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Abstrak :
ABSTRAK
Praktik Spesialis Keperawatan Anak bertujuan untuk melakukan praktik dengan mengaplikasikan peran perawat melalui pendekatan Model Adaptasi Roy. Peran sebagai pemberi asuhan keperawatan diterapkan pada 5 orang klien anak dengan masalah perkemihan yang mengalami ketidakseimbangan cairan, dimana satu orang klien sebagai kelolaan utama yaitu klien sindroma nefrotik relaps dan hipoalbuminemia yang mengalami edema anasarka. Peran sebagai inovator melalui penyusunan program pemberian edukasi manajemen cairan pada keluarga dan perawat yang bertujuan untuk mengurangi kelebihan volume cairan tubuh, mengurangi udema, meningkatkan diuresis, meningkatkan kenyamanan klien anak dengan masalah perkemihan, dan meningkatkan kualitas asuhan keperawatan dengan menerapkan tindakan keperawatan yang berbasis pembuktian ilmiah (evidence based nursing). Hasil praktik ini menunjukkan bahwa Model Adaptasi Roy efektif digunakan pada klien anak dengan masalah perkemihan yang mengalami ketidakseimbangan cairan, dan edukasi efektif untuk mengurangi risiko masalah yang dapat timbul akibat kelebihan volume cairan tubuh.

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ABSTRACT
Practice of Pediatric Nursing Specialist aims to practice the application of the role of nurses through the Roy Adaptation Model approach. Role as nurse provider applied to 5 children clients with urinary problems that undergo fluid imbalance, and one major client is a client of relapse nephritic syndrome and hypoalbuminemia who experienced edema within whole body. Role as an innovator by designing fluid management program of education providing for families and nurses which aims to reduce excess body fluid volume, reduce edema, increase diuresis, improve the comfort of children client with urinary problems, and improve the quality of nursing care by implementing nursing actions based on scientific evidence (evidence based nursing). Roy Adaptation Model is proving that education to families and nurses is one of fluid management techniques in children with urinary problems. The result of this practice indicates that this model is effective to be used on the children client with urinary problems with imbalance of fluid and effective education to reduce the risk of problems due to excess body fluid volume.;

Abstrak :
Ileostomi merupakan tindakan pembedahan pembuatan lubang (stoma) antara ileum dan dinding abdomen, bertujuan untuk pengalihan feses. Ileostomi umumnya dibuat pada pasien yang menjalani penanganan kanker kolorektal, neoplasma stadium lanjut dengan infiltrasi usus halus, maupun peradangan saluran cerna. Ileostomi high output (produksi stoma ileum >1500 mL/hari) dapat menyebabkan gangguan keseimbangan cairan dan elektrolit, maupun malnutrisi pada pasien. Saat ini belum ada pedoman tata laksana nutrisi komprehensif untuk pasien ileostomi high output. Serial kasus ini bertujuan untuk mendukung terapi, mengatasi malnutrisi, menunjang perbaikan klinis, sehingga dapat menurunkan morbiditas dan mortalitas pasien ileostomi high output. Empat pasien ileostomi high output dengan rentang usia 42 hingga 50 tahun mendapatkan terapi medik gizi selama perawatan di rumah sakit. Tiga kasus merupakan kasus kronik dengan keganasan, sementara satu kasus lainnya merupakan kasus akut yaitu adhesi dan perforasi akibat hernia femoralis strangulata. Keempat kasus tersebut merupakan ileostomi high output onset awal, yaitu yang terjadi kurang dari tiga minggu pasca pembuatan stoma. Berdasarkan kriteria malnutrisi American Society for Parenteral and Enteral Nutrition (ASPEN), keempat pasien ini tergolong malnutrisi berat. Terapi medik gizi diberikan dengan prinsip pemberian makanan dan minuman porsi kecil namun sering, restriksi cairan hipotonik, pemberian minuman berupa larutan elektrolit-glukosa, pemberian medikasi anti motilitas, serta koreksi cairan dan elektrolit menurut kebutuhan dan kondisi klinis pasien. Target asupan energi dan protein pada keempat pasien dapat tercapai selama perawatan. Selama pemantauan, keempat pasien mengalami penurunan output ileostomi, serta perbaikan keseimbangan cairan dan elektrolit darah. Satu pasien mengalami perburukan klinis dan meninggal akibat sepsis pada hari perawatan ke-18. Tiga pasien pulang dengan kondisi klinis perbaikan. Satu pasien mengalami peningkatan output ileostomi saat perawatan di rumah, kemudian dirawat kembali sepuluh hari setelah pulang karena komplikasi anemia gravis dan ketidakseimbangan elektrolit, dan pada akhirnya meninggal. Terapi medik gizi dapat menurunkan produksi stoma, memperbaiki kadar elektrolit darah, serta memperbaiki keseimbangan cairan pada pasien ileostomi high output.

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Ileostomy is a surgical procedure to divert the ileum onto an artificial opening in the abdominal wall, aimed for fecal diversion. Ileostomy is commonly created in patients undergoing treatment for colorectal cancer, advanced neoplasms with intestinal infiltration, or gastrointestinal inflammation. High output ileostomy (stoma output >1500 mL per day) can cause imbalance of fluid and electrolytes, and malnutrition in patients. At present, there is no comprehensive nutrition management guideline for high output ileostomy patients. This case series aimed to support therapy, prevent malnutrition, improve clinical condition, as well as to reduce the morbidity and mortality of high output ileostomy patients. Four high output ileostomy patients, with a range of age 42 to 50 years old received medical nutrition therapy during their hospital stay. Three cases were chronic cases in malignancy, while the other case was an acute case of adhesion and perforation due to strangulated femoral hernia. All four cases were early onset high output ileostomy, occurring in three weeks after stoma creation. Based on the American Society for Parenteral and Enteral Nutrition (ASPEN) malnutrition criteria, these four patients were classified as severe malnutrition. Medical nutrition therapy was administered according to a set of principles: small frequent feeding and drinking, hypotonic fluid restriction, oral electrolyte-glucose solution administration, antimotility medication administration, as well as fluid and serum electrolyte correction, according to patients' needs and clinical conditions. The target of energy and protein intake in all patients were achieved during hospital stay. During hospital monitoring, decreased ileostomy output as well as improvement in fluid and electrolyte balance were observed in all patients. One patient clinically worsened and died due to sepsis on the 18th day of hospital stay. Three patients showed improvement in clinical condition and were discharged. One patient experienced an increase in ileostomy output at home, and then readmitted ten days after hospital discharge due to severe anemia and electrolyte imbalance and subsequently died. Medical nutrition therapy may decrease output as well as improve fluid and electrolyte balance in patients with high output ileostomy.

Abstrak :
Latar Belakang: Pasien pascabedah abdomen mayor seringkali berhubungan dengan terjadinya general increase permeability sindrom akibat kelebihan cairan selama selama durante operasi dan pada saat perawatan pascabedah. Tujuan dari penelitian ini adalah ingin membuktikan apakah keseimbangan cairan kumulatif, tekanan vena sentral dan rasio albumin-kreatinin urin dapat digunakan sebagai prediktor kebocoran kapiler. Metode: Penelitian ini merupakan penelitian kohort prospektif dengan subjek penelitian adalah pasien dewasa yang menjalani tindakan bedah abdomen mayor. Dilakukan pemeriksaan keseimbangan cairan kumulatif, tekanan vena sentral, rasio albumin-kreatinin urin dan indeks kebocoran kapiler, pada saat sebelum induksi anestesi, 48 jam dan 72 jam pasca bedah. Hasil: Pada penelitian ini didapatkan nilai titik potong dari indeks kebocoran kapiler 155 (AUC 0,013, sensitifitas 100% dan spesifisitas 74,50%. Analisis dengan Generalized Estimating Equations didapatkan tekanan vena sentral menujukan hubungan tidak bermakna dengan indeks kebocoran kapiler (OR 1,62 ; CI 95% = 0,92 – 2,83), sedangkan keseimbangan cairan kumulatif dan rasio albumin kreatinin urin menunjukkan hubungan yang bermakna dengan indeks kebocoran kapiler (OR = 2,561 ; CI 95% = 1,352-4,850 dan OR = 2,017 ; CI 95% = 1,086-3,749). Faktor skor SOFA terkategori sepsis juga mempunyai hubungan dengan indeks kebocoran kapiler (OR = 2,764 ; CI 95% = 1,244-6,140). Kesimpulan: Kelebihan cairan kumulatif, rasio albumin kreatinin urin dan skor SOFA terbukti dapat digunakan untuk memprediksi kebocoran kapiler.

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Background: Patients after major abdominal surgery are often associated with the occurrence of general increase in permeability syndrome due to excess fluid during surgery and during postoperative care. The purpose of this study was to prove whether cumulative fluid balance, central venous pressure and urine albumin-creatinine ratio of urine can be used as predictors of capillary leakage. Method: This study is a prospective cohort study with research subjects as adult patients undergoing major abdominal surgery. Cumulative fluid balance, central venous pressure, urine albumin-creatinine ratio and capillary leak index were examined, before anesthesia induction, 48 hours and 72 hours postoperatively. Result: In this study, a cut-off point from the capillary leak index ≥155 (AUC 0.013, sensitivity 100% and specificity 74.50%) was obtained. Generalized Estimating Equations analysis showed that the central venous pressure showed no significant relationship with the capillary leak index (OR 1.62; 95% CI = 0.92 - 2.83), while cumulative fluid balance and urine albumin : creatinin ratio showed a significant association with capillary leak index (OR = 2.561; 95% CI = 1.352-4.850 and OR = 2.017; 95% CI = 1,086-3,749) Sepsis categorized SOFA score factors also have a relationship with capillary leak index (OR = 2.764; 95% CI = 1,244-6,140). Conclusion: Cumulative fluid overload, urine creatinine albumin ratio and SOFA score have been shown to predict capillary leakage.