LAPORAN PENDAHULUAN DIABETES MELITUS (DM) DENGAN ULKUS
A. DEFINISI Diabetes Melitus (DM) adala !e"#a$it %etab&li$ #a"' $eba"#a$a" eedite de"'a" ta"da*ta"da i!e'li$e%ia da" 'lu$&suia disetai de"'a" atau tida$ ada"#a 'e+ala $li"i$ a$ut atau!u" $&"i$ seba'ai a$ibat dai $ua"'a"#a i"suli" e,e$ti, di dala% tubu 'a"''ua 'a"''ua" " !i%e !i%e teleta$ teleta$ !ada !ada %etab&li %etab&lis%e s%e $ab&id $ab&idat at #a"' #a"' biasa"# biasa"#aa disetai disetai +u'a 'a"''ua" 'a"''ua" %etab&li %etab&lis% s% le%a$ le%a$ da" !&tei" !&tei" ( As$a"da - ). Diabetes %elitus adala !e"#a$it i!e'li$e%ia #a"' dita"dai &le $etiadaa" abs&lut i"suli" atau i"se"siti,itas sel teada! i"suli" (/&0i" -1). Ul$us adala lu$a tebu$a !ada !e%u$aa" $ulit atau sela!ut le"de da" ul$usadala $e%atia" +ai"'a" #a"' luas da" disetai i"2asi, $u%a" sa!&,it. Ada"#a $u%a" sa!&,it tesebut %e"#ebab$a" ul$us bebau ul$us diabeti$u% +u'a %eu!a$a" sala satu 'e+ala $li"i$ da" !e+ala"a" !e"#a$it DM de"'a" "eu&!ati !ei,e (A"d#a'ee"i -1). Ul$us Diabeti$ %eu!a$a" $&%!li$asi $&"i$ dai Diabetes Melllitus seba'ai sebab uta%a %&biditas %&talitas seta $e3a3ata" !e"deita Diabetes. Diabetes. Kada LDL #a"' ti"''i %e%ai"$a" %e%ai"$a" !ea"a" !e"ti"' u"tu$ te+adi"#a Ul$us Uiabeti$ u"tu$ u"tu$ te+adi"#a Ul$us Ul$us Diabeti$ %elalui !e%be"tu$a" !la$ ate&s$le&sis !ada di"di"' !e%bulu daa (4aida -5). Ul$u Ul$uss $a$i Diabe iabete tess (UK (UKD)
%eu!a u!a$ $a"
$&%!l &%!lii$asi $asi
#a"'
be$a e$ait itaa"
de"'a" 'a"
Melitus. Ul$us $a$i Diabetes %eu!a$a" $&%!li$asi seius a$ibat Diabetes (A"d#a'ee"i -1).
%&bi &bidi dita tass
a$iba $ibatt Dia Diabetes tes
Ka$i Diabetes B. KLASIFIKASI TIPE DM Klasi,i$a Klasi,i$asi si Diabetes Diabetes Melitus dai Nati&"al Diabetus Diabetus Data G&u!6 /lassi,i3 /lassi,i3ati& ati&" " a"d Dia'"&si Dia'"&siss &, Diabetes Diabetes Melitus a"d Ote Ote /ate'&ies &, Glu3&sa I"t&lea"3e6 1. a.
Klasi,i$asi Kli"is Diabetes Melitus
Ka$i Diabetes B. KLASIFIKASI TIPE DM Klasi,i$a Klasi,i$asi si Diabetes Diabetes Melitus dai Nati&"al Diabetus Diabetus Data G&u!6 /lassi,i3 /lassi,i3ati& ati&" " a"d Dia'"&si Dia'"&siss &, Diabetes Diabetes Melitus a"d Ote Ote /ate'&ies &, Glu3&sa I"t&lea"3e6 1. a.
Klasi,i$asi Kli"is Diabetes Melitus
1)
Ti!e te'a"tu"' i"suli" (DMTI) Ti!e Ti!e I
-)
Ti!e ta$ te'a"tu"' i"suli" (DMTTI) Ti!e II (DMTTI #a"' tida$ %e"'ala%i &besitas da" DMTTI de"'a" &besitas)
b.
Ga"''ua" Ga"''ua" T&lea"si T&lea"si Glu$&sa Glu$&sa (GTG)
3.
Diabetes Kea%ila" (GDM)
-.
Klasi,i$asi isi$& statisti$
a.
Sebelu%"#a !e"a %e"deita $elai"a" t&lea"si 'lu$&sa
b.
Be!&te"si %e"deita %e"deita $elai"a" $elai"a" t&lea"si t&lea"si 'lu$&sa
/. ETIOLOGI Me"uut S%elt4e da" Bae (-1) !e"#ebab dai diabetes %elitus adala6 1.
Diabetes Melitus te'a"tu"' te'a"tu"' i"suli" (DMTI)
a.
Fa$t& 'e"eti3 Pe"deita diabetes tida$ %e0aisi diabetes ti!e I itu se"dii teta!i %e0aisi suatu !esdis!&sisi !esdis!&sisi atau $e3e"deu"'a" $e3e"deu"'a" 'e"eti3
$eaa te+adi"#a diabetes ti!e I. Ke3e"deu"'a" 'e"eti3 i"i dite"tu$a" !ada i"di2idu #a"' %e%ilili$i ti!e a"ti'e" HLA(Hu%a" Leu3&3#te A"ti'e") tete"tu. HLA %eu!a$a" $u%!ula" 'e" #a"' beta"''u"' +a0ab atas a"ti'e" ta"!la"tasi da" !&ses i%u" lai""#a.
b.
Fa$t& i%u"&l&'i i%u"&l&'i Pada diabetes diabetes ti!e I teda!at bu$ti bu$ti ada"#a ada"#a suatu es!&" es!&" aut&i%u". aut&i%u". I"i %eu!a$a" %eu!a$a" es!&" ab"&%al ab"&%al di%a"a di%a"a a"tib&d# a"tib&d# teaa teaa !ada
+ai"'a" "&%al "&%al tubu de"'a" de"'a" 3aa beea$si beea$si teada! teada! +ai"'a" +ai"'a" tesebut #a"' #a"' dia"''a!"#a dia"''a!"#a se&la*&la se&la*&la seba'ai seba'ai +ai"'a" asi"'. 3.
Fa$t& li"'$u"'a" Fa$t& e$ste"al #a"' da!at %e%i3u destu$si sel 7 !a"3eas seba'ai 3&"t& asil !e"#elidi$a" !e"#elidi$a" %e"#ata$a" %e"#ata$a" ba0a 2ius atau
t&$si" tete"tu da!at %e%i3u !&ses autui%u" #a"' da!at %e"i%bul$a" destu$si sel 7 !a"$eas. -.
Diabetes Melitus ta$ te'a"tu"' te'a"tu"' i"suli" (DMTTI) Se3aa !asti !e"#ebab dai DM ti!e II i"i belu% di$etaui ,a3t& 'e"eti3 di!e$ia$a" %e%e'a"' !ea"a" dala% !&ses te+adi"#a
esiste"si i"suli". Diabetes Melitus ta$ te'a"tu"' te'a"tu"' i"suli" (DMTTI) !e"#a$it"#a !e"#a$it"#a %e%!u"#ai !&la ,a%ilia #a"' $uat. DMTTI dita"dai de"'a" $elai"a" dala% se$esi i"suli" %au!u" dala% $e+a i"suli". Pada a0al"#a ta%!a$ teda!at esiste"si dai sel*sel sasaa" teada! $e+a i"suli". I"suli" %ula*%ula %e"'i$at dii"#a $e!ada ese!t&*ese!t& !e%u$aa" sel tete"tu $e%udia" te+adi ea$si i"tasellule #a"' %e"i"'$at$a" ta"s!&t 'lu$&sa %e"e%bus %e%ba" sel. Pada !asie" de"'a" DMTTI teda!at $elai"a" dala% !e"'i$ata" !e"'i$ata" i"suli" de"'a" ese!t&. ese!t&. Hal i"i da!at disebab$a" disebab$a" &le be$ua"'"#a be$ua"'"#a +u%la te%!at ese!t& #a"' es!&"si, i"suli" !ada %e%ba" sel. A$ibat"#a te+adi !e"''abu"'a" ab"&%al a"taa $&%!le$ ese!t& i"suli" de"'a" s#ste% ta"s!&t 'lu$&sa. Kada 'lu$&sa "&%al da!at di!etaa"$a" dala% 0a$tu #a"' 3u$u! la%a da" %e"i"'$at$a" se$esi i"suli" teta!i !ada a$i"#a se$esi i"suli" #a"' beeda tida$ la'i %e%adai u"tu$ %e%!etaa"$a" eu'li$e%ia (Pi3e1885). Diabetes Melitus ti!e II disebut +u'a Diabetes Melitus tida$ te'a"tu"' i"suli" (DMTTI) atau N&" I"suli" De!e"de"t Diabetes Melitus(NIDDM) #a"' %eu!a$a" suatu $el&%!&$ ete&'e" ete&'e" be"tu$*be"tu$ Diabetes #a"' lebi i"'a" teuta%a di+u%!ai !ada &a"' de0asa teta!i te$ada"' da!at ti%bul !ada %asa $a"a$*$a"a$. $a"a$*$a"a$. Fa$t& isi$& #a"' beubu"'a" beubu"'a" de"'a" de"'a" !&ses !&ses te+adi"#a te+adi"#a DM ti!e II dia"taa"#a dia"taa"#a adala6 adala6 1)
Usia ( esiste"si esiste"s i i"suli" 3e"deu"' %e"i"'$at !ada usia di atas 95 tau")
-)
Obesitas
:)
Ri0a#at $elua'a
;)
Kel&%!&$ et"i$
:.
Diabetes de"'a" Ul$us
a. Fa$t& e"d&'e"6 1) Neu&!ati6 Te+adi $eusa$a" saa, se"s&i$ #a"' di%a"i,estasi$a" de"'a" !e"uu"a" se"s&i "#ei !a"as ta$ teasa sei"''a %uda te+adi tau%a da" &t&"&%
Is$e%ia
Adala Adala ate&s$ ate&s$le& le&sis sis (!e"'a!u (!e"'a!ua" a" da" !e"#e%!i !e"#e%!ita" ta" !e%bulu !e%bulu daa) daa) !ada !ada !e%bulu !e%bulu daa daa besa besa tu"'$ai tu"'$ai (%a$&a" (%a$&a"'i&! 'i&!ati) ati) %e"#ebab$a" !e"uu"a" alia" daa $e tu"'$ai bila teda!at t&%bus a$a" %e%!ebeat ti%bul"#a 'a"'e"e #a"' luas. Ate&s$le&sis da!at disebab$a" &le ,a$t&6
Ada"#a &%&"e ate&'e"i$
Me&$&$
Hi!eli!ide%ia
Ma"i,estasi $a$i diabetes is$e%ia6 Ka$i di"'i" N#ei "&3tu"al Tida$ teaba"#a de"#ut "adi Ada"#a !e%u3ata" e$sti%itas i",ei& Kulit %e"'$ila! Hila"'"#a a%but dai +ai $a$i Pe"ebala" $u$u Ga"'e"e $e3il atau luas.
b. Fa$t& e$s&'e" 1)
Tau%a
-)
I",e$si
D. ANATOMI DAN FISIOLOGI 1. A"at&%i Pa"$eas Pa"$eas %eu!a$a" se$u%!ula" $ele"+a #a"' !a"+a"'"#a $ia*$ia 15 3% leba 5 3% %ulai dai du&de"u% sa%!ai $e li%!a da" beat"#a ata*ata 9*8 'a%. Tebe"ta"' !ada 2etebata lu%balis 1 da" - di bela$a"' la%bu"'. Pa"$eas +u'a %eu!a$a" $ele"+a e"d&$i" tebesa #a"' teda!at di dala% tubu bai$ e0a" %au!u" %a"usia. Ba'ia" de!a" ( $e!ala ) $ele"+a !a"$eas teleta$ !ada le$u$a" #a"' dibe"tu$ &le du&de"u% da" ba'ia" !il&us dai la%bu"'. Ba'ia" bada" #a"' %eu!a$a" ba'ia" uta%a dai &'a" i"i %ee"ta"' $e aa li%!ade"'a" ba'ia" e$&"#a %e"#e"tu atau teleta$ !ada alat i"i. Dai se'i !e$e%ba"'a" e%bi&l&'is $ele"+a !a"$eas tebe"tu$ dai e!itel #a"' beasal dai la!isa" e!itel #a"' %e%be"tu$ usus (Ta%ba#&"' -1). Fu"'si !a"$eas ada - #aitu 6 a.
Fu"'si e$s&i" #aitu %e%be"tu$ 'eta !a"$eas #a"' beisi e"4i% da" ele$t&lit.
b.
Fu"'si e"d&$i" #aitu se$el&%!&$ $e3il atau !ulau la"'ea"s #a"' besa%a*sa%a %e%be"tu$
&'a" e"d&$i" #a"'
%e"se$esi$a" i"suli". Pulau la"'ea"s%a"usia %e"'a"du"' ti'a +e"is sel uta%a#aitu 6 1)
Sel*sel A ( al!a ) +u%la"#a se$ita -*; = > %e%!&du$si 'lu$a'&" #a"' %a"+adi ,a$t& i!e'li$e%i$ suatu &%&" #a"'
%e%!u"#ai ? a"ti i"suli" li$e a3ti2it# ?. -)
Sel*sel B ( beta ) +u%la"#a se$ita 9*@ = %e%buat i"suli".
:)
Sel*sel D
(delta) +u%la"#a
se$ita
!ele!asa" i"suli" da" 'lu$a'&" . (Ta%ba#&"' -1).
5*15
=
%e%buat s&%at&stati" #a"'
%e"'a%bat
A"at&%i Pa"$eas
-. Fisi&l&'i Kada 'lu$&sa dala% daa sa"'at di!e"'aui ,u"'i e!a !a"$eas ade"&i!&,isis da" ade"al. Glu$&sa #a"' beasal dai abs&!si %a$a"a" dii"testi" diali$a" $e e!a %elalui 2e"a !&ta seba'ia" 'lu$&sa a$a" disi%!a" seba'ai 'li$&'e". Pada saat i"i $ada 'lu$&sa di 2e"a !&ta lebi ti"''i dai!ada 2e"a e!ati3a setela abs&si selesai 'li&'e" e!a di!e3a la'i %e"+adi 'lu$&sa sei"''a $ada 'lu$&sa di 2e"a e!ati3a lebi ti"''i dai 2e"a !&ta. adi e!a be!ea" seba'ai 'lu$&stat. Pada $eadaa" "&%al 'li$&'e" di e!a 3u$u! u"tu$ %e%!etaa"$a" $ada 'lu$&sa dala% bebea!a ai teta!i bila ,u"'si e!a te'a"''u a$a" %uda te+adi i!&'li$e%i atau i!e'li$e%i. Seda"'$a" !ea" i"suli" da" 'lu3a'&" sa"'at !e"ti"' !ada %etab&lis%e $ab&"idat. Glu$a'&" %e"#ebab$a" 'li$&'e"&lisis de"'a" %ea"'sa"' ade"ilsi$lase e"4i% #a"' dibutu$a" u"tu$ %e"'a$ti,$a" ,&s,&ilase. E"4i% ,&s,&ilase !e"ti"' u"tu$ 'li&'e"&lisis. Bila 3ada"'a" 'li$&'e" e!a %e"uu" %a$a 'lu$&"e&'e"esis a$a" lebi a$ti,. u%la 'lu$&sa #a"'
dia%bil
da" dile!as$a"
&le
ati
da"
#a"'
di!e'u"a$a" &le
+ai"'a" !ei,e te'a"tu"'
$esei%ba"'a" ,isi&l&'is bebea!a &%&" a"taa lai" 6 a.
H&%&" #a"' da!at %ee"da$a" $ada 'ula daa #aitu i"suli".
Ke+a i"suli" #aitu %eu!a$a" &%&" #a"' %e"uu"$a" 'lu$&sa daa de"'a" 3aa %e%ba"tu 'lu$&sa daa %asu$ $edala% sel. 1)
Glu$a'&" #a"' dise$esi &le sel al,a !ulau le"'ea"s.
-)
E!i"e,i" #a"' dise$esi &le %edula ade"al da" +ai"'a" $&%a,i".
:)
Glu$&$&ti$&id #a"' dise$esi$a" &le $&te$s ade"al.
;). G&0t &%&"e #a"' dise$esi &le $ele"+a i!&,isis a"tei&.
dai
b.
Glu$&'e" e!i"e!i" 'lu$&$&ti$&id da" '&0t &%&"e %e%be"tu$ suatu %e$a"is%e 3&u",e*e'ulat& #a"' %e"3e'a
ti%bul"#a i!&'li$e%ia a$ibat !e"'au i"suli".
Diabetes Melitus (DM) E. PATOFISIOLOGI DAN PATHAC Me"uut S%elt4e da" Bae (-1) !at&,isi&l&'i dai diabetes %elitus adala 6
1.
Diabetes ti!e I
Pada Diabetes ti!e I teda!at $etida$%a%!ua" u"tu$ %e"'asil$a" i"suli" $ae"a sel*sel beta !a"$eas tela dia"3u$a" &le !&ses aut&i%u". Hi!e'li$e%ia !uasa te+adi a$ibat !&du$si 'lu$&sa #a"' tida$ teu$u &le ati. Disa%!i"' itu 'lu$&sa #a"' beasal dai %a$a"a" tida$ da!at disi%!a" dala% ati %es$i!u" teta! beada dala% daa da" %e"i%bul$a" i!e'li$e%ia !&st!a"dial (sesuda %a$a"). i$a $&"se"tasi 'lu$&sa dala% daa 3u$u! ti"''i 'i"+al tida$ da!at %e"#ea! $e%bali se%ua 'lu$&sa #a"' tesai"' $elua a$ibat"#a 'lu$&sa tesebut %u"3ul dala% ui" (Glu$&suia). Keti$a 'lu$&sa #a"' belebi die$sesi$a" dala% ui" e$s$esi i"i a$a" disetai !e"'eluaa" 3aia" da" ele$t&lit #a"' belebia". Keadaa" i"i di"a%a$a" diuesis &s%&ti$. Seba'ai a$ibat dai $eila"'a" 3aia" #a"' belebia" !asie" a$a" %e"'ala%i !e"i"'$ata" dala% be$e%i (!&liuia) da" asa aus (!&lidi!sia). De,isie"si i"suli" +u'a %e"''a"''u %etab&lis%e !&tei" da" le%a$ #a"' %e"#ebab$a" !e"uu"a" beat bada". Pasie" da!at %e"'ala%i !e"i"'$ata" selea %a$a" (!&li,a'ia) a$ibat %e"uu""#a si%!a"a" $al&i. Ge+ala lai""#a %e"3a$u! $elelaa" da" $ele%aa".P&ses i"i a$a" te+adi ta"!a a%bata" da" lebi la"+ut tuut %e"i%bul$a" i!e'li$e%ia. Disa%!i"' itu a$a" te+adi !e%e3aa" le%a$ #a"' %e"'a$ibat$a" !e"i"'$ata" !&du$si bada" $et&" #a"' %eu!a$a" !&du$ sa%!i"' !e%e3aa" le%a$. Bada" $et&" %eu!a$a" asa% #a"' %e"''a"''u $esei%ba"'a" asa% basa tubu a!abila +u%la"#a belebia". Ket&asid&sis diabeti$ #a"' dia$ibat$a""#a da!at %e"#ebab$a" ta"data"da da" 'e+ala se!eti "#ei abd&%i"al %ual %u"ta i!e2e"tilasi "a!as bebau aset&" da" bila tida$ dita"'a"i a$a" %e"i%bul$a" !eubaa" $esadaa" $&%a ba$a" $e%atia". -.
Diabetes ti!e II
Pada Diabetes ti!e II teda!at dua %asala #a"' beubu"'a" de"'a" i"suli" #aitu esiste"si i"suli" da" 'a"''ua" se$esi i"suli". N&%al"#a i"suli" a$a" tei$at de"'a" ese!t& $usus !ada !e%u$aa" sel. Seba'ai a$ibat tei$at"#a i"suli" de"'a" ese!t& tesebut te+adi suatu a"'$aia" ea$si dala% %etab&lis%e 'lu$&sa didala% sel. Resiste"si i"suli" !ada diabetes ti!e II disetai de"'a" !e"uu"a" ea$si i"tasel i"i. De"'a" de%i$ia" i"suli" %e"+adi tida$ e,e$ti, u"tu$ %e"sti%ulasi !e"'a%bila" 'lu$&sa &le +ai"'a". A$ibat i"t&lea"si 'lu$&sa #a"' bela"'su"' la%bat da" !&'esi, %a$a a0ita" diabetes ti!e II da!at be+ala" ta"!a tedete$si. i$a
'e+ala"#a diala%i !asie" 'e+ala tesebut sei"' besi,at i"'a" da" da!at %e"3a$u! $elelaa" iitabilitas !&liuia !&lidi!sia lu$a #a"' la%a se%bu i",e$si 2a'i"a atau !a"da"'a" #a"' $abu ( +i$a $ada 'lu$&sa"#a sa"'at ti"''i). Pe"#a$it Diabetes %e%buat 'a"''ua"< $&%!li$asi %elalui $eusa$a" !ada !e%bulu daa di seluu tubu disebut a"'i&!ati diabeti$. Pe"#a$it i"i be+ala" $&"is da" teba'i dua #aitu 'a"''ua" !ada !e%bulu daa besa (%a$&2as$ula) disebut %a$&a"'i&!ati da" !ada !e%bulu daa alus (%i$&2as$ula) disebut %i$&a"'i&!ati. Ul$us Diabeti$u% tedii dai $a2itas se"tal biasa"#a lebi besa disba"di"' !i"tu %asu$"#a di$elili"'i $alus $eas da" tebal. A0al"#a !&ses !e%be"tu$a" ul$us beubu"'a" de"'a" i!e'li$e%ia #a"' bee,e$ teada! saa, !ei,e $&la'e" $eati" da" su!lai 2as$ule. De"'a" ada"#a te$a"a" %e$a"i$ tebe"tu$ $eati" $eas !ada daea $a$i #a"' %e"'ala%i beba" tebesa. Neu&!ati se"s&is !ei,e %e%u"'$i"$a" te+adi"#a tau%a beula"' %e"'a$ibat$a" te+adi"#a $eusa$a" +ai"'a" diba0a aea $alus. Sela"+ut"#a tebe"tu$ $a2itas #a"' %e%besa da" a$i"#a u!tu sa%!ai !e%u$aa" $ulit %e"i%bul$a" ul$us. Ada"#a is$e%ia da" !e"#e%bua" lu$a ab"&%al %a"'ala"'i es&lusi. Mi$&&'a"is%e #a"' %asu$ %e"'ada$a" $&l&"isasi didaea i"i. Dai"ase #a"' i"ade$uat %e"i%bul$a" 3l&sed s!a3e i",e3ti&". A$i"#a seba'ai $&"se$ue"si siste% i%u" #a"' ab"&%al ba$teia sulit dibesi$a" da" i",e$si %e"#eba $e +ai"'a" se$ita"#a (A"&"i% -8).
Pat0a# Diabetes Melitus (DM)
Pat0a# DIABETES MELITUS (DM)
F.
MANIFESTASI KLINIS
1.
Diabetes Ti!e I
a.
i!e'li$e%ia be!uasa
b.
'lu$&suia diuesis &s%&ti$ !&liuia !&lidi!sia !&li,a'ia
3.
$eletia" da" $ele%aa"
d.
$et&asid&sis diabeti$ (%ual "#ei abd&%e" %u"ta i!e2e"tilasi "a,as bau bua ada !eubaa" ti"'$at $esadaa" $&%a
$e%atia") -.
Diabetes Ti!e II
a.
la%bat (sela%a tau"a") i"t&lea"si 'lu$&sa !&'esi,
b.
'e+ala sei"'$ali i"'a" %e"3a$u! $eletia" %uda tesi"''u"' !&liuia !&lidi!sia lu$a !ada $ulit #a"' se%bu"#a la%a
i",e$si 2a'i"al !e"'liata" $abu 3.
$&%!li$aasi +a"'$a !a"+a"' (eti"&!ati "eu&!ati !e"#a$it 2as$ula !ei,e)
:.
Ul$us Diabeti$u%
Ul$us Diabeti$u% a$ibat %i$ia"'i&!ati$ disebut +u'a ul$us !a"as 0alau!u" "e$&sis daea a$al itu ta%!a$ %ea da" teasa a"'at &le !eada"'a" da" biasa"#a teaba !ulsasi atei diba'ia" distal . P&ses %i$&a"'i!ati %e"#ebab$a" su%bata" !e%bulu daa seda"'$a" se3aa a$ut e%b&li %e%bei$a" 'e+ala $li"is 5 P #aitu 6 a.
Pai" ("#ei)
b.
Pale"ess ($e!u3ata")
3.
Paestesia ($ese%uta")
d.
Pulseless"ess (de"#ut "adi ila"')
e.
Paal#sis (lu%!u).
Bila te+adi su%bata" $&"i$ a$a" ti%bul 'a%baa" $li"is %e"uut !&la dai ,&"tai"e6 a.
Stadiu% I 6 asi%!t&%atis atau 'e+ala tida$ $as ($ese%uta").
b.
Stadiu% II 6 te+adi $laudi$asi& i"te%ite"
3.
Stadiu% III 6 ti%bul "#ei saat istitaat.
d.
Stadiu% I 6 te+adi"#a $eusa$a" +ai"'a" $ae"a a"&$sia (ul$us).
S%elt4e da" Bae (-16 1--).
DIABETES MELITUS (DM) Klasi,i$asi 6 a'"e (18@:). %e%ba'i 'a"'e" $a$i diabeti$ %e"+adi e"a% ti"'$ata"#aitu6 Dea+at
6Tida$ ada lesi tebu$a $ulit %asi utu de"'a" $e%u"'$i"a" disetai $elai"a" be"tu$ $a$i se!eti ? 3la03allus ?.
Dea+at I
6 Ul$us su!e,isial tebatas !ada $ulit.
Dea+at II
6Ul$us dala% %e"e%bus te"d&" da" tula"'
Dea+at III
6 Abses dala% de"'a" atau ta"!a &ste&%ielitis.
Dea+at I
6 Ga"'e" +ai $a$i atau ba'ia" distal $a$i de"'a" atau ta"!a selulitis.
Dea+at
6 Ga"'e" seluu $a$i atau seba'ia" tu"'$ai.
DIABETES MELITUS (DM)
G. KOMPLIKASI K&%!li$asi #a"' be$aita" de"'a" $edua ti!e DM di'&l&"'$a" seba'ai a$ut da" $&"i$ 6 1.
K&%!li$asi a$ut
K&%!li$asi a$ut te+adi seba'ai a$ibat dai $etida$sei%ba"'a" +a"'$a !e"de$ dai 'lu$&sa daa. a.
Hi!&'li$e%ia.
b.
Ket&asid&sis diabeti3 (DKA)
3.
si"d&% i!e'li$e%i$ i!e&s%&la "&" $et&ti$ (HONK).
-.
K&%!li$asi $&"i$
U%u%"#a te+adi 1 sa%!ai 15 tau" setela a0ita". a.
Ma$&2as$ula (!e"#a$it !e%bulu daa besa) %e"'e"ai si$ulasi $&&"e 2as$ula !ei,e da" 2as$ula selebal.
b.
Mi$&2as$ula (!e"#a$it !e%bulu daa $e3il) %e"'e"ai %ata (eti"&!ati) da" 'i"+al ("e,&!ati). K&"t&l $ada 'lu$&sa daa
u"tu$ %e%!ela%bat atau %e"u"da a0ita" bai$ $&%!li$asi %i$&2as$ula %au!u" %a$&2as$ula. 3.
Pe"#a$it "eu&!ati %e"'e"ai saa, se"s&i$*%&t&i$ da" aut&"&%i seta %e"u"+a"' %asala se!eti i%!&te"si da" ul$us !ada
$a$i. d.
Ul$us<'a"'e"
Teda!at li%a 'ade ul$us diabeti$u% a"taa lai"6 1)
Gade 6 tida$ ada lu$a
-)
Gade I 6 $eusa$a" a"#a sa%!ai !ada !e%u$aa" $ulit
:)
Gade II 6 $eusa$a" $ulit %e"3a!ai &t&t da" tula"'
;)
Gade III
6 te+adi abses
5)
Gade I
6 Ga"'e" !ada $a$i ba'ia" distal
9)
Gade
6 Ga"'e" !ada seluu $a$i da" tu"'$ai
:.
K&%!li$asi +a"'$a !a"+a"' dai diabetes
O'a"<+ai"'a" #' te$e"a
C' te+adi
K&%!li$asi
Pe%bulu daa
Pla$ ate&s$le&ti$ tebe"tu$ %e"#u%bat Si$ulasi #' +ele$ %e"#ebab$a" !e"#e%bua" atei beu$ua" besa atau seda"' di +a"tu"' lu$a #' +ele$ bisa %e"#ebab$a" !e"#a$it &ta$ Di"di"' $eusa$a"
tu"'$ai !e%bulu sei"''a
daa
$e3il
!e%bulu
!e"is. +a"tu"' st&$e 'a"'e" $a$i ta"'a" i%!&te" %e"'ala%i i",e$si tida$
da!at
%e"ta"s,e &$si'e" se3aa "&%al %e"'ala%i $eb&3&a" Mata
Te+adi $eusa$a" !ada !e%bulu daa $e3il Ga"''ua" !e"'liata" !ada a$i"#a bisa
eti"a Gi"+al
Saa,
te+adi $ebutaa"
Pe"ebala" !e%bulu daa 'i"+al
P&tei" b&3& $e dala% ai $e%i
Daa tida$ disai"' se3aa "&%al
Keusa$a"
saa,
$ae"a
'lu$&sa
Fu"'si
'i"+al
#'
buu$
Ga'al 'i"+al
tida$
Kele%aa" tu"'$ai #' te+adi se3aa tiba*
di%etab&lisi se3aa "&%al $ae"a alia" tiba atau se3aa !elaa" daa be$ua"'
Be$ua"'"#a asa $ese%uta" "#ei di
ta"'a" $a$i
Siste% saa, &t&"&%
Keusa$a" !ada saa, #' %e"'e"dali$a" te$a"a" daa salua" !e"3e"aa"
Keusa$a" saa, %e"au" Te$a"a" daa #' "ai$*tuu" Kesulita" %e"ela" !eubaa" ,u"'si
!e"3e"aa" disetai sea"'a" diae Kulit
Be$ua"'"#a alia" daa $e $ulit ila"'"#a asa #' %e"#ebab$a" 3edea beula"'
Daa
Ga"''ua" ,u"'si sel daa !uti
Lu$a i",e$si dala% (ul$us diabeti$u%) Pe"#e%bua" lu$a #' +ele$
Muda te$e"a i",e$si teuta%a i",e$si salua" $e%i $ulit
H. PEMERIKSAAN PENUNANG 1.
Glu$&sa daa6 daa atei < $a!ile 5*1= lebi ti"''i dai!ada daa 2e"a seu%
de"'a" de!&tei"isasi 5= lebi ti"''i dai!ada %et&de ta"!a de!&tei"isasi -.
Glu$&sa ui"6 85= 'lu$&sa dieabs&!si tubulus bila 'lu$&sa daa 19*1@= %a$a se$esi dala% ui"e a$a" "ai$ se3aa
e$s!&"e"sial u+i dala% ui"6 "ilai a%ba"' i"i a$a" "ai$ !ada &a"' tua. Met&de #a"' !&!ule6 3ai$ 3elu! %e%a$ai GOD. :.
Be"da $et&" dala% ui"e6 baa" ui"e se'a $ae"a asa% aset&asetat 3e!at dide$b&$silasi %e"+adi aset&". Met&de #a"' di!a$ai
Nat&!usid :*id&$sibutiat tida$ tedete$si ;.
Pe%ei$sa" lai"6 ,u"'si 'i"+al ( Ueu% 3eati"i") Le%a$ daa6 (K&leste&l HDL LDL Ti'leseid) ,u"'si ati a"tib&di a"ti
sel i"sula la"'ea"s ( islet 3ella"tib&d#)
I.
PENATALAKSANAAN
1. Medis a.
Obat
1)
Tablet OAD (Oal A"tidiabetes)
a)
Me$a"is%e $e+a sul,a"iluea
$e+a OAD ti"'$at !eese!t& 6 !a"$eati$ e$sta !a"3eas
b)
$e+a OAD ti"'$at ese!t& Me$a"is%e $e+a Bi'ua"ida
Bi'ua"ida tida$ %e%!u"#ai e,e$ !a"$eati$ teta!i %e%!u"#ai e,e$ lai" #a"' da!at %e"i"'$at$a" e,e$ti2itas i"suli" #aitu6
Bi'ua"ida !ada ti"'$at !eese!t& e$sta !a"$eati$
(1) Me"'a%bat abs&!si $ab&idat (-) Me"'a%bat 'lu$&"e&'e"esis di ati (:) Me"i"'$at$a" a,i"itas !ada ese!t& i"suli" (;) Bi'ua"ida !ada ti"'$at ese!t& 6 %e"i"'$at$a" +u%la ese!t& i"suli" (5) Bi'ua"ida !ada ti"'$at !as3aese!t& 6 %e%!u"#ai e,e$ i"taselule b.
I"suli"
1)
I"di$asi !e"''u"aa" i"suli"
a)
DM ti!e I
b)
DM ti!e II #a"' !ada saat tete"tu tida$ da!at dia0at de"'a" OAD
3)
DM $ea%ila"
d)
DM da" 'a"''ua" ,aal ati #a"' beat
e) ,)
DM da" i",e$si a$ut (selulitis 'a"'e") DM da" TB/ !au a$ut
')
DM da" $&%a lai" !ada DM
)
DM &!easi
-)
I"suli" di!elu$a" !ada $eadaa" 6
a)
Pe"uu"a" beat bada" #a"' 3e!at.
b)
Hi!e'li$e%ia beat #a"' disetai $et&asid&sis.
3)
Ket&asid&sis diabeti$.
d)
Ga"''ua" ,u"'si 'i"+al atau ati #a"' beat.
-. Ke!ea0ata" Usaa !ea0ata" da" !e"'&bata" #a"' ditu+u$a" teada! ul$us a"taa lai" de"'a" a"tibi&ti$a atau $e%&tea!i. Pea0ata" lu$a de"'a" %e"'&%!es$a" ul$usde"'a" lauta" $l&ida atau lauta" a"tise!ti3 i"'a". Misal"#a i2a"&l da" lauta" $aliu% !e%a"'a"ate 1 6 5 %' da" !e"utu!a" ul$us de"'a" $assa steil. Alat*alat &t&!edi #a"' se3aa%e$a"i$ #a"' da!at %eata te$a"a" tubu teada! $a$i #a"' lu$a a%!utasi %u"'$i" di!elu$a" u"tu$ $asus DM.Me"uut S%elt4e da" Bae (-16 1--9) tu+ua" uta%a !e"atala$sa"aa" tea!i !ada Diabetes Melitus adala %e"&%al$a" a$ti,itas i"suli" da" $ada 'lu$&sa daa seda"'$a" tu+ua" +a"'$a !a"+a"'"#a adala u"tu$ %e"'i"dai te+adi"#a $&%!li$asi. Ada bebea!a $&%!&"e" dala% !e"atala$sa"aa" Ul$us Diabeti$6
a.
Diet
Diet da" !e"'e"dalia" beat bada" %eu!a$a" dasa u"tu$ %e%bei$a" se%ua u"su %a$a"a" ese"sial %e%e"ui $ebutua" e"e'i %e"3e'a $ada 'lu$&sa daa #a"' ti"''i da" %e"uu"$a" $ada le%a$. Pi"si! diet DM adala6 1)
u%la sesuai $ebutua"
-)
ad0al diet $etat
:)
e"is6 b&le di%a$a"
Diit DM sesuai de"'a" !a$et*!a$et #a"' tela disesuai$a" de"'a" $a"du"'a" $al&i"#a. (1) Diit DM I
6
11 $al&i
(-) Diit DM II
6
1: $al&i
(:) Diit DM III
6
15 $al&i
(;) Diit DM I 6
1 $al&i
(5) Diit DM
6
18 $al&i
(9) Diit DM I 6
-1 $al&i
() Diit DM II 6
-: $al&i
(@) Diit DM III6
-5 $al&i
Diit I s
6 dibei$a" $e!ada !e"deita #a"' telalu 'e%u$
Diit I s
6 dibei$a" $e!ada !e"deita de"'a" beat bada" "&%al
Diit I s
******************J 1 = TB (3%) 1
1)
Kuus (u"de0ei't)
6
-)
N&%al (ideal)
:)
Ge%u$ (&2e0ei't)
6
;)
Obesitas a!abila 6
BBR 1- =
6
BBR 8 11 =
* Obesitas i"'a" 6 * Obesitas seda"' * Obesitas beat * M&bid
6
BBR 11 =
BBR 1- 1: = 6
6
BBR 8 =
BBR 1: 1; = BBR 1; - =
BBR - =
Seba'ai !ed&%a" +u%la $al&i #a"' di!elu$a" seai*ai u"tu$ !e"deita DM #a"' be$e+a biasa adala6 1)
$uus
-)
N&%al
6 BB J : $al&i seai
:)
Ge%u$
6 BB J - $al&i seai
;)
Obesitas
6 BB J 1*15 $al&i seai
b.
6 BB J ; 9 $al&i seai
Latia"
De"'a" latia" i"i %isal"#a de"'a" be&laa'a #a"' teatu a$a" %e"uu"$a" $ada 'lu$&sa daa de"'a" %e"i"'$at$a" !e"'a%bila" 'lu$&sa &le &t&t da" %e%!ebai$i !e%a$aia" $ada i"suli". 3.
Pe%a"taua"
De"'a" %ela$u$a" !e%a"tau"a" $ada 'lu$&sa daa se3aa %a"dii diaa!$a" !ada !e"deita diabetes da!at %e"'atu tea!i"#a se3aa &!ti%al. d.
Tea!i (+i$a di!elu$a")
Pe"#u"ti$a" i"suli" sei"' dila$u$a" dua $ali !e ai u"tu$ %e"'e"dali$a" $e"ai$a" $ada 'lu$&sa daa sesuda %a$a" da" !ada %ala% ai. e.
Pe"didi$a"
Tu+ua" dai !e"didi$a" i"i adala su!a#a !asie" da!at %e%!ela+ai $etea%!ila" dala% %ela$u$a" !e"atala$sa"aa" diabetes #a"' %a"dii da" %a%!u %e"'i"dai $&%!li$asi dai diabetes itu se"dii. Pe"didi$a" $eseata" !ea0ata" $a$i 1. Hie'e"e $a$i6
/u3i $a$i setia! ai $ei"'$a" sela*sela +ai de"'a" 3aa %e"e$a" +a"'a" di'&s&$
Setela $ei"' dibei l&ti&" u"tu$ %e"3e'a $ei"' besisi$ da" 'ese$a" #a"' belebi
P&t&"' $u$u se3aa teatu da" susut $u$u +a"'a" di!&t&"'
Gu"a$a" se!atu tu%it e"da $ulit lu"a$ da" tida$ se%!it
Gu"a$a" $a&s $a$i #a"' ti!is da" a"'at seta tida$ se%!it
Bila teda!at 3allus ila"'$a" 3allus #a"' belebia" de"'a" 3aa $a$i die"da% dala% ai a"'at se$ita 1 %e"it $e%udia"
'&s&$ de"'a" a"du$ atau di$i$i +a"'a" di$elu!as. -. Alas $a$i #a"' te!at :. Me"3e'a tau%a $a$i ;. Bee"ti %e&$&$ 5. Se'ea beti"da$ +i$a ada %asala ,.
K&"t&l "utisi da" %etab&li3
Fa$t& "utisi %eu!a$a" sala satu ,a$t& #a"' be!ea" dala% !e"#e%bua" lu$a. Ada"#a a"e%ia da" i!&albu%i"e%ia a$a" be!e"'au dala% !&ses !e"#e%bua". Pelu %e%&"it& Hb diatas 1- 'a%
Stes Me$a"i$
Pelu %e%i"i%al$a" beba" beat (0ei't beai"') !ada ul$us. M&di,i$asi 0ei't beai"' %eli!uti bedest %e%a$ai 3ut3 $usi &da se!atu #a"' tetutu! da" se!atu $usus. Se%ua !asie" #a"' istiaat dite%!at tidu tu%it da" %ata $a$i aus dili"du"'i seta $edua tu"'$ai aus dii"s!e$si tia! ai. Hal i"i di!elu$a" $ae"a $a$i !asie" suda tida$ !e$a la'i teada! asa "#ei sei"''a a$a" te+adi tau%a beula"' dite%!at #a"' sa%a %e"#ebab$a" ba$tei %asu$ !ada te%!at lu$a. .
Ti"da$a" Beda
Bedasa$a" beat i"'a""#a !e"#a$it %e"uut a'"e %a$a ti"da$a" !e"'&bata" atau !e%bedaa" da!at dite"tu$a" seba'ai bei$ut6 a. Dea+at 6 !ea0ata" l&$al se3aa $usus tida$ ada. b. Dea+at I * 6 !e"'el&laa" %edi$ da" beda %i"&
DIABETES MELITUS (DM)
SOP PERAATAN LUKA DM A. TAHAP PRE INTERAKSI 1.
/e$ 3atata" %edis da" !ea0ata"
-.
Ka+i $ebutua" $lie" u"tu$ %a"a+e%e" "#ei ,a%a$&l&'i (a"al'eti$) atau "&",a%a$&l&'i saat a$a" dila$u$a" !ea0ata" lu$a.
:.
/u3i ta"'a"
;.
Sia!$a" alat*alat6
a.
Satu set !ea0ata" lu$a steil< ba$ steil6
*
Sau"' ta"'a" steil 1 !asa"'
*
Pi"set a"at&%is - bua
*
Pi"set 3iu'is 1 bua
*
Gu"ti"' +ai"'a" 1 bua
*
Kassa steil
*
K&% beisi lauta" !e%besi ("&%al sali" 8= sesuai &de d&$te)
b.
Alat "&" steil6
*
Sau"' ta"'a" besi
*
Ka!as al$&&l
*
K&e"ta"'
*
Pela$ atau !e"'alas
*
Be"'$&$
*
K&% beisi L#s&l 1=
*
Gu"ti"' 2eba"< !leste
*
eba"
*
Pleste
*
S3&t
*
Mas$e
*
Obat sesuai !&'a% %edis
*
Te%!at sa%!a
B. TAHAP ORIENTASI 1.
Sia!$a" da" de$at$a" alat*alat de$at !asie"
-.
Me%bei sala% !a"''il $lie" seta %e"'e"al$a" dii
:.
Me"ea"'$a" !&sedu da" tu+ua" ti"da$a"
;.
Bei$a" $ese%!ata" !ada !asie" u"tu$ beta"#a.
/. TAHAP KERA
1.
/u3i ta"'a"
-.
a'a !i2asi $lie"
:.
Gu"a$a" s3&t %as$e
;.
Gu"a$a" sau"' ta"'a" besi seba'ai !&te$si
5.
Te%!at$a" te%!at sa%!a de$at de"'a" $ita
9.
Atu !&sisi $lie" se"#a%a" %u"'$i" da" #a"' %e%uda$a" dala% !ea0ata" lu$a
.
Pasa"' !ela$ da" !e"'alas di ba0a !ada ba'ia" lu$a #a"' a$a" dia0at
@.
Tau be"'$&$ de$at de"'a" lu$a
8.
Le!as$a" !leste i$ata" atau baluta" de"'a" !i"set basai !leste de"'a" $a!as #a"' di&lesi al3&&l da" tai$ !leste !elaa"
se+a+a !ada $ulit da" %e"'aa !ada baluta" de"'a" %e"''u"a$a" !i"set a"at&%is. Bila baluta" le"'$et de"'a" lu$a %a$a basai de"'a" de"'a" NS se3u$u!"#a. 1. A"'$at baluta" da" !etaa"$a" !e%u$aa" $&t& +au dai !e"'liata" $lie". 11. Bua"' baluta" $&t& !ada be"'$&$ 1-. I"s!e$si $eadaa" lu$a (ti!e lu$a dea+at lu$a ta"da*ta"da i",e$si!us) 1:. Tau !i"set #a"' tela di'u"a$a" di 3aia" desi",e$ta" da" le!as$a" sau"' ta"'a" besi. 1;. Gu"a$a" te$"i$ steil dala% %e%bu$a alat*alat steil da" %e"ua"'$a" 3aia" sesuai &de.
15. Pa$ai sau"' ta"'a" steil da" a%bil !i"set a"at&%is da" 3iu'is 19. Pe'a"' !i"set 3iu'is !ada ta"'a" d&%i"a" da" a"at&%is !ada ta"'a" "&" d&%i"a" u"tu$ %e%e'a"' $assa #a"' tela dibasai de"'a" "&%al sali" 8=. 1. Besi$a" lu$a %e"''u"a$a" ta"'a" d&%i"a"t de"'a" 'ea$a" satu aa si$ule (dala% $e lua) atau (atas $e ba0a) de"'a" 'a"ti $assa !ada tia! aea.$elua$a" !us de"'a" %e"e$a" aea lu$a se3aa !elaa" !ada +ai"'a" "e$&sis da!at dila$u$a" debide%e"t. 1@. Kei"'a$a" lu$a de"'a" $assa $ei"' 18. Bei &bat !ada aea lu$a sesuai de"'a" &de -. Tutu! lu$a de"'a" $assa $ei"' sesuai de"'a" $ebutua" -1. Balut lu$a de"'a" 2eba" --. Pasa"' !leste u"tu$ ,i$sasi baluta" -:. Bua"' $&t&a" !ada be"'$&$ !ada te%!at sa%!a da" bees$a" alat -;. Le!as$a" sau"' ta"'a" -5. /u3i ta"'a"
D. TAHAP TERMINASI
1.
E2aluasi !easaa" $lie"
-.
Si%!ul$a" asil $e'iata"
:.
Bei$a" ei",&3e%e"t !&siti,
;.
La$u$a" $&"ta$ u"tu$ $e'iata" sela"+ut"#a
5.
A$ii $e'iata"
E. TAHAP DOKUMENTASI 1.
Hai ta"''al "a%a !asie" ti"da$a" $eadaa" lu$a ta"da ta"'a" !ea0at.
Ka$i Diabeti$< Diabetes
ASUHAN KEPERAATAN
A. PENGKAIAN Pe"'$a+ia" !ada $lie" de"'a" 'a"''ua" siste% e"d&$i" diabetes %elitus dila$u$a" %ulai dai !e"'u%!ula" data #a"' %eli!uti 6 bi&data i0a#at $eseata" $elua" uta%a si,at $elua" i0a#at $eseata" %asa lalu !e%ei$saa" ,isi$ !&la $e'iata" seai*ai. Hal #a"' !elu di$a+i !ada $lie" de'a" diabetes %elitus 6 1. A$ti2itas da" istiaat 6 Kele%aa" susa be+ala"
Pe%be"'$a$a" !eut %ei"'is. . Res!iasi Ta3i!"ea $uss%aul &"3i 0ee4i"' da" sesa$ "a,as. @. Kea%a"a" Kulit usa$ lesi
B. DIAGNOSA KEPERAATAN 1.
N#ei a$ut b
-.
Ketida$sei%ba"'a" "utisi $ua"' dai $ebutua" tubu beubu"'a" de"'a" $etida$%a%!ua" tubu %e"'abs&bsi 4at*4at 'i4i
beubu"'a" de"'a" ,a$t& bi&l&'is. :.
Keusa$a" i"te'itas +ai"'a" beubu"'a" de"'a" ,a$t& %e$a"i$6 !eubaa" si$ulasi i%&bilitas da" !e"uu"a" se"sabilitas
("eu&!ati) ;.
Keusa$a" %&bilitas ,isi$ beubu"'a" de"'a" tida$ "#a%a" "#ei i"t&lea"si a$ti,itas !e"uu"a" $e$uata" &t&t
5.
Kua"' !e"'etaua" beubu"'a" de"'a" tida$ %e"'e"al (Fa%ilia) de"'a" su%be i",&%asi.
9.
De,i3it sel, 3ae b
.
PK6 Hi!& < Hi!e'li$e%i
@.
PK 6 I",e$si
DIABETES MELITUS (DM)
/. REN/ANA KEPERAATAN N&
Dia'"&sa
NO/
NI/
1
N#ei a$ut b
Setela dila$u$a" asua"
Ma"a+e%e" "#ei 6
i"+ui ,isi$
$e!ea0ata"ti"'$at
1.
$e"#a%a"a" $lie" %e"i"'$at da" dibu$ti$a" de"'a" le2el "#ei6
La$u$a"
se3aa
!e'$a+ia"
$&%!ee"si,
l&$asi
te%asu$
$aa$teisti$
,e$ue"si
$ualitas
"#ei
duasi
da"
&"t&
$lie" da!at %ela!&$a" !esi!itasi. "#ei
!ada
!etu'as
,e$ue"si "#ei e$s!esi 0a+a
da" %e"#ata$a"
$e"#a%a"a" !si$&l&'is
,isi$ TD
da"
-. Obse2asi ea$si "&"2ebal dai $etida$"#a%a"a". :. Gu"a$a"
1-<@ tea!euti$
te$"i$ u"tu$
$&%u"i$asi %e"'etaui
%%H' N6 9*1 <%"t !e"'ala%a" "#ei $lie" sebelu%"#a. RR6 19*-<%"t /&"t&l
"#ei dibu$ti$a"
de"'a" $lie" %ela!&$a" 'e+ala "#ei da" 3&"t&l "#ei.
;. K&"t&l &"t& li"'$u"'a" #a"' %e%!e"'aui "#ei se!eti suu ua"'a" !e"3aa#aa" $ebisi"'a". 5. Kua"'i &"t& !esi!itasi "#ei. 9. Pili da" la$u$a" !e"a"'a"a" "#ei
(,a%a$&l&'is<"&"
,a%a$&l&'is).. . A+a$a" te$"i$ "&" ,a%a$&l&'is (ela$sasi
dista$si
dll)
u"tu$
%e"'etasi "#ei.. @. Bei$a"
a"al'eti$
u"tu$
%e"'ua"'i "#ei. 8. E2aluasi
ti"da$a"
!e"'ua"'
"#ei<$&"t&l "#ei. 1.
K&lab&asi de"'a" d&$te
bila ada $&%!lai" te"ta"' !e%beia" a"al'eti$ tida$ beasil. 11.
M&"it& !e"ei%aa" $lie"
te"ta"' %a"a+e%e" "#ei.
Ad%i"istasi a"al'eti$ 6. 1. /e$ a"al&'eti$> ,e$ue"si.
!&'a% +e"is
!e%beia" d&sis
da"
-. /e$ i0a#at ale'i.. :. Te"tu$a" a"al'eti$ !ilia" ute !e%beia" da" d&sis &!ti%al. ;. M&"it&
TT
sebelu%
da"
sesuda !e%beia" a"al'eti$. 5. Bei$a" a"al'eti$ te!at 0a$tu teuta%a saat "#ei %u"3ul. 9. E2aluasi
e,e$ti,itas
a"al'eti$
ta"da da" 'e+ala e,e$ sa%!i"'.
-.
Ketida$sei%ba"'a"
Setela dila$u$a" asua"
"utisi $ua"' dai $e!ea0ata" $ebutua"
tubu
$lie"
%e"u"+u$a" status "utisi
bd
ade$uatdibu$ti$a" de"'a"
$etida$%a%!ua"
BB stabil tida$ te+adi %al
tubu
"utisi
ti"'$at
e"e'i
Ma"a+e%e" Nutisi 1. $a+i !&la %a$a" $lie" -. Ka+i ada"#a ale'i %a$a"a". :. Ka+i %a$a"a" #a"' disu$ai &le $lie".
%e"'abs&bsi 4at* ade$uat %asu$a" "utisi 4at
'i4i ade$uat
!e"#ediaa" "utisi te!ili sesuai
beubu"'a" de"'a"
;. K&lab&asi d' ali 'i4i u"tu$
,a$t&
bi&l&'is.
de"'a" $ebutua" $lie". 5. A"+u$a"
$lie"
u"tu$
%e"i"'$at$a" asu!a" "utisi"#a. 9. Ca$i"$a" diet #a"' di$&"su%si %e"'a"du"'
3u$u!
seat
u"tu$
%e"3e'a $&"sti!asi. . Bei$a"
i",&%asi
te"ta"'
$ebutua" "utisi da" !e"ti"'"#a ba'i tubu $lie". M&"it& Nutisi 1. M&"it&
BB setia! ai
+i$a
%e%u"'$i"$a". -. M&"it& es!&" $lie" teada! situasi #a"' %e"'aus$a" $lie" %a$a". :. M&"it&
li"'$u"'a"
sela%a
%a$a". ;. ad0al$a"
!e"'&bata"
da"
ti"da$a" tida$ besa%aa" de"'a" 0a$tu $lie" %a$a". 5. M&"it& ada"#a %ual %u"ta. 9. M&"it& ada"#a 'a"''ua" dala% !&ses
%asti$asi
%a$a"a"
%isal"#a !edaaa" be"'$a$ dsb. . M&"it& i"ta$e "utisi da" $al&i.
:.
Keusa$a" i"te'itas
Setela dila$u$a" asua" +ai"'a" $e!ea0ata"
&u"d
bd ,a$t& %e$a"i$6 eali"' %e"i"'$at !eubaa" si$ulasi i%&bilitas da"
!e"uu"a"
%e"'e3il
1.
/atat $aa$teisti$ lu$a6te"tu$a"
u$ua" da" $edala%a" lu$a da"
de"'a" 3iteia6 Lu$a
&u"d 3ae
$lasi,i$asi !e"'au ul3es dala%
se"sabilitas
u$ua" da" !e"i"'$ata"
("eu&!ati)
'a"ulasi +ai"'a"
-.
/atat $aa$teisti$ 3aia" se3et
#a"' $elua :.
Besi$a" de"'a" 3aia" a"ti
ba$tei ;.
Bilas de"'a" 3aia" Na/l 8=
5.
La$u$a" "e$&t&%i K
9.
La$u$a" ta%!&" #a"' sesuai
.
Dessi"'
de"'a"
$asa
steil
sesuai $ebutua" @.
La$u$a" !e%baluta"
8.
Petaa"$a"
te"i$
dessi"'
steil $eti$a %ela$u$a" !ea0ata" lu$a 1. A%ati setia! !eubaa" !ada baluta" 11. Ba"di"'$a"
da" 3atat
setia!
ada"#a !eubaa" !ada lu$a 1-. Bei$a" !&sisi
tei"da
dai
te$a"a"
;..
Keusa$a"
Setela dila$u$a" Asua"
%&bilitas ,isi$ bd $e!ea0ata" tida$
"#a%a"
teide"ti,i$asi
da!at M&bilit#
Tea!i Ee3ise 6 Pe'ea$a" se"di 1. Pasti$a"
$etebatasa"
'ea$
"#ei
i"t&lea"si le2el
a$ti,itas !e"uu"a" $e$uata" &t&t
se"di #a"' diala%i
&i"t %&2e%e"t6 a$ti,.
-.
K&lab&asi de"'a" ,isi&tea!i
Sel, 3ae6ADLs
:.
Pasti$a" %&ti2asi $lie" u"tu$
%e%!etaa"$a" !e'ea$a" se"di
De"'a" 3iteia asil6 1.
A$ti2itas
,isi$
%e"i"'$at
Pasti$a"
$lie"
u"tu$
%e%!etaa"$a" !e'ea$a" se"di 5.
-. ROM "&%al
Pasti$a" $lie" bebas dai "#ei
sebelu% dibei$a" latia"
:. Mela!&$a"
!easaa"
!e"i"'$ata"
$e$uata"
$e%a%!ua"
dala%
be'ea$ ;. Klie" bisa %ela$u$a" a$ti2itas
9.
A"+u$a" ROM Ee3ise a$ti,6
+adual>
$eteatua"
Lati
ROM
!asi,. Ee3ise !&%&ti&" 1.
5. Kebesia" dii $lie" te!e"ui
;.
Ba"tu
ide"ti,i$asi
!&'a%
latia" #a"' sesuai
0alau!u" -.
Dis$usi$a"
da"
i"stu$si$a"
diba"tu &le !ea0at atau !ada $lie" %e"'e"ai latia" #a"' $elua'a
te!at Ee3ise tea!i a%bulasi
1.
A"+u$a" da" Ba"tu $lie" dudu$
di te%!at tidu sesuai t&lea"si -.
Atu !&sisi setia! - +a% atau
sesuai t&lea"si :.
Fasilitasi !e"''u"aa" alat Ba"tu
Sel, 3ae assista"3e6 Bati"'<#'ie"e dessi"' ,eedi"' a"d t&ileti"'. 1.
D&&"'
$elua'a
u"tu$
be!atisi!asi u"tu$ $e'iata" %a"di da"
$ebesia"
dii
be!a$aia"
%a$a" da" t&ileti"' $lie" -.
Bei$a"
ba"tua"
$ebutua"
seai ai sa%!ai $lie" da!at %ea0at se3aa %a"dii :.
M&"it& $ebesia" $u$u $ulit
be!a$aia"
diet"#a
da"
!&la
eli%i"asi"#a. ;. dii
M&"it& $e%a%!ua" !ea0ata" $lie"
dala%
%e%e"ui
$ebutua" seai*ai 5.
D&&"'
$lie"
%ela$u$a"
a$ti2itas "&%al $eseaia" sesuai $e%a%!ua" 9.
P&%&si a$ti2itas sesuai usia
5.
Kua"'
Setela
!e"'etaua"
asua"$e!ea0ata"
te"ta"'
dila$u$a"
!e"#a$it !e"'etaua"
da" !ea0ata" "#a
$lie"
%e"i"'$at. K"&0led'e
6
Ill"ess
/ae d' $iteia 6
Tea3i"' 6 Dissease P&3ess 1.
Ka+i ti"'$at !e"'etaua" $lie"
da" $elua'a te"ta"' !&ses !e"#a$it -.
elas$a" te"ta"' !at&,isi&l&'i
!e"#a$it ta"da da" 'e+ala seta !e"#ebab #a"' %u"'$i"
1 Tau Diit"#a
:.
Sedia$a"
- P&ses !e"#a$it
$&"disi $lie"
: K&"se2asi e"e'i
;.
5.
Sedia$a"
i",&%asi
te"ta"'
#a"' dia'"&sa $lie"
dia"+u$a" P&sedu !e"'&bata"
!e"'&bata"
Sia!$a" $elua'a atau &a"'*
te"ta"' !e$e%ba"'a" $lie"
5 Pe"'&bata"
@ Re'i%e"
te"ta"'
&a"' #a"' beati de"'a" i",&%asi
; K&"t&l i",e$si
9 A$ti2itas
i",&%asi
9.
Dis$usi$a"
!eubaa"
'a#a
idu! #a"' %u"'$i" di!elu$a" u"tu$ %e"3e'a $&%!li$asi di %asa #a"' a$a" data"' da" atau $&"t&l !&ses !e"#a$it
8 Su%be*su%be $eseata"
.
Dis$usi$a"
te"ta"'
!ilia"
1
Ma"a+e%e
" !e"#a$it
te"ta"' tea!i atau !e"'&bata" @.
elas$a" alasa" dila$sa"a$a""#a
ti"da$a" atau tea!i 8.
D&&"' $lie" u"tu$ %e"''ali
!ilia"*!ilia"
atau
%e%!e&le
alte"ati, !ilia" 1. Ga%ba$a"
$&%!li$asi
#a"'
%u"'$i" te+adi 11. A"+u$a" $lie" u"tu$ %e"3e'a e,e$ sa%!i"' dai !e"#a$it 1-. Gali
su%be*su%be
atau
du$u"'a" #a"' ada 1:. A"+u$a"
$lie"
u"tu$
%ela!&$a" ta"da da" 'e+ala #a"' %u"3ul !ada !etu'as $eseata" 1;. $&lab&asi d' ti% #a"' lai". 9.
De,isit sel, 3ae
Setela dila$u$a" asua" $e!ea0ata"
$lie"
%a%!u Pea0ata" dii
Ba"tua" !ea0ata" dii 1. M&"it&
$e%a%!ua"
!asie"
Sel, 3ae 6A3ti2it# Dal# teada! !ea0ata" dii Li2i"'
(ADL)
de"'a"
i"di3at& 6
#'ie"e be!a$aia" t&ileti"' da"
Pasie"
da!at
%ela$u$a"
a$ti2itas
seai*ai
(%a$a"
be!a$aia"
-. M&"it& $ebutua" a$a" !es&"al
$ebesia"
t&ileti"' a%bulasi) Kebesia"
!asie" te!e"ui
dii
%a$a" :. Bei
ba"tua"
%e%!u"#ai
sa%!ai
$e%a!ua"
$lie" u"tu$
%ea0at dii ;. Ba"tu $lie" dala% %e%e"ui $ebutua""#a. 5. A"+u$a" $lie" u"tu$ %ela$u$a" a$ti2itas
seai*ai
sesuai
$e%a%!ua""#a 9. Petaa"$a" a$ti2itas !ea0ata" dii se3aa uti" . E2aluasi $e%a%!ua" $lie" dala% %e%e"ui $ebutua" seai*ai. @. Bei$a" ei",&3e%e"t atas usaa #a"' dila$u$a" dala% %ela$u$a"
!ea0ata" dii seai ai. .
PK6
Hi!&
Hi!e'li$e%i
< Setela dila$u$a" asua" $e!ea0ata"
diaa!$a"
!ea0at a$a" %e"a"'a"i da"
%e%i"i%al$a"
e!is&de i!e'li$e%ia
i!&
<
Ma"a'e%e" Hi!&'li$e%ia6 1.
M&"it&
ti"'$at
'ula
daa
ta"da
da"
'e+ala
sesuai i"di$asi -. M&"it&
i!&'li$e%i > $ada 'ula daa %'
i$a $lie" da!at %e"ela" bei$a"
+us +eu$ < se+e"is +ae setia! 15 %e"it sa%!ai $ada 'ula daa 98 %'
Bei$a" 'lu$&sa 5 = dala% I
sesuai !&t&$&l 5.
K
u"tu$ diet"#a.
Ma"a'e%e" Hi!e'li$e%ia 1.
M&"it& GDR sesuai i"di$asi
-. M&"it&
ta"da
da"
'e+ala
diabeti$ $et&asid&sis > 'ula daa : %'
%ual
da"
%u"ta
ta3i$adi TD e"da !&l#uia !&lid#!sia!&li!a'ia !a"da"'a"
$abu
$eletia" atau
$ada
NaKP&; %e"uu". :.
M&"it& 2
i"di$asi ;.
Bei$a" i"suli" sesuai &de
5.
Petaa"$a" a$ses I
9.
Bei$a"
I
,luids
sesuai
$ebutua" .
K&"sultasi de"'a" d&$te +i$a
ta"da
da"
'e+ala
Hi!e'li$e%ia
%e"eta! atau %e%buu$ @.
Da%!i"'i< Ba"tu a%bulasi +i$a
te+adi i!&te"si 8.
Batasi latia" $eti$a 'ula daa
-5 %'
da"
si$ulasi
( ,e$ue"si ia%a 0a"a $ulit 0a$tu !e"'isia" $a!ile "adi !ei,e da" $aliu% 11. A"+u$a" ba"#a$ %i"u% M&"it& status 3aia" I
PK 6 I",e$si
Setela dila$u$a" asua" $e!ea0ata" a$a"
!ea0at !i%e se$u"de
%e"a"'a"i
%e"'ua"'i
1. Pa"tau ta"da da" 'e+ala i",e$si
<
$&%!li$asi
de,esie"si i%u"
-. Besi$a"
li"'$u"'a"
setela
di!a$ai !asie" lai". :. Batasi !e"'u"+u"' bila !elu.
;. I"tu$si$a"
$e!ada
$elua'a
u"tu$ %e"3u3i ta"'a" saat $&"ta$ da" sesuda"#a. 5. Gu"a$a"
sabu"
a"ti
%i&ba
u"tu$ %e"3u3i ta"'a". 9. La$u$a" 3u3i ta"'a" sebelu% da" sesuda ti"da$a" $e!ea0ata". . Gu"a$a" ba+u da" sau"' ta"'a" seba'ai alat !eli"du"'. @. Petaa"$a" te$"i$ ase!ti$ u"tu$ setia! ti"da$a". 8. La$u$a" !ea0ata" lu$a da" desi"' i",us setia! ai. 1. A%ati se$ita"#a
$eadaa" dai
ta"da
lu$a
da" ta"da
%eluas"#a i",e$si 11. Ti"'$at$a" 3aia"
i"ta$e
"utisi.da"
1-. Bei$a"
a"tibi&ti$
sesuai
!&'a%. 1:. M&"it& itu"' 'a"ul&sit da" B/. 1;. A%bil $ultu +i$a !elu da" la!&$a" bila asil"#a !&siti!. 15. D&&"' istiaat #a"' 3u$u!. 19. D&&"' !e"i"'$ata" %&bilitas da" latia". 1. A+a$a" $elua'a<$lie" te"ta"' ta"da da" 'e+ala i",e$si.
DAFTAR PUSTAKA
Bu""e Suddat -- Bu$u A+a Ke!ea0ata" Medi$al Beda &l : Edisi @ Pe"ebit RG/ a$ata. &"s&" M.et all -- Nusi"' Out3&%es /lassi,i3ati&" (NO/) Se3&"d Editi&" IOA I"te2e"ti&" P&+e3t M&sb#.
