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Nyeri akut adalah salah satu masalah keperawatan yang sering muncul pada klien post laparoskopi kolesistektomi dan berdampak pada aktivitas sehari-hari klien. Nyeri akut pada klien dapat diatasi dengan manajemen nyeri farmakologi dan non-farmakologi. Karya ilmiah akhir ini bertujuan untuk menganalisis manajemen nyeri teknik relaksasi pada klien kolelitiasis post laparoskopi kolesistektomi. Data pengkajian dianalisis dan didapatkan masalah keperawatan utama pada klien yaitu nyeri akut. Penulis melakukan analisis terhadap 8 literature review untuk menyusun asuhan keperawatan pada klien post laparoskopi kolesistektomi. Hasil analisis didapatkan bahwa manajemen nyeri farmakologi dengan pemberian ketorolak  dapat membantu mengurangi nyeri post laparoskopi kolesistektomi. Sedangkan manajemen nyeri non-farmakologi teknik relaksasi efektif untuk mengurangi nyeri pada klien post laparoskopi kolesistektomi. Edukasi teknik relaksasi pada klien merupakan salah satu peran perawat, agar manfaat teknik relaksasi untuk mengurangi nyeri post laparoskopi kolesistektomi dapat dirasakan oleh klien

 

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Acute pain is one of the nursing problems that often arises in post-laparoscopic cholecystectomy clients and impacts on clients daily activities. Acute pain in the client can be overcome by pharmacological and non-pharmacological pain management. This final scientific work aims to analyze the pain management of relaxation techniques in post-laparoscopic cholecystectomy clients. The assessment data were analyzed and the main nursing problem for the client was acute Pain. The author conducted an analysis of 8 literature reviews related to compile nursing care in post-laparoscopic cholecystectomy clients. The results of the analysis found that pharmacological pain management by giving ketorolac can help reduce post-laparoscopic cholecystectomy pain. Whereas non-pharmacological pain management relaxation techniques are effective for reducing pain in post laparoscopic cholecystectomy clients. Relaxation education on clients is one of the roles of nurses, so that the benefits of relaxation techniques to reduce post laparoscopic cholecystectomy pain can be felt by the client.

 

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"ABSTRAKTeknik laparoskopi kolesistektomi merupakan baku emas untuk penanganan kolelitiasis simptomatik. Angka kejadian rawat inap ulang merupakan representasi dari kualitas perawatan yang diberikan Rumah Sakit. Kejadian rawat inap ulang dapat dipengaruhi oleh berbagai macam faktor, baik faktor fisik, sosial budaya, dan medikal pasien. Tujuan penelitian: Menganalisis faktor-faktor yang berhubungan dengan kejadian rawat inap ulang pada pasien paska laparoskopi kolesistektomi. Penelitian ini menggunakan desain cross-sectional dengan pendekatan retrospektif dan memilih 80 responden dengan tehnik consecutive sampling. Metode pengumpulan data dengan kuesioner dan lembar pengumpulan data. Analisis hasil penelitian menggunakan uji korelasi Spearman dan Coefficient contingency, serta uji komparasi Mann-Whitney. Analisis multivariat menggunakan regresi linier. Hasil penelitian menunjukkan bahwa faktor kejadian rawat inap ulang pasien paska laparoskopi kolesistektomi ditentukan usia, tingkat ekonomi, kepatuhan diet, dan tingkat aktivitas pasien sebesar 54,1%, sedangkan sisanya ditentukan oleh faktor lain. Faktor yang paling dominan berhubungan dengan kejadian rawat inap ulang paska laparoskopi kolesistektomi adalah tingkat aktivitas (β= -0,383).

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ABSTRACT

Laparoscopic cholecystectomy is the gold standard for the treatment of symptomatic cholelithiasis. The incidence of readmission is a representation of the quality of care provided by the Hospital. Readmission can be influenced by various factors, both physical, socio-cultural, and medical factors. Objective: To analyze factors associated with readmission patients with laparoscopic cholecystectomy. This study used cross-sectional design with retrospective approach and recruited 80 respondents by consecutive sampling technique. Methods of data collection with questionnaires and data collection sheets. Analysis used Spearman and Contingency coefficient correlation, and Mann-Whitney comparison test. Multivariate analysis used linear regression. The results showed that readmission patients pasca laparoscopic cholecystectomy determined by age, economic level, diet adherence, and activity level amounted to 54.1%, while the rest is determined by other factors. The most dominant factor associated with the incidence of readmission pasca laparoscopic cholecystectomy is the level of activity (β = -0,383)."

"ABSTRAK Latar belakang: Kolesistektomi merupakan tindakan abdomen tersering dan saat inikolesistektomi laparoskopi (KL) merupakan baku emas dan telah dilakukan pada 90% kasuskolesistitis simtomatik. Tujuan penelitian ini adalah untuk mengetahui hasil KL di RSCM,Jakarta. Metode: Penelitian retrospektif observasional ini menggunakan data dari departemen bedahdivisi digestif RSCM dari bulan Januari hingga Desember 2014. Partisipan penelitian iniadalah pria atau wanita yang berusia 23-66 tahun yang menjalani KL. Tindakan bedahdilakukan baik berupa perawatan 1 hari (one day care (ODC)) maupun elektif. Data yangdikaji adalah temuan preoperatif dan intraoperatif, durasi operasi, lama rawat inap, dan angkakonversi ke tindakan kolesistektomi terbuka (open). Kemudian kami menganalisis faktoryang mempengaruhi angka konversi. Hasil: Jumlah pasien yang masuk inklusi adalah 90 orang. Usia rata-rata 43,9 tahun (SE=1,26tahun) dengan jumlah pasien wanita 61 orang (67,8%). Median durasi operasi adalah 90±36,9menit dimana pasien yang konversi membutuhkan operasi lebih dari 2 jam lebih banyak(12% vs 1,5%), namun tidak bermakna secara statistik (p= 0,63). Median lama rawat inapadalah 9±27.2 hari dan meningkat bermakna pada kasus yag konversi (24±9 hari, p = 0.011).Median lama pre-operasi = 7±26,8 hari, dan pasca-operasi = 2±3.8 hari, dengan 13,3% pasiendilakukan endoscopic retrograde cholangio-pancreatography (ERCP) sebelum KL. Cederaduktus biliaris komunis (CBDK) ditemukan pada 3 kasus (3,33%). Konversi menjadilaparotomi dibutuhkan pada 4,44% kasus. Faktor yang mempengaruhi angka konversi hanyapada kasus adhesi (RR (95%IK) = 25,7 (2,4-273,5); p=0,007. Kesimpulan temuan: kolesistektomi laparoskopi menawarkan lama rawat inap yang lebihsingkat. Durasi operasi pendek dan prosedur ini standard, aman, dan efektif di institusi kami. ABSTRACT Background: Cholecystectomy is the most frequently performed abdominal operation andcurrently laparoscopic cholecystectomy (LC) is considered gold standard being performed in90% cases of symptomatic gallstones. The aim of the study was to determine results obtainedwith LC at our hospital, RSCM, Jakarta. Methods: This retrospective observational study was conducted in digestive divison insurgery department of RSCM using data from January to December 2014. The studyparticipants were patients of both gender aged 23?66 years undergoing LC. Surgery wasperformed either in one day care (ODC) or elective schedule. Demographic variables,preoperative and intraoperative findings, mean operation time, hospital stay, and conversionrate were evaluated. Factors influencing rate of conversion were also studied. Results: A total of 90 patients were included. Mean age was 43.9 years (SE=1.26 years) witha female 61 (67.8%). Median operative time was 90±36.9 minutes which converted casespatient needed to operate in more than 2 hours (12% vs 1.5%), but not statistically significant(p= 0.63). Median hospital stay was 9±27.2 days that significantly increased in convertedcases (24±9 days, p-value= 0.011). Median of pre-operation = 7±26.8 days, and postoperation= 2±3.8 days, with 13.3% patients underwent endoscopic retrograde cholangiopancreatography(ERCP). Common bile duct injury (CBDI) was found in 3 cases (3.33%).Conversion to laparotomy was required in 4.44% cases. Factors that influenced the rate ofconversion included was only adhesion (RR (95%CI) = 25.7 (2.4-273.5), p=0.007. Findings: Laparoscopic cholecystectomy offers shorter hospital stay. The operative time isshort and procedure is standard, safe and effective in our institution.;Background: Cholecystectomy is the most frequently performed abdominal operation andcurrently laparoscopic cholecystectomy (LC) is considered gold standard being performed in90% cases of symptomatic gallstones. The aim of the study was to determine results obtainedwith LC at our hospital, RSCM, Jakarta. Methods: This retrospective observational study was conducted in digestive divison insurgery department of RSCM using data from January to December 2014. The studyparticipants were patients of both gender aged 23?66 years undergoing LC. Surgery wasperformed either in one day care (ODC) or elective schedule. Demographic variables,preoperative and intraoperative findings, mean operation time, hospital stay, and conversionrate were evaluated. Factors influencing rate of conversion were also studied. Results: A total of 90 patients were included. Mean age was 43.9 years (SE=1.26 years) witha female 61 (67.8%). Median operative time was 90±36.9 minutes which converted casespatient needed to operate in more than 2 hours (12% vs 1.5%), but not statistically significant(p= 0.63). Median hospital stay was 9±27.2 days that significantly increased in convertedcases (24±9 days, p-value= 0.011). Median of pre-operation = 7±26.8 days, and postoperation= 2±3.8 days, with 13.3% patients underwent endoscopic retrograde cholangiopancreatography(ERCP). Common bile duct injury (CBDI) was found in 3 cases (3.33%).Conversion to laparotomy was required in 4.44% cases. Factors that influenced the rate ofconversion included was only adhesion (RR (95%CI) = 25.7 (2.4-273.5), p=0.007. Findings: Laparoscopic cholecystectomy offers shorter hospital stay. The operative time isshort and procedure is standard, safe and effective in our institution.;Background: Cholecystectomy is the most frequently performed abdominal operation andcurrently laparoscopic cholecystectomy (LC) is considered gold standard being performed in90% cases of symptomatic gallstones. The aim of the study was to determine results obtainedwith LC at our hospital, RSCM, Jakarta. Methods: This retrospective observational study was conducted in digestive divison insurgery department of RSCM using data from January to December 2014. The studyparticipants were patients of both gender aged 23?66 years undergoing LC. Surgery wasperformed either in one day care (ODC) or elective schedule. Demographic variables,preoperative and intraoperative findings, mean operation time, hospital stay, and conversionrate were evaluated. Factors influencing rate of conversion were also studied. Results: A total of 90 patients were included. Mean age was 43.9 years (SE=1.26 years) witha female 61 (67.8%). Median operative time was 90±36.9 minutes which converted casespatient needed to operate in more than 2 hours (12% vs 1.5%), but not statistically significant(p= 0.63). Median hospital stay was 9±27.2 days that significantly increased in convertedcases (24±9 days, p-value= 0.011). Median of pre-operation = 7±26.8 days, and postoperation= 2±3.8 days, with 13.3% patients underwent endoscopic retrograde cholangiopancreatography(ERCP). Common bile duct injury (CBDI) was found in 3 cases (3.33%).Conversion to laparotomy was required in 4.44% cases. Factors that influenced the rate ofconversion included was only adhesion (RR (95%CI) = 25.7 (2.4-273.5), p=0.007. Findings: Laparoscopic cholecystectomy offers shorter hospital stay. The operative time isshort and procedure is standard, safe and effective in our institution.;Background: Cholecystectomy is the most frequently performed abdominal operation andcurrently laparoscopic cholecystectomy (LC) is considered gold standard being performed in90% cases of symptomatic gallstones. The aim of the study was to determine results obtainedwith LC at our hospital, RSCM, Jakarta. Methods: This retrospective observational study was conducted in digestive divison insurgery department of RSCM using data from January to December 2014. The studyparticipants were patients of both gender aged 23?66 years undergoing LC. Surgery wasperformed either in one day care (ODC) or elective schedule. Demographic variables,preoperative and intraoperative findings, mean operation time, hospital stay, and conversionrate were evaluated. Factors influencing rate of conversion were also studied. Results: A total of 90 patients were included. Mean age was 43.9 years (SE=1.26 years) witha female 61 (67.8%). Median operative time was 90±36.9 minutes which converted casespatient needed to operate in more than 2 hours (12% vs 1.5%), but not statistically significant(p= 0.63). Median hospital stay was 9±27.2 days that significantly increased in convertedcases (24±9 days, p-value= 0.011). Median of pre-operation = 7±26.8 days, and postoperation= 2±3.8 days, with 13.3% patients underwent endoscopic retrograde cholangiopancreatography(ERCP). Common bile duct injury (CBDI) was found in 3 cases (3.33%).Conversion to laparotomy was required in 4.44% cases. Factors that influenced the rate ofconversion included was only adhesion (RR (95%CI) = 25.7 (2.4-273.5), p=0.007. Findings: Laparoscopic cholecystectomy offers shorter hospital stay. The operative time isshort and procedure is standard, safe and effective in our institution.;Background: Cholecystectomy is the most frequently performed abdominal operation andcurrently laparoscopic cholecystectomy (LC) is considered gold standard being performed in90% cases of symptomatic gallstones. The aim of the study was to determine results obtainedwith LC at our hospital, RSCM, Jakarta. Methods: This retrospective observational study was conducted in digestive divison insurgery department of RSCM using data from January to December 2014. The studyparticipants were patients of both gender aged 23?66 years undergoing LC. Surgery wasperformed either in one day care (ODC) or elective schedule. Demographic variables,preoperative and intraoperative findings, mean operation time, hospital stay, and conversionrate were evaluated. Factors influencing rate of conversion were also studied. Results: A total of 90 patients were included. Mean age was 43.9 years (SE=1.26 years) witha female 61 (67.8%). Median operative time was 90±36.9 minutes which converted casespatient needed to operate in more than 2 hours (12% vs 1.5%), but not statistically significant(p= 0.63). Median hospital stay was 9±27.2 days that significantly increased in convertedcases (24±9 days, p-value= 0.011). Median of pre-operation = 7±26.8 days, and postoperation= 2±3.8 days, with 13.3% patients underwent endoscopic retrograde cholangiopancreatography(ERCP). Common bile duct injury (CBDI) was found in 3 cases (3.33%).Conversion to laparotomy was required in 4.44% cases. Factors that influenced the rate ofconversion included was only adhesion (RR (95%CI) = 25.7 (2.4-273.5), p=0.007. Findings: Laparoscopic cholecystectomy offers shorter hospital stay. The operative time isshort and procedure is standard, safe and effective in our institution."

"Kolelitiasis merupakan penyakit kandung empedu dimana terdapat endapan satu atau lebih komponen diantaranya empedu, kolesterol, billirubin, garam empedu, kalsium, protein, asam lemak, dan fosfolipid yang membentuk suatu senyawa padat yang disebut batu empedu. Laparoskopi kolesistektomi merupakan salah satu prosedur pembedahan yang ditujukan sebagai upaya kuratif untuk mengatasi masalah penyumbatan saluran empedu, yaitu dengan mengangkat kandung empedu. Asuhan keperawatan dilakukan untuk mengatasi masalah keperawatan yang terjadi pada pasien post laparoskopi kolesistektomi. Penulisan karya ilmiah bertujuan untuk menganalis asuhan keperawatan yang dilakukan pada pasien kolelitiasis dengan penerapan mobilisasi dini post laparoskopi kolesistektomi. Hasil evaluasi didapatkan masa pemulihan yang lebih cepat dengan masa rawat yang singkat, nyeri lebih cepat teratasi, dan penyembuhan luka yang baik. Mobilisasi dini sangat disarankan untuk diterapkan sesegera mungkin bagi para pasien usai dilakukan pembedahan untuk menghindari terjadinya perlambatan pemulihan pasca bedah.

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Cholelithiasis is a gallbladder disease where there is one or more deposits of the bile, cholesterol, billirubin, bile salt, calcium, proteins, fatty acids, and phospholipids that form a solid compound called gallstones. Laparoscopic cholecystectomy is one of the surgical procedures aimed at curative efforts to overcome the problem of bile duct blockage, by removing the gallbladder. Nursing care is done to overcome the nursing problems of the patient who have had a laparoscopic cholecystectomy. Scientific writing aims to analize nursing care conducted in cholelithiasis patients with the application of early mobilization post laparoscopic cholecystectomy. The results of the evaluation are obtained faster recovery time with short length of stay, faster pain resolved, and good wound healing. Early mobilization is recommended to be carried out as soon as possible for patients after surgery to avoid slowing down post-surgical recovery."

"Nyeri adalah gangguan rasa nyaman yang dialami oleh klien pasca pembedahan laparatomi yang berasal dari Iuka insisi di abdomen. Penanganan nyeri ada 2 macam, yaitu secara farmakologi dan nonfarmakologi. Kompres dingin sebagai salah satu bentuk stimulasi cutaneus merupakan contoh penanganan nyeri nonfarmakologi. Penelitian ini bertujuan untuk mengetahui keefektivitasan kompres dingin dalam menurunkan nyeri pada klien pasca pembedahan laparatomi 1-2 hari. Metode penelitian yang digunakan adalah pr-eexperiment one group pretest postest. Data diperoleh dari klien pasca pembedahan laparalomi 1-2 hari yang dirawat di ruang IRNA A lantai 4 kiri RSUPN Cipto Mangunkusumo yang memenuhi kriteria inklusi dan bersedia menjadi responden. Metode pengolahan data yang digunakan yaitu fischer exact probability test. Hasil penelitian menyatakan bahwa tidak terdapat perbedaan tingkat nyeri pada klien pasca pembedahan laparatomi 1-2 hari sebelum dan sesudah dilakukan kompres dingin."

"Latar belakang: Cedera duktus bilier sewaktu operasi laparoskopi kolesistektomi berpotensi menimbulkan masalah untuk pasien dan ahli bedahnya. Rekonstruksi duktus bilier cukuplah sulit dimana diagnosis dini dan tatalaksana yang tepat diperlukan untuk mencegah morbiditas lanjut dan komplikasi yang mengancam jiwa. Operasi koreksi oleh ahli bedah hepatobilier yang berpengalaman di rumah sakit pusat rujukan penting untuk menjamin keberhasilan rekonstruksi.Metode: Sepanjang Juni 2010 hingga Juni 2015 terdapat 7 kasus cedera saluran bilier. Dilakukan penelitian secera retrospektif, mengevaluasi karakteristik, tindakan dan keluaran dari operasi rekonstruksi.Hasil: Satu dari 7 kasus cedera duktus bilier ditangani secara endoskopi, selebihnya menjalani pembedahan. Lima kasus (83,3%) menjalani operasi koreksi yang ditunda. Mean interval dari waktu terjadinya cedera hingga saat rujukan adalah 45 hari (median 45 hari). Mean interval dari waktu terjadinya cedera hingga operasi rekonstruksi adalah 182 hari (median 65 hari). Semua pasien mengalami biloma, dua pasien telah dilakukan drainase sebelum dirujuk. Satu pasien datang dengan ikterus dan 3 pasien mengalami peningkatan kadar bilirubin. Berdasarkan kolangiografi pra operasi; dua pasien dengan cedera Strassberg E3 dan satu pasien dengan cedera Strassberg E1. Dua pasien lain masing-masing mengalami cedera Strassberg C dan D. Pada semua pasien dilakukan rekonstruksi hepatikoyeyunostomi Roux en Y dan stent internal dipasang pada 2 pasien. Stent internal ini dilepas masing-masing pada hari post operatif ke-18 dan ke-20. Rerata durasi operasi adalah 4 jam 42 menit. Rerata durasi rawat inap adalah 38,2 hari. Hanya satu pasien yang mengalami morbiditas pasca operasi. Pasien ini memerlukan tindakan operasi untuk memperbaiki luka operasi yang terbuka. Dilakukan pemantauan pasca operasi selama 6-24 bulan. Semua pasein tidak ada yang mengalami ikterus maupun kolangitis pada periode tersebut.Simpulan: Tindakan koreksi operatif pada cedera duktus bilier akan menunjukkan hasil yang baik bila dilakukan oleh ahli bedah hepatobilier yang berpengalaman. Hepatikoyeyunostomi merupakan tindakan yang terbaik untuk mengembalikan kontinuitas aliran bilier. Follow up jangka panjang tetap dibutuhkan untuk melihat keluaran pada seluruh pasien.

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Background: Bile duct injury (BDI) during laparoscopic cholecystectomy (LC) procedure bears problem for the patients and the surgeon. Biliary reconstruction is often challenging while prompt diagnosis and proper treatment are needed to prevent long term morbidity and life threatenting complications. Surgical repair by an experienced hepatobiliary surgeon in a tertiary care is important to ensure the success of the reconstruction.

Methods: From June 2010 to June 2015 there are 7 BDI. We conduct a retrospective study by evaluating the characteristic, type of surgery and the outcome.

Results: One out of 7 BDI cases were managed endoscopically. The rest had surgical reconstruction. Five cases (83.3%) had a late surgical repair. The mean interval from the time of BDI to referral was 45 days (median 45 days). The mean interval from the time of BDI to the reconstruction surgery was 182 days (median 65 days). All of the patients had biloma, two patients had drainage prior of the referral. One patient had clinical jaundice, three patients with slightly elevated bilirubin level. Based on the cholangiography studies prior of the surgery, two patients had Strassberg E3 injury and 1 patient had Strassberg E1 injury. Two other patients each had Strassberg C and D injury . All of the patients had a hepaticojejunostomy Roux en Y reconstruction; an internal stent was placed in two patients. The internal stent were removed on POD 18 and POD 20. Mean operative time was 4 hours 42 minutes. Mean hospital stay was 38.2 days. Only one patient developed a post operative morbidity. She needed another surgery to repair the burst abdomen. The follow up period range from 6-24 months. All patients did not develop jaundice or cholangitis during that period.

Conclusion: Surgical repair for BDI will show a better outcome when being done by an experienced hepatobilliary surgeon. Hepaticojejunostomy offers the best chance to restore the continuity of the biliary flow. A long term follow up still needed to see the overall result on these patients."

"Nyeri pasca bedah merupakan salah satu penyebab nyeri akut yang paling umum. Penanganan nyeri yang efektif merupakan komponen fundamental dari pelayanan pasien yang berkualitas. Di RS Prima Medika belum ada protokol standar penanganan nyeri pasca bedah. Tujuan penelitian ini untuk mengukur intensitas nyeri pasien pasca bedah di RS Prima Medika, membuat protokol standar penanganan nyeri pasca bedah di RS Prima Medika dalam mewujudkan pelayanan yang berkualitas dan aman bagi pasien. Penelitian ini merupakan penelitian deskriptif kualitatif dengan teknik pengambilan data melalui observasi intensitas nyeri pada pasien pasca laparotomi dan wawancara mendalam dengan informan serta telaah dokumen. Hasil penelitian menunjukkan intensitas nyeri pada periode 24 jam pasca bedah adalah nyeri ringan, pada periode 48 jam pasca bedah intensitas nyeri bervariasi antara nyeri ringan sampai sedang dengan prosedur penanganan nyeri yang tidak terarah dengan baik. Diperlukan suatu SOP untuk memberikan penanganan nyeri pasca bedah yang optimal.

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Fundamental component to serve a quality service to the patient. There is no Standard operating procedure in pain management in Prima Medika Hospital. The aim of this study is to measure the intensity of pain in postoperative patient in this hospital, to arrange a standard operating procedure for postoperative pain management to serve a quality and safe service to the patient.

This is a qualitative descriptive study where data were collect by observed pain intensity in post laparotomy patient, in-depth interviews with the informans and reviewed documents.

Result show that pain intensity in 24 hours after surgery were mild, and in 48 hours the pain intensity were mild to moderate with no proper protocol. A standard operatimg procedure is needed to give the best pain management to the patient"