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DIABETES MELLITUS

A. PENGERTIAN

Diabetes mellitus merupakan sekelompok kelainan heterogen yang ditandai oleh kenaikan kadar glukosa dalam darah atau hiperglikemia. (Brunner dan Suddarth. 2002)

B. TIPE DM

1. Tipe I : Diabetes mellitus tergantung insulin (IDDM)

2. Tipe II : Diabetes mellitus tidak tergantung insulin (NIDDM)

3. Diabetes mellitus yang berhubungan dengan keadaan atau sindrom lainnya

4. Diabetes mellitus gestasional (GDM)

C. ETIOLOGI

1. Diabetes tipe I:

a. Faktor genetik

b. Faktor-faktor imunologi

c. Faktor lingkungan

2. Diabetes Tipe II

Mekanisme yang tepat yang menyebabkan resistensi insulin dan gangguan sekresi insulin pada diabetes tipe II masih belum diketahui.

Faktor-faktor resiko :

a. Usia (resistensi insulin cenderung meningkat pada usia di atas 65 th)

b. Obesitas

c. Riwayat keluarga

D. MANIFESTASI KLINIS

a. Poliuria b. Polifagia c. Polidipsi d. Lemas e. BB turun

f. Kesemutan g. Gatal h. Mata kabur i. Impotensi pada pria j. Pruritus vulva pada wanita

E. PEMERIKSAAN PENUNJANG

1. Glukosa darah sewaktu

2. Kadar glukosa darah puasa

3. Tes toleransi glukosa

Kadar darah sewaktu dan puasa sebagai patokan penyaring diagnosis DM (mg/dl)

	Bukan DM	Belum pasti DM	DM
Kadar glukosa darah sewaktu - Plasma vena - Darah kapiler Kadar glukosa darah puasa - Plasma vena - Darah kapiler	<> <80 <110 <90	100-200 80-200 110-120 90-110	>200 >200 >126 >110

Kriteria diagnostik WHO untuk diabetes mellitus

® Pada sedikitnya 2 kali pemeriksaan :

1. Glukosa plasma sewaktu >200 mg/dl (11,1 mmol/L)

2. Glukosa plasma puasa >140 mg/dl (7,8 mmol/L)

3. Glukosa plasma dari sampel yang diambil 2 jam kemudian sesudah mengkonsumsi 75 gr karbohidrat (2 jam post prandial (pp) > 200 mg/dl

F. PENATALAKSANAAN

Tujuan utama terapi diabetes mellitus adalah mencoba menormalkan aktivitas insulin dan kadar glukosa darah dalam upaya untuk mengurangi komplikasi vaskuler serta neuropati. Tujuan terapeutik pada setiap tipe diabetes adalah mencapai kadar glukosa darah normal.

Ada 5 komponen dalam penatalaksanaan diabetes :

1. Diet

2. Latihan

3. Pemantauan

4. Terapi (jika diperlukan)

5. Pendidikan

G. KOMPLIKASI

1. Hipoglikemia

2. Hiperglikemia

3. Ketoosidosis Diabetik

H. PEMERIKSAAN DIAGNOSTIK

- Glukosa darah : meningkat 200-100 mg/dl atau lebih

- Aseton plasma : Positif secara mencolok

- Asam lemak bebas : Kadar lipid dan kolesterol meningkat

- Osmolalitas serum : meningkat

- Elektrolit :

l Natrium : mungkin normal meningkat/menurun

l Kalium : Normal, peningkatan semu selanjutnya akan menurun

l Fosfor : lebih sering menurun

- ureum/ kreatinin : mungkin meningkat/normal

- Insulin darah : mungkin menurun

- Urine : gula dan aseton positif

- Kultur dan sensivitas : kemungkinan adanya infeksi pada saluran kemih

H. ASUHAN KEPERAWATAN

1. Pengkajian

a. Aktivitas/istirahat

b. Sirkulasi

c. Integritas Ego

d. Eliminasi

e. Makanan/Cairan

f. Neurosensori

g.Nyeri/ketidaknyamanan

h. Pernapasan

i. Keamanan

j. Seksualitas

k. Penyuluhan

l.

2. Diagnosa keperawatan

a. Kekurangan volume cairan b.d. gejala poliuria, masukan dibatasi

b. Perubahan nutrisi : kurang dari kebutuhan tubuh b.d. gangguan keseimbangan insulin, anoreksia, mual

c. Resiko infeksi b.d kadar glukosa tinggi

d. Kelelahan b.d penurunan produksi energi metabolik, insufisiensi insulin

ASUHAN KEPERAWATAN PADA Tn. A

DENGAN DIABETES MELLITUS DI RUANG GERIATRI

RS. DOKTER KARIADI SEMARANG

DISUSUN OLEH :

CHATARINA HATRI ISTIARINI

DWI RETNO S

EKO MARDIYANINGSH

HENI KRISTIANA

PROGRAM STUDI ILMU KEPERAWATAN

FAKULTAS KEDOKTERAN UNIVERSITAS DIPONEGORO

SEMARANG

2003

DAFTAR PUSTAKA

1. Doenges Marilynn E Rencana Asuhan keperawatan : Pedoman untuk Perencanaan dan Pendokumentasian Perawatan pasien, Edisi 3 Jakarta: EGC, 2000

2. Smeltzer Suzanne C, Bare Brendo G Buku Ajar Keperawatan Medikal Bedah Brunner, Suddart, Edisi 8, vol 2, Jakarta: EGC 2002

3. Soegondo Sidartawan, Soewondo Pradana, Penatalaksanaan Diabetes Mellitus Terpadu, Jakarta : Heul 2002

4. Mansyoer Arif. Kapita Selekta Kedokteran Edisi Ketiga, Jilid I, Jakarta Media Aesculapius. 1999

BRONKITIS

A.DEFINITION

Bronchitis is an inflammation of the broncitisthat is associated with increased production of mucus. The larynx and the trachea may also be inflamed, causing tracheobronchitis or laringotracheo bronchitis. Most person suffer from this infection much time throughout life.

(Smeltzer & Bare 2001)

B. ETIOLOGI

A wide variety of agent can produce bronchitis including noxious gases, particulate irritants and various microorganism . Some infecting organism are streptococcus, staphylococcus, hemophylus and paeroginose. Infection of the trachea and bronchi commonly occurs after upper reparatory tract viral syndrome. In adult, the most common cause of acute bronchitis is exacerbation of choric bronchitis. In the elderly, predisposing underlying condition such as chronic bronchitis or emphysema combined with an aging immune system account for the onset disease, other client who are prone to develop the disease are those whit immunologlobulin deficiencies, ciliary’s dyskinesia or cystic fibrosis.

Any individual with a defect and mucous secretion of muscularly transport system is ro to the development of bronchitis. Because of smoke cause bronchial irritation and ciliary’s paralysis, smoker are also at risk.

(Smeltzer & Bare, 2001)

C. PATHOPHYSIOLOGI

When the conducting airways are assultated by chemical agnate or microorganism, they response by inducing an inflammatory respond. The typical sequence of this response includes vasoconstriction by vasodilatation, and transudation of fluid into interstitial space and into luminal surface of the airways. PMNs migrate from the capillaries into the mucous exudates and changer it to the characteristically yellow-green sputum of tracheobronchitis. Ulceration of the mucosa may develop, with exfoliation of bronchial epithelial cellos and bleeding may occur. This bleeding result in blood tinged mucus. The extend of injury depends on the distribution of the noxious agent and or organism and it’s concatenation at various levels of tracheobronchitis tree

( Prize, 1999)

.

D. MANAGEMENT

In assessing the client an episode of bronchitis, age and the presence of chronic lung disease are important to note because they are major risk factors. The nurse also inquires as to the use of medications, particularly steroids, bronchodilators, or antibiotics that are been taken for an ongoing chronic condition or recent infection. The client’s use of cigarettes and alcohol is reordered, as a well as the client’s recent sleep, rest and activity regiment. The nurse ascertain whether the client has been exposed to influenza has experienced a recent viral episode or infection. Because environmental exposure to noxious gasses or particulate material predisposes and individual to bronchitis, the nurse question the client about exposure to forms of environmental pollution. Finally, rhea nurse list the symptom that brought the client to hospital or physician’s office. Symptom commonly reported are dypsnea, increased irritability and anxiety, fatigue, sleep disturbance, chest tightness, chest fullness, wheezing and coughing.

(Smeltzer & Bare, 2001)

E.CLINICAL MANIFESTATION

The client with bronchitis is assessed for dyspnea; the nurse observes the client’s breathing pattern, or position. A pulmonary examination is performed, including auscultation for adventitious sound and percussion for abnormal dunless. The amount, color and quality of sputum are observed, as well as frequency of coughing. The nurse assesses vital sign and notes temperatures elevation with tachycardia. Condition and mental status changes occur frequently in the nearly, with indicate hypoxemia.

(Price, 1999)

F. LABORATORY FINDING

As with pneumonia, septum cultures are important and determining the causative organism so that the client a receive apropptriate antibiotic. In addition, a CBC with differential count is done. ABGs may be assayed if client appears to be hypoxemic and toned supplemental oxygen.

(Smeltzer & Bare, 2001)

G. OTHER DIAGNOSTIC TESTS

In the presence of obstructive disease, severe hypoxemia, and dyspnea, pulmonary function studies are one to gather baseline information and are repeated owner to assess the respone to treatment. Chest x-ray may also be taken to follow thwe course the dyspnea.

(Smeltzer & Bare, 2001)

H. FOCUS INTERVENTION

1. Nursing diagnose : pain related inflammatory response

goal : pain will be decreased

Intervention : - assess pain scale

- give distraction technique

- give relaxation technique

- collaboration with medical team to give analgesic

2. Nursing diagnose : ineffective air way clearance

Goal : effective of air ways

Intervention : - assess with coughing and breathing technique that help

Her to maxim Mize expectoration of secretion.

- assist liquefaction of secretion and in the maintenance

Of fluid balance

- give supply oxygen

- collaboration with the doctor to give antibiotic.

3. Nursing diagnose : hyperthermia related to infection process

Goal : the Body temperature is well

Intervention : - monitor vital sign especially body temperature

- give goal compress

- in structure to many drink

- avoid using the blanket

- collaboration with the doctor to give antipyretic

(Doenges, E Marlyn,1999)

I. PATHWAY

Chemical agent or microorganism

Enter to respiratory tract ( in the ronchi )

Inflammatory response

PAIN

Infection posses With progressive

Vasodilatation and

Transudation of fluid

Production

HYPERTERMIA

hhhh

Transdution of fluid into

Interstitial speaces and

Luminal surface of the airway

				INEFFECTIVEAIRWAY CLEARANCE