cause pressured nerve tissue spinal. Treatment operation debridement will result in pain postoperative do. The role of nurse in to overcome the problem of pain was to education benefits the installation of spinal brace, that clients not afraid will happen pain on do mobilization. After conducted intervention, knowledge client?s increase, pain client?s reduced and can do mobilization."

"Praktek Spesialis Keperawatan merupakan sebuah proses penting dari pendidikan profesi dalam rangka mengaplikasikan peran seorang perawat spesialis yang memberikan dampak dalam upaya meningkatkan kualitas layanan keperawatan. Praktek ini dilakukan dan dikembangkan berdasarkan ilmu pengetahuan dan teknologi melalui penelitian yang berbasis fakta dan dengan pendekatan teori Henderson dan teori sosial kognitif Bandura di RS Persahabatan dan RS Fatmawati Jakarta. Tiga kompetensi yang harus dicapai dalam praktek residensi ini adalah memberikan asuhan keperawatan menggunakan pendekatan teori keperawatan, menerapkan implementasi keperawatan yang berbasis bukti ilmiah (evidence based nursing practice), dan melakukan proyek inovasi keperawatan yang berguna bagi lahan yang menjadi tempat praktek residensi. Mahasiswa residensi sebagai pemberi asuhan keperawatan telah memberikan asuhan keperawatan menggunakan pendekatan teori Henderson pada satu kasus kelolaan utama dan 30 kasus resume pasien HIV/AIDS dengan berbagai infeksi oportunitis. Tugas mahasiswa residensi sebagai peneliti telah mengaplikasi penerapan efektifitas terapi musik untuk menurunkan tingkat stes pada pasien dengan penyakit kronis dan hasil dari evidence based nursing ini menunjukkan bahwa terapi musik memberikan hasil yang signifikan untuk menurunkan tingkat stres pada pasien dengan penyakit kronis. Fungsi sebagai innovator, mahasiswa residensi telah melakukan inovasi yaitu pembuatan modul peer group dalam meningkatkan dukungan emosional dan kepatuhan minum obat pada ODHIV dan hasil penerapan proyek inovasi ini menunjukkan manfaat yang sangat signifikan bagi ODHIV dalam meningkatkan kepatuhan minum obat ART.

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Nursing Specialist Practice is an important process of professional education in order to apply the role of a specialist nurse which has an impact in efforts to improve the quality of nursing services. This practice is carried out and developed based on science and technology through fact-based research and using Henderson's theoretical approach and Bandura's social cognitive theory at Persahabatan Hospital and Fatmawati Hospital, Jakarta. The three competencies that must be achieved in this residency practice are providing nursing care using a nursing theory approach, implementing nursing implementation based on scientific evidence (evidence based nursing practice), and carrying out nursing innovation projects that are useful for the land where the residency practice takes place. Residency students as providers of nursing care have provided nursing care using Henderson's theoretical approach to one primary management case and 30 resume cases of HIV/AIDS patients with various opportunistic infections. The job of residency students as researchers has been to apply the effectiveness of music therapy to reduce stress levels in patients with chronic illnesses and the results of this evidence-based nursing show that music therapy provides significant results in reducing stress levels in patients with chronic illnesses. Functioning as innovators, residency students have innovated, namely creating a peer group module to increase emotional support and medication adherence for PLWHA and the results of implementing this innovation project show very significant benefits for PLWHA in increasing adherence to taking ART medication."

"Masyarakat perkotaan berisiko mengalami masalah kesehatan karena adanya gaya hidup dan lingkungan yang buruk. Salah satu penyakit yang dipengaruhi kedua faktor terebut yaitu tuberkulosis paru. Selain menimbulkan dampak fisik, tuberkulosis paru juga menimbulkan dampak psikososial. Masalah psikososial yang paling sering ditemui yaitu ansietas. Akibat ansietas jika tidak teratasi dapat menimbulkan depresi dan ketidakpatuhan pengobatan sehingga memperburuk prognosa. Karya Ilmiah Akhir Ners ini melaporkan hasil praktik keperawatan kesehatan masyarakat perkotaan terkait asuhan keperawatan pada klien ansietas dengan tuberkulosis paru.

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Urban community has risk health problems because of their unhealthy lifestyle and environment. One the health diseases that influenced by those factors is lung tuberculosis. Tuberculosis do not only cause in physical but also psychosocial problems. Anxiety is one of the psychosocial problems that most often found. Hospitalization and the tuberculosis symptoms experienced by the client is the causes of anxiety. Anxiety that is not resolved can lead to depression and non compliance which may worsen the prognosis. This final scientific task is to report nursing care plan in urban community nursing to a client with anxiety associated with lung tuberculosis."

"[ABSTRAK Praktik residensi keperawatan medikal bedah peminatan sistem respirasi memiliki tujuan untuk menjalankan tiga peran ners spesialis. Peran sebagai manajer kasus, pemberi layanan dan inovator. Sebagai manajer kasus, residen mengelola kasus utama pasien tuberculosis dan diabetes mellitus, dan 30 kasus resume dengan menggunakan Teori Self-Care Orem. Masalah keperawatan utama yang paling sering muncul adalah ketidakefektifan bersihan jalan napas. Sebagai pemberi layanan, residen telah menerapkan intervensi keperawatan berdasarkan pembuktian yaitu oral hygiene dengan chlorhexidine 0,12% yang dapat mencegah terjadinya Ventilator Associated Pneumonia (VAP). Inovasi keperawatan yang dilakukan yaitu modifikasi Water Seal Drainage (WSD) 1 botol yang telah mendapatkan respon yang baik dari para ahli dibidangnya untuk meningkatkan keselamatan pasien dan keselamatan pekerja atau petugas kesehatan dalam proses asuhan keperawatan.ABSTRACT The purpose of medical-surgical nurse resident in respiratory system clinical practice is to perform three roles of a nurse specialist as a case manager, healthcare provider and innovator. As a case manager, the resident managed a case of Tuberculosis and Diabetes Mellitus patient, and 30 resume cases with Orem Self-Care theory approach. The main nursing problem found during the clinical practice was ineffective airway clearance. As a healthcare provider, the resident had applied an evidence-based nursing intervention that has been using chlorhexidine 0,12% in oral hygiene procedure that can prevent Ventilator Associated Pneumonia (VAP). As an innovator, resident had made a modification of one bottle water-sealed drainage that has received good response from the experts to increase patients and employers or healthcare provider safety during the nursing care process.;The purpose of medical-surgical nurse resident in respiratory system clinical practice is to perform three roles of a nurse specialist as a case manager, healthcare provider and innovator. As a case manager, the resident managed a case of Tuberculosis and Diabetes Mellitus patient, and 30 resume cases with Orem Self-Care theory approach. The main nursing problem found during the clinical practice was ineffective airway clearance. As a healthcare provider, the resident had applied an evidence-based nursing intervention that has been using chlorhexidine 0,12% in oral hygiene procedure that can prevent Ventilator Associated Pneumonia (VAP). As an innovator, resident had made a modification of one bottle water-sealed drainage that has received good response from the experts to increase patients and employers or healthcare provider safety during the nursing care process., The purpose of medical-surgical nurse resident in respiratory system clinical practice is to perform three roles of a nurse specialist as a case manager, healthcare provider and innovator. As a case manager, the resident managed a case of Tuberculosis and Diabetes Mellitus patient, and 30 resume cases with Orem Self-Care theory approach. The main nursing problem found during the clinical practice was ineffective airway clearance. As a healthcare provider, the resident had applied an evidence-based nursing intervention that has been using chlorhexidine 0,12% in oral hygiene procedure that can prevent Ventilator Associated Pneumonia (VAP). As an innovator, resident had made a modification of one bottle water-sealed drainage that has received good response from the experts to increase patients and employers or healthcare provider safety during the nursing care process.]"