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Friday, December 31, 2010

Laporan Pendahuluan DBD

Posted by vini np at 5:15 PM

DEMAM BERDARAH DENGUE (DBD)


A. PENGERTIAN

Dengue adalah penyakit virus didaerah tropis yang ditularkan oleh nyamuk dan ditandai dengan demam, nyeri kepala, nyeri pada tungkai, dan ruam (Brooker, 2001). Demam dengue/dengue fever adalah penyakit yang terutama pada anak, remaja, atau orang dewasa, dengan tanda-tanda klinis demam, nyeri otot, atau sendi yang disertai leukopenia, dengan/tanpa ruam (rash) dan limfadenophati, demam bifasik, sakit kepala yang hebat, nyeri pada pergerakkan bola mata, rasa menyecap yang terganggu, trombositopenia ringan, dan bintik-bintik perdarahan (ptekie) spontan (Noer, dkk, 1999). Demam berdarah dengue adalah suatu penyakit yang disebabkan oleh virus dengue (arbovirus) yang masuk ke dalam tubuh melalui gigitan nyamuk Aedes aegypti (Suriadi & Yuliani, 2001).


B. ETIOLOGI

Gigitan nyamuk Aedes aegypti yang membawa virus dengue (sejenis arbovirus).


C. PATOFISIOLOGI

Virus dengue masuk kedalam tubuh melalui gigitan nyamuk aedes aegypti dan kemudian bereaksi dengan antibodi dan terbentuklah kompleks virus-antibody, dalam asirkulasi akan mengaktivasi sistem komplemen (Suriadi & Yuliani, 2001). Virus dengue masuk kedalam tubuh melalui gigitan nyamuk dan infeksi pertama kali menyebabkandemam dengue. Reaksi tubuh merupakan reaksi yang biasa terlihat pada infeksi oleh virus. Reaksi yang amat berbeda akan tampak, bila seseorang mendapat infeksi berulang dengan tipe virus dengue yang berlainan. Dan DHF dapat terjadi bila seseorang setelah terinfeksi pertama kali, mendapat infeksi berulang virus dengue lainnya. Re-infeksi ini akan menyebabkan suatu reaksi anamnestik antibodi, sehingga menimbulkan konsentrasi kompleks antigen-antibodi (kompleks virus-antibodi) yang tinggi (Noer, dkk, 1999).


D. MANIFESTASI KLINIS

- Demam tinggi 5-7 hari.
- Perdarahan, terutama perdarahan bawah kulit ; ptekie, ekhimosis, hematoma.
- Epistaksis, hematemesis, melena, hematuria.
- Mual, muntah, tidak ada napsu makan, diare, konstipasi.
- Nyeri otot, tulang dan sendi, abdomen dan ulu hati.
- Sakit kepala.
- Pembengkakan sekitar mata.
- Pembesaran hati, limpa dan kelenjar getah bening.
- Tanda-tanda renjatan (sianosis, kulit lembab dan dingin, tekanan darah menurun, gelisah, capillary reffil time lebih dari dua detik, nadi cepat dan lemah).


E. KLASIFIKASI

WHO, 1986 mengklasifikasikan DHF menurut derajat penyakitnya menjadi 4 golongan, yaitu :
- Derajat I : Demam disertai gejala klinis lain, tanpa perdarahan spontan. Panas 2-7 hari, Uji tourniquet positif, trombositipenia, dan hemokonsentrasi.
- Derajat II : Sama dengan derajat I, ditambah dengan gejala-gejala perdarahan spontan seperti petekie, ekimosis, hematemesis, melena, perdarahan gusi.
- Derajat III : Ditandai oleh gejala kegagalan peredaran darah seperti nadi lemah dan cepat (>120x/mnt ) tekanan nadi sempit (120 mmHg), tekanan darah menurun, (120/80 , 120/100 , 120/110, 90/70, 80/70, 80/0, 0/0)
- Derajat IV : Nadi tidak teaba, tekanan darah tidak teatur (denyut jantung  140x/mnt) anggota gerak teraba dingin, berkeringat dan kulit tampak biru.


F. PEMERIKSAAN DIAGNOSTIK

- Minum banyak 1,5 liter – 2 liter/24 jam (dengan air teh, gula, susu).
- Antipiretik jika terdapat demam.
- antikonvulsan jika terdapat kejang.
- Pemberian cairan melalui infus, dilakukan jika pasien mengalami kesulitan minum dan nilai hematokrit cenderung meningkat.


KONSEP ASUHAN KEPERAWATAN


A. Pengkajian

1. Identitas
DHF merupakan penyakit daerah tropis yang sering menyebabkan kematian anak, remaja dan dewasa (Effendy, 1995).

2. Keluhan Utama
Pasien mengeluh panas, sakit kepala, lemah, nyeri ulu hati, mual dan nafsu makan menurun.

3. Riwayat penyakit sekarang
Riwayat kesehatan menunjukkan adanya sakit kepala, nyeri otot, pegal seluruh tubuh, sakit pada waktu menelan, lemah, panas, mual, dan nafsu makan menurun.

4. Riwayat penyakit terdahulu
Tidak ada penyakit yang diderita secara specific.

5. Riwayat penyakit keluarga
Riwayat adanya penyakit DHF pada anggota keluarga yang lain sangat menentukan, karena penyakit DHF adalah penyakit yang bisa ditularkan melalui gigitan nyamuk aides aigepty.

6. Riwayat Kesehatan Lingkungan
Biasanya lingkungan kurang bersih, banyak genangan air bersih seperti kaleng bekas, ban bekas, tempat air minum burung yang jarang diganti airnya, bak mandi jarang dibersihkan.

7. Riwayat Tumbuh Kembang

8. Pengkajian Per Sistem

Sistem Pernapasan
Sesak, perdarahan melalui hidung, pernapasan dangkal, epistaksis, pergerakan dada simetris, perkusi sonor, pada auskultasi terdengar ronchi, krakles.
Sistem Persyarafan
Pada grade III pasien gelisah dan terjadi penurunan kesadaran serta pada grade IV dapat trjadi DSS
Sistem Cardiovaskuler
Pada grde I dapat terjadi hemokonsentrasi, uji tourniquet positif, trombositipeni, pada grade III dapat terjadi kegagalan sirkulasi, nadi cepat, lemah, hipotensi, cyanosis sekitar mulut, hidung dan jari-jari, pada grade IV nadi tidak teraba dan tekanan darah tak dapat diukur.
Sistem Pencernaan
Selaput mukosa kering, kesulitan menelan, nyeri tekan pada epigastrik, pembesarn limpa, pembesaran hati, abdomen teregang, penurunan nafsu makan, mual, muntah, nyeri saat menelan, dapat hematemesis, melena.
Sistem perkemihan
Produksi urine menurun, kadang kurang dari 30 cc/jam, akan mengungkapkan nyeri sat kencing, kencing berwarna merah.
Sistem Integumen.
Terjadi peningkatan suhu tubuh, kulit kering, pada grade I terdapat positif pada uji tourniquet, terjadi pethike, pada grade III dapat terjadi perdarahan spontan pada kulit.


B. Diagnosa Keperawatan

1. Hipertermi berhubungan dengan proses infeksi virus dengue.
2. Resiko defisit cairan berhubungan dengan pindahnya cairan intravaskuler ke ekstravaskuler.
3. Resiko syok hypovolemik berhubungan dengan perdarahan yang berlebihan, pindahnya cairan intravaskuler ke ekstravaskuler.
4. Resiko gangguan pemenuhan kebutuhan nutrisi kurang dari kebutuhan tubuh berhubungan dengan intake nutrisi yang tidak adekuat akibat mual dan nafsu makan yang menurun.
5. Resiko terjadi perdarahan berhubungan dengan penurunan factor-faktor pembekuan darah (trombositopeni).



download file DBD yang lebih lengkap :)




DAFTAR PUSTAKA

Hidayat, Aziz Alimul A. 2006. Pengantar Ilmu Keperawatan Anak jilid.2. Salemba Medika : Jakarta

Nasrul, Effendi. 1995. Pengantar Proses Keperawatan. EGC : Jakarta

Noer, Sjaifoellah dkk. 1998. Standar Perawatan Pasien. Monica Ester : Jakarta.

Suriadi & Yuliani, Rita. 2001. Buku Pegangan Praktek Klinik : Asuhan Keperawatan pada Anak. Sagung Seto : Jakarta

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